Original article
Vol. 141 No. 1718 (2011)
Gender-related ADL performance of old people recently admitted to a Swiss nursing home
Summary
QUESTIONS UNDER STUDY: The aim of this paper was to establish gender-specific associations between the characteristics of residents recently admitted to Swiss nursing homes (NH) and their activities of daily living (ADL) performance.
METHODS: A sample of 17’331 NH residents living in 90 Swiss NHs received a Resident Assessment Instrument Minimum Data Set (RAI-MDS) shortly after NH entry, in the period from 1997 to 2007. ADL performance was assessed using the MDS-ADL long-form scale that measures self-performance in the seven following tasks: bed mobility, transfer, locomotion, dressing, eating, toilet use and personal hygiene. Associations between ADL performance and health and personal characteristics of the residents were then investigated using bivariate and multivariate analyses.
RESULTS: A total of 40% of the residents recently admitted to Swiss NHs were completely dependent for ADL. Absence of physical activity and having been admitted to a NH before 2003 were gender-specific variables associated with poorer ADL. Incontinence, poor balance, impaired cognition and vision as well as low BMI were important factors associated with poorer ADL performance in both genders.
CONCLUSION: The general scheme of ADL impairment was quite similar for both genders, but females tended to do slightly but significantly better than males. Overall, strategies improving balance, continence, cognition and sensory function including treatment of vision impairment, promoting healthy nutrition as well as physical activity – particularly among elderly women with musculoskeletal conditions – may facilitate care in recently admitted residents and/or delay NH admission.
References
- Mukamel DB, Brower CA. The influence of risk adjustment methods on conclusions about quality of care in nursing homes based on outcome measures. Gerontologist. 1998;38(6):695–703.
- Mukamel DB, Spector WD. Quality report cards and nursing home quality. Gerontologist. 2003;43 Spec No 2:58–66.
- Ruuskanen JM, Parkatti T. Physical activity and related factors among nursing home residents. J Am Geriatr Soc. 1994;42(9):987–91.
- Hung LC, et al. Effects of a nursing intervention program on disabled patients and their caregivers. Arch Gerontol Geriatr. 2003;36(3):259–72.
- Williams BC, et al. Activities of daily living and costs in nursing homes. Health Care Financ Rev. 1994;15(4):117–35.
- Demura S, et al. Gender and age differences in basic ADL ability on the elderly: comparison between the independent and the dependent elderly. J Physiol Anthropol Appl Human Sci. 2003;22(1):19–27.
- Wennie Huang WN, et al. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc. 58(5):844–52.
- Civitas: The Institute for the Study of Civil Society. The Swiss Healthcare System (2002). 2002 [cited 2011 2nd February]; Available from: http://www.civitas.org.uk/pdf/Switzerland.pdf.
- Eidgenössisches Departement des Innern. Aeltere Menschen. Alter, Generationen 2010 2010/08/26 [cited 2011 01/25]; Available from: http://www.bsv.admin.ch/themen/kinder_jugend_alter/00068/index.html?lang=de.
- Kesselring A, et al. Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission. Eur J Public Health. 2001;11(3):267–73.
- Saxer S, et al. Prevalence and incidence of urinary incontinence of Swiss nursing home residents at admission and after six, 12 and 24 months. J Clin Nurs. 2008;17:2490–6.
- Hoogerduijn JG, et al. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs. 2007;16(1):46–57.
- Coustasse A, et al. Disparities in ADL and IADL disabilities among elders of Hispanic subgroups in the United States: results from the National Health Interview Survey 2001–2003. Hosp Top. 2009;87(1):15–23.
- Fuller-Thomson E, et al. Basic ADL disability and functional limitation rates among older AMERICANS from 2000–2005: the end of the decline? J Gerontol A Biol Sci Med Sci. 2009;64(12):1333–6.
- Clune A, et al. Prevalence and predictors of recommendations to lose weight in overweight and obese older adults in Georgia senior centers. Prev Med. 2010.
- Stuck AE, et al. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48(4):445–69.
- Lin MY, et al. Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. J Am Geriatr Soc. 2004;52(12):1996–2002.
- Webb E, et al. Proximal predictors of change in quality of life at older ages. J Epidemiol Community Health. 2010.
- Achterberg W, et al. Depressive symptoms in newly admitted nursing home residents. Int J Geriatr Psychiatry. 2006;21(12):1156–62.
- Whitson HE, et al. The combined effect of visual impairment and cognitive impairment on disability in older people. J Am Geriatr Soc. 2007;55(6):885–91.
- Katz S, et al. Progress in development of the index of ADL. Gerontologist. 1970:10(1):20–30.
- Luppa M, et al. Gender-Specific Predictors of Institutionalisation in the Elderly – Results of the Leipzig Longitudinal Study of the Aged (LEILA 75+). Psychiatr Prax, 2010.
- Luppa M, et al. Gender differences in predictors of nursing home placement in the elderly: a systematic review. Int Psychogeriatr. 2009;21(6):1015–25.
- Katz SJ, Kabeto M, Langa KM. Gender disparities in the receipt of home care for elderly people with disability in the United States. JAMA. 2000;284(23):3022–7.
- Office fédéral de la statistique (2007) Portrait démographique de la Suisse.
- Anliker M, et al. RAI-Handbuch. Gesamtausgabe. 2.0 ed. 2000, St.Gallen: Q-Sys AG.
- Wodchis W, Hirdes J, Feeny D. Health-related quality of life measure based on minimal data set. Int J Techn Ass Health. 2003;19:490–506.
- Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54(11):M546–53.
- Morris JN, et al. MDS Cognitive Performance Scale. J Gerontol. 1994;49(4):M174–82.
- Burrows AB, et al. Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing. 2000;29(2):165–72.
- Martin JC, Engle VF, Graney MJ. Health status gender differences of newly admitted black nursing home residents. J Am Geriatr Soc. 1997;45(2):166–73.
- Confédération Suisse. Encyclopédie statistique de la Suisse. 2009 [cited 2010 June 10th]; Available from: http://www.bfs.admin.ch/bfs/portal/fr/index/infothek/lexikon/bienvenue.
- Dunlop DD, et al. Risk factors for functional decline in older adults with arthritis. Arthritis Rheum. 2005;52(4):1274–82.
- Fillenbaum GG, et al. Prevalence and correlates of functional status in an older community – representative sample in Brazil. J Aging Health. 2010;22(3):362–83.
- Wu SC, Leu SY, Li CY. Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. J Am Geriatr Soc. 1999;47(9):1082–6.
- Richardson J, Bedard M, Weaver B. Changes in physical functioning in institutionalized older adults. Disabil Rehabil. 2001;23(15):683–9.
- Wang J, et al. The effects of resident and nursing home characteristics on activities of daily living. J Gerontol A Biol Sci Med Sci. 2009;64(4):473–80.
- Oliveira MR, Fogaca KC, Leandro-Merhi VA. Nutritional status and functional capacity of hospitalized elderly. Nutr J. 2009;8:54.
- Hsieh YM, Sung TS, Wan KS. A survey of nutrition and health status of solitary and non-solitary elders in taiwan. J Nutr Health Aging. 14(1):11–4.
- de Castro, K.C. and R.O. Guerra, Impact of cognitive performance on the functional capacity of an elderly population in Natal, Brazil. Arq Neuropsiquiatr. 2008;66(4):809–13.
- Buchanan RJ, et al. Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set. Mult Scler. 2003;9(2):171–88.
- Townson CA. Predictors of acute care discharge destinations of patients with primary diagnosis of stroke: The influence of activities of daily living skills and behaviors. 2003, University of Florida.
- McMillan TM, Laurie M. Young adults with acquired brain injury in nursing homes in Glasgow. Clin Rehabil. 2004;18(2):132–8.
- de Meijer CA, et al. The role of disability in explaining long-term care utilization. Med Care. 2009;47(11):1156–63.
- Abelin T, Schlettwein-Gsell D. Handicaps and needs of the elderly. A multifactor epidemiologic study under urban conditions. Schweiz Med Wochenschr. 1986;116(44):1524–42.
- Thygesen E, et al. Predicting needs for nursing home admission – does sense of coherence delay nursing home admission in care dependent older people? A longitudinal study. Int J Older People Nurs. 2009;4(1):12–21.
- Luppa M, et al. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2010;39(1):31–8.
- Verbeek H, et al. Small-scale, homelike facilities versus regular psychogeriatric nursing home wards: a cross-sectional study into residents' characteristics. BMC Health Serv Res. 10: p. 30.
- Christen D. Living at home with the nursing services of a nursing home. Krankenpfl Soins Infirm. 2008;101(5):32.
- Fjelltun AM, et al. Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study. Scand J Caring Sci. 2009;23(4):736–47.
- Gaugler JE, et al. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatr. 2007;7:13.
- Bates-Jensen BM, et al. Evaluating the accuracy of minimum data set bed-mobility ratings against independent performance assessments: systematic error and directions for improvement. Gerontologist. 2005;45(6):731–8.
- Coustasse A, et al. Disparities in disability among non-Hispanic black elders: results from the National Interview Survey 2001–2003. J Hosp Mark Public Relations. 2009;19(2):101–12.
- von Gunten A, Mosimann UP. Delirium upon admission to Swiss nursing homes: a cross-sectional study. Swiss Med Wkly. 2010;140(25-26):376–81.
- Legarth KH, Ryan S, Avlund K. The Most Important Activity and the Reasons for that Experience Reported by a Danish Population at Age 75 Years Br J Occup Ther. 2005;68(11):501–8.