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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 28-32

Assessment of functional capacity in patients attending geriatrics outpatient department at Civil Hospital, Ahmedabad


Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Neeta Mathur
Flat No. 30301, Cedar Block, Indu Fortune Field Gardenia, KPHB Phase 13, Kukatpally, Hyderabad - 500 072, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.172392

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  Abstract 

Aims: To access the quality of life in terms of functional capacity and to estimate the prevalence of depression among geriatric patients. Settings and Design: A hospital-based study was conducted in Civil Hospital, Ahmedabad between July and September 2006. The patients aged 65 years and above were included in the geriatrics outpatient department. Methods: The geriatric patients were interviewed during their geriatric clinic visit using a structured questionnaire regarding instrumental activities of daily living (IADL), basic activities of daily living (ADL), Nagi physical disability scale, and short version of the geriatric depression scale. Statistical Analysis Used: Data were analyzed using EPI-Info Statistical Packages. Using a scoring system, mean, standard deviation, and the significance of the results was tested using the Chi-square test and Z-test was used to compare quantitative data. Results: Mean IADL score of males is 4.05 whereas of females is 2.91 which is significant (P < 0.05). Overall scores for ADL showed no statistically significant results between male and female geriatric subjects. The mean scores of restriction of basic activities on the Nagi scale of physical disability were not significant among women. Mean scores of depression were highly significant in IADL, basic ADL, and limitation of basic movement while significant in a greater number of reported symptoms. Conclusions: Depression was due to combined effect of increased scores of IADL, ADL, and Nagi physical disability scale.

Keywords: Basic activities of daily living, geriatric depression scale, instrumental activities of daily living, Nagi physical disability scale


How to cite this article:
Mathur N. Assessment of functional capacity in patients attending geriatrics outpatient department at Civil Hospital, Ahmedabad. CHRISMED J Health Res 2016;3:28-32

How to cite this URL:
Mathur N. Assessment of functional capacity in patients attending geriatrics outpatient department at Civil Hospital, Ahmedabad. CHRISMED J Health Res [serial online] 2016 [cited 2019 Oct 14];3:28-32. Available from: http://www.cjhr.org/text.asp?2016/3/1/28/172392


  Introduction Top


Aging is a universal process. In the words of Seneca “old age is an incurable disease.” However more recently “Sir James sterling Ross Commented” your do not heal old age, you protect it, you promote it, and you extend it. These are in fact the principles of preventive medicine. The expectation of life at birth for males and females has increased more in recent years. In India, it is projected to be 67 years in 2011–2016 for males and 69 years for females. A projection beyond 2016 made by United Nations [1] has indicated that 21% of the Indian population will be 60+ by 2050 which was 6.8% in 1991.

As the aging process continues, diseases, and impairment become common. Psychological problems mainly depression [2] is common among elderly and poses major threats to their mental and physical well-being. Depression in this age group is characterized by physical comorbidity and significant disability.[3] With the continuing increase in life expectancy [4] and the multitude of ailments afflicting old people, the capability of the elderly to maintain independence becomes a focus of attention. Health and functional ability are crucially important to the quality of life of old people as they determine the extent to which they can cope independently with the demands of everyday living.[5] Hence, the present study was conducted to determine the functional capacity of geriatric patients attending geriatrics outpatient department (OPD) at Civil Hospital, Ahmedabad which could be of help in planning policies for their better care in future.


  Methods Top


A hospital-based study was conducted in Civil Hospital, Ahmedabad between July and September 2006. The patients aged 65 years, and above were included in the geriatrics OPD. There were 327 patients in the age group of 65 years and above of which 204 (60.5%) were males, and 133 (39.5%) were females. There were no refusals to participate. The consent was taken from all the participants in the study and was interviewed during their geriatric clinic visit using a pretested questionnaire, which had been piloted tested to check the appropriateness of the questions and the participants to understand them. The questionnaire consisted of the following sections.

Instrumental activities of daily living (IADL)[6] which reflects the capability of an elderly person to live independently in his/her own home. Activities include subject's capability of preparing meals, performing household chores, taking medications, managing finances, getting around, using the telephone, and shopping. Three possibilities were given for each area: Independent (scored 0), a variable degree of assistance required (scored 1) and dependent or full assistance required (scored 2). Scores ranged from 0 to 14. Higher scores indicate impaired activities of daily living (ADL).

Basic ADL [7] which comprises survival tasks, namely eating, bathing, using the toilet, dressing, and moving inside the house. For each task, two possibilities were given: Capable without assistance (scored 0), not capable, and assistance required (scored 1). As regards using the toilet and moving inside the house, a third possibility, which scored 2, was considered that included going to the toilet in bed and not being able to move or being paralyzed. Scores ranged from 0 to 7. Higher scores indicate impaired basic activities.

Limitation of basic movement using the Nagi physical disability scale [8] which covers subjects ability to squat/bend, carry 5 kg, walk for a distance of 200–300 m, get up 3–5 stairs, and use fingers for holding. Responses were dichotomized into not limited (scored 0) and limited (scored 1). Scores ranged from 0 to 5. Higher scores indicate a limitation of movement.

The short version of the geriatric depression scale [9],[10] was used to screen for depression. It consists of 15 questions to be answered by yes or no. One point is awarded when the answer matches the answer given in the test, and zero points when not. Anybody who scores over five points is considered to be depressed.

Data were analyzed using EPI-Info Statistical Packages 7. Using a scoring system, mean, standard deviation, and the significance of the results was tested using the Chi-square test and Z-test was used to compare quantitative data.


  Results Top


Capability to perform IADL is shown in [Table 1]. A quarter of the geriatric patients (26%) were able to carry out all these activities independently. Male patients were significantly more (P < 0.001) dependent in performing meals and doing household chores. There is no significant difference in other instrumental activities such as taking medications, managing finance, using the phone, getting around, and shopping. Considering all IADL items males were significantly more (P < 0.001) dependent in partial or full assistance then female geriatric patients. Mean IADL score of males is 4.05 whereas of females is 2.91 which is significant (P < 0.05).
Table 1: State of dependence assessed using IADL

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[Table 2] only (14.8%) of geriatric subjects reported impairment of ADL. Dependence in moving around the house was encountered among (16.9%) of the elderly subjects. Lower proportions were dependent on others for going to toilet (10.4%), bathing/shaving (8.9%), and getting dressed (8.9%). Few required assistance in eating (2.4%). Men were significantly more in need for assistance in going to the toilet (P < 0.05) while no gender difference was observed in other activities. Overall scores for ADL showed no statistically significant results between male and female geriatric subjects.
Table 2: Functional capacity of the participants assessed by ADL

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[Table 3] a substantial proportion (68.8%) reported limitation of one or more of the basic movement. The movement most commonly limited was squatting/bending (69.1%) and carrying a weight of 5 kg (61.4%). Lower proportions were limited in getting up 3–5 stairs (36.2%) and walking 200–300 m (30.6%). These movements were significantly (P < 0.05) more likely to be limited among women. The mean scores of restriction of basic activities on the Nagi scale of physical disability were not significant among women.
Table 3: Limitation of basic movement based on Nagi physical disability scale

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[Table 4] mean scores of depression were highly significant in IADL, basic ADL, and limitation of basic movement while significant in a greater number of reported symptoms.
Table 4: Predictors of depression status among the geriatric patients

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  Discussion Top


Traditionally, research on aging has been concerned with health but recently the concept of functional capacity has been attracting growing attention.[5] This study explored the functional capacity of geriatric patients based on IADL, basic ADL, and limitation of basic movement using the Nagi physical disability scale. Among the studied population, body movement, and basic activities were less likely to be restricted compared to IADL as only 26.1% were capable of performing activities that enabled them to live independently whereas in Youssef et al.[11] it was 8%. Laukkanen et al.[12] and Sauvaget et al.[13] indicated that independent life in IADL is much shorter than independent life in basic activities or mobility. A longitudinal study from Japan provides evidence of the progressive deterioration in IADL among the elderly living with their children simply because they rely on them even if they have no strong need for their help.[14] In this respect, the role of children should be strengthened and oriented toward encouraging old people to maintain independence. Such a role could alleviate much of the social burden on the government and contribute to the mental well-being of old people. The female patients were significantly independent in household chores, meal preparation, and going to toilet which was explained by Laukkanen et al.

[12] as cultural differences in coping with everyday activities.

In most developing countries, depressive disorders are not well characterized and are often dismissed as the normal behavior of old age or senility.[15]

The routine use of the geriatric depression scale has been recommended for the early detection of depression.[9],[10] In this study, this screening tool detected 106 previously undiagnosed cases of depression, giving a prevalence of 31.5%. This is relatively high compared to a prevalence of around 10% in the Western communities [16],[17] and 17.5% in Abolfotouch et al.[18] Depression was not found to be characteristic of female gender but a consequence of their restricted capacity in coping with the demands of daily living. Previous studies have underscored the impact of limitation and disability [3],[19],[20],[21],[22] on the increase in depressive symptoms. Indeed, each depressive symptom increases impairment and disability and reduces the chance of recovery.[21] This study demonstrated that depression and the limited coping capacities with everyday demands reinforce each other. Such information is important to physicians who tend to focus on the medical diagnosis of physical ailments. Public health strategies should be directed toward comprehensive assessment of geriatric populations giving equal attention to the effective management of depression, comorbidity, and functional limitation. Physicians should be particularly vigilant for functional decline in old people who perceive their health negatively as further decline within a year would be expected.[23]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Population Prospects: The sex and age distribution of population. United Nations Publications; 1990.  Back to cited text no. 1
    
2.
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World Health Organization. Growing older – Staying well: Ageing and physical activity in everyday life. Geneva: World Health Organization; 1998.  Back to cited text no. 5
    
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7.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963;185:914-9.  Back to cited text no. 7
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Nagi SZ. An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc 1976;54:439-67.  Back to cited text no. 8
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9.
Lyness J. Short survey is an effective screen for significant depression in elders in the primary care setting. Mod Med Middle East 1997;14:21.  Back to cited text no. 9
    
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Allen N, Ames D, Ashby D, Bennetts K, Tuckwell V, West C. A brief sensitive screening instrument for depression in late life. Age Ageing 1994;23:213-9.  Back to cited text no. 10
    
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Youssef RM. Comprehensive health assessment of senior citizens in Al-Karak governorate, Jordan. East Mediterr Health J 2005;11:334-48.  Back to cited text no. 11
    
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Laukkanen P, Era P, Heikkinen RL, Suutama T, Kauppinen M, Heikkinen E. Factors related to carrying out everyday activities among elderly people aged 80. Aging (Milano) 1994;6:433-43.  Back to cited text no. 12
    
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Sauvaget C, Tsuji I, Aonuma T, Hisamichi S. Health-life expectancy according to various functional levels. J Am Geriatr Soc 1999;47:1326-31.  Back to cited text no. 13
    
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Ishizaki T, Kobayashi Y, Kai I. Functional transitions in instrumental activities of daily living among older Japanese. J Epidemiol 2000;10:249-54.  Back to cited text no. 14
    
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Hafez G, Bagchi K. Health Care for the Elderly: A Manual for Primary Health Care Workers. Alexandria, Egypt: World Health Organization, Regional Office for the Eastern Mediterranean; 1994.  Back to cited text no. 15
    
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Livingston G, Hawkins A, Graham N, Blizard B, Mann A. The Gospel Oak Study: Prevalence rates of dementia, depression and activity limitation among elderly residents in inner London. Psychol Med 1990;20:137-46.  Back to cited text no. 16
    
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Copeland JR, Dewey ME, Wood N, Searle R, Davidson IA, McWilliam C. Range of mental illness among the elderly in the community. Prevalence in liverpool using the GMS-AGECAT package. Br J Psychiatry 1987;150:815-23.  Back to cited text no. 17
    
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Abolfotouh MA, Daffallah AA, Khan MY, Khattab MS, Abdulmoneim I. Psychosocial assessment of geriatric subjects in Abha City, Saudi Arabia. East Mediterr Health J 2001;7:481-91.  Back to cited text no. 18
    
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Kiosses DN, Klimstra S, Murphy C, Alexopoulos GS. Executive dysfunction and disability in elderly patients with major depression. Am J Geriatr Psychiatry 2001;9:269-74.  Back to cited text no. 19
    
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Hybels CF, Blazer DG, Pieper CF. Toward a threshold for subthreshold depression: An analysis of correlates of depression by severity of symptoms using data from an elderly community sample. Gerontologist 2001;41:357-65.  Back to cited text no. 20
    
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Cronin-Stubbs D, de Leon CF, Beckett LA, Field TS, Glynn RJ, Evans DA. Six-year effect of depressive symptoms on the course of physical disability in community-living older adults. Arch Intern Med 2000;160:3074-80.  Back to cited text no. 21
    
22.
Dunlop DD, Lyons JS, Manheim LM, Song J, Chang RW. Arthritis and heart disease as risk factors for major depression: The role of functional limitation. Med Care 2004;42:502-11.  Back to cited text no. 22
    
23.
Lyness JM, King DA, Conwell Y, Duberstein PR, Eberly S, Sörensen SM, et al. Self-rated health, depression, and one-year health outcomes in older primary care patients. Am J Geriatr Psychiatry 2004;12:110-3.  Back to cited text no. 23
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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