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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 19
| Issue : 1 | Page : 42-46 |
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Functional limitation among older adults in a rural area in South Kerala and its associated factors
Rahul S Pillai1, Sherin Susan Paul2
1 Department of Community Medicine, P K Das Institute of Medical Sciences, Palakkad, Kerala, India
2 Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| Date of Submission | 22-Jan-2023 |
| Date of Decision | 21-Feb-2023 |
| Date of Acceptance | 22-Feb-2023 |
| Date of Web Publication | 17-Mar-2023 |
Correspondence Address:
Rahul S Pillai
Assistant Professor, Department of Community Medicine, P K Das Institute of Medical Sciences, Vaniyamkulam 679522, Ottapalam, Palakkad, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jiag.jiag_6_23
Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health-care facilities for them, with respect to early identification and management of their functional limitations.
Keywords: Functional limitations, modified Barthel index, older adults
How to cite this article:
Pillai RS, Paul SS. Functional limitation among older adults in a rural area in South Kerala and its associated factors. J Indian Acad Geriatr 2023;19:42-6 |
How to cite this URL:
Pillai RS, Paul SS. Functional limitation among older adults in a rural area in South Kerala and its associated factors. J Indian Acad Geriatr [serial online] 2023 [cited 2023 Mar 22];19:42-6. Available from: http://www.jiag.com/text.asp?2023/19/1/42/371905 |
| Introduction | |  |
Virtually every country in the world is experiencing growth in both size and proportion of the population of older adults.[1] According to the National Policy on Older Persons adopted by the Government of India in January 1999, “elderly” or “older” adult or “senior citizen” is a person of age 60 or above.[2] As per the 2011 census, there are nearly 10.4 crore elderly persons in India accounting for 13% of the world's elderly population. In Kerala, almost 13% of the population is above the age of 60 years which is higher than that of any other state in India.[3] With this demographic trend, the current health system has to deal with the health challenges of the elderly who may be prone to chronic diseases. Functional limitations are a common complication of chronic diseases. A person is said to have a functional limitation when he/she, does not have the physical or cognitive ability to independently perform the routine activities of daily living and/or self-care. If recognized at an early stage, these can often be improved greatly, helping the elderly to regain their functional abilities and independence.[4] Since the functional limitation of the geriatric population has important public health implications, its assessment is of prime importance. With this background, this study was conducted to determine the prevalence of functional limitation among older adults in a rural area in south Kerala.
| Materials and Methods | | |
This community-based cross-sectional survey was conducted among adults of age 60 years and above residing in the field practice area of rural health training center under community medicine department of a medical college in south Kerala. The study duration was 3 months from October 2019 to December 2019. Taking the prevalence of functional limitations as 37.4% from Gupta et al. with the level of significance α as 95% and a relative precision of 15%, the sample size was calculated as 286.[5] Data collection was done after obtaining approval from the institutional research and ethics committee (No.PIMSRC/E1/388A/33/2018). Details of the study were explained to all the participants and written informed consent for being a part of the study was obtained from them. Confidentiality was maintained. No financial expenses were borne from the side of the participant. The study had no potential risk to the health of the participant and also no invasive or painful procedures were involved in the study. Households selected using the simple random sampling method were visited and data were collected by personal interview of the participants by the investigator using the questionnaire and information collected was recorded in the questionnaire. The questionnaire consisted of two sections, the first being sociodemographic variables, the second section on functional limitations using the modified Barthel Index for activities of daily living wherein scores are given for each item in terms of whether individuals can perform activities independently, with some assistance, or are dependent (scored as 2, 1, or 0). The scores for each of the items are then summed to create a total score, with higher scores indicating greater ability to function independently and vice versa.
- A score of 20 indicates no functional limitation
- A score of 10–19 indicates mild functional limitation
- A score of 5–9 indicates moderate functional limitation
- A score of 1–4 indicates severe functional limitation
- A score of 0 indicates total functional limitation.
Statistical Package for the Social Sciences (SPSS) version 25 IBM Corp. Armonk, NY was used for statistical analysis. The prevalence of functional limitations was expressed as percentage with 95% confidence interval (CI). The Chi-square test was used for finding the association between categorical variables and functional limitations. P <0.05 was considered statistically significant.
| Results | | |
In the present study, 290 elderly people, aged 60 years and above, were assessed for Functional limitations. The sociodemographic details of the study population are explained in [Table 1]. The overall prevalence of Functional limitation among older adults in a rural area in south Kerala was found to be 35.9% (95% CI: 30.38 - 41.42). This is depicted through a pie diagram in [Figure 1]. In this 29.3% had mild functional limitation, 3.4% had moderate, 1.7% had severe and 1.7% had total functional limitation [Figure 2]. The most common functional limitation experienced by the study subjects was difficulty in climbing stairs (33.7%). The second most common was difficulty in taking bath without any supervision (14.4 %) and difficulty in dressing without any help (14.4 %). The least common functional limitation was bowel incontinence (8.2 %) This is depicted through a bar diagram in [Figure 3]. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the study participants [Table 2]. | Figure 1: Pie diagram showing the prevalence of Functional limitation among study participants (n = 290)
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 | Figure 2: Distribution of study participants according to their levels of Functional limitation (n = 290)
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 | Figure 3: Functional limitations in the basic activities of daily living among the study participants (n = 290)
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| Discussion | | |
The mean age of the 290 study participants surveyed was 68.18 ± 7.93 years. About 63.8% of them were females and remaining 36.2% were males. In our study, the prevalence of functional limitation was found to be 35.9%. The most common functional limitation among the study participants was difficulty in climbing stairs (33.7%) followed by difficulty in taking bath without any supervision (14.4%) and difficulty in dressing without any help (14.4%). About 8.2% of the study participants needed aid during the passage of the bowels which was the least common.
Gupta et al. estimated the prevalence of functional limitation among elderly persons in a rural area of Haryana (Ballabhgarh) in 2002 as 37.4%.[5] In a study by Sowmiya et al., the prevalence of functional limitation among 476 elderly individuals in rural Tamilnadu in 2010 was 46.84%.[6] Gupta et al. conducted a study on 265 elderly people and found that the prevalence of functional limitation was 23.4%.[7] Fuchs et al. reported that among the community-dwelling elderly population living in Israel, 19% of the population had difficulty in performing one or more activities of daily living.[8]
Del Duca et al. reported that the prevalence of functional limitation was 26.8% and was lowest for feeding by themselves and highest for controlling urination and/or bowel evacuation.[9] A study conducted by the Population Research Centre, Kerala, from June to September 2011 identified that in Kerala, 10% of the older population need full or partial assistance in any one of the activities of daily living. Among these, the highest percentage of elderly face difficulty in bathing followed by dressing, toilet use, and mobility.[3] Ralph et al. reported that the prevalence of functional limitation was 28.7% in a population of 1036 in New York in 2009.[10] In a cross-sectional survey of functional status among elderly Hong Kong, Chinese, aged 70 years by Woo et al., the prevalence of functional limitation varied from 0.8% to 26%; lowest for feeding and highest for climbing stairs and bathing.[11] Dunlop et al. reported that the progression of limitations in activities of daily living limitation among the elderly was as follows: walking, bathing, transferring, dressing, toileting, and feeding.[12]
In the present study, the prevalence of functional limitation increased with advancing age; it was 31.4% in the 60–79 years of age group, which rose to 68.6% in the 80 and above age group. A statistically significant association was observed between functional limitation and age group. This was consistent with the results of the study by Sowmiya et al., Gupta et al., Fuchs et al., Del Duca et al., Ralph et al., and Woo et al.[6],[7],[8],[9],[10],[11] With advancing age, various physiological systems decline gradually, including the nervous and musculoskeletal systems, essential for carrying out certain basic activities of daily living.
With respect to the socioeconomic class of the study participants on the basis of the modified Kuppuswamy socioeconomic scale 2021, the prevalence of functional limitation was highest (73.3%) among the study participants who were in socioeconomic class 5 and was lowest (26.9%) among those in socioeconomic class 1 and 2. A statistically significant association was observed between functional limitation and socioeconomic class of the study participants. This was consistent with results of the study by Gupta et al. and Zhang and Feldman[7],[13] This could be due to the fact that elderly in high socioeconomic class generally has better access to prevention, treatment, and health rehabilitation services, implying lower prevalence of functional disability among them.
With respect to the family type, the prevalence of functional limitation was highest (42.2%) among individuals living in a three-generation family and the lowest (27.4%) among individuals living in a nuclear family. A statistically significant association was observed between functional limitation and family type of the study participants. This may be due to the less individual care given in the joint/three-generation family due to the higher number of family members when compared to nuclear family.
Limitations
The present study has several limitations. It was conducted in a small geographic setting. Furthermore, this study is limited by involving only elderly people in rural community, excluding elders from institutions and those residing in urban areas. Therefore, the result may not be representative of the whole elderly population in south Kerala. Comorbidities are one of the major factors for functional limitation in older adults; however, the same has not been included in the study. Furthermore, those who have had functional limitations as a result of diseases or trauma that happened during their childhood or adolescence, or adulthood (<60 years) were excluded from the study.
| Conclusion | | |
The overall prevalence of functional limitation among older adults in a rural area in south Kerala was found to be 35.9%. The association between functional limitations and age group, socioeconomic status, and type of family of the study participants verified in this study is shown as an important guide for health actions that must be addressed mainly to the oldest old, lower socioeconomic status, and morbid who are potentially more likely to develop functional limitations. There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health-care facilities for them, with respect to early identification and management of their functional limitations. Moreover, it is necessary to identify the factors associated with these groups to provide elements for building measures aiming to improve, maintain, or restore the functional capacity of the elderly as long as possible.
Financial support and sponsorship
All the expenses of the study were borne by the researcher.
Conflicts of interest
There are no conflicts of interest.
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| 10. | Ralph NL, Mielenz TJ, Parton H, Flatley AM, Thorpe LE. Multiple chronic conditions and limitations in activities of daily living in a community-based sample of older adults in New York City, 2009. Prev Chronic Dis 2013;10:E199. |
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
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