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The effect of chronic diseases on physical function. Comparison between activities of daily living scales and the Physical Performance Test

Age and Ageing, July, 1997 by Renzo Rozzini, Giovanni B. Frisoni, Luigi Ferrucci, Piera Barbisoni, Bruno Bertozzi, Marco Trabucchi

Abstract

Aim: to verify the capacity of basic and instrumental activities of daily living (BADL and IADL) disability scales and of a performance-based test (Physical Performance Test; PPT) to detect the effect on the functional capacity of several common chronic conditions in elderly people.

Method: a cross-sectional survey of the entire population aged 70 and over, living in Ospitaletto (Brescia, northern Italy) -- 549 subjects; 89.6% of the eligible population; 179 males and 370 females -- was carried out in 1992. A multi-dimensional questionnaire administered at the subject's home was used to collect information on demographics, presence of several common chronic diseases and BADL and IADL. Objective physical capacity was assessed using the PPT.

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Results: only cognitive deterioration and depression were independently associated with disability, as detected by BADL or IADL scales. Cognitive deterioration, stroke, parkinsonism, heart disease and hearing and visual loss were independently associated with PPT. The performance at PPT remained statistically associated with most of the same diseases when the analysis was restricted to subjects with no BADL or IADL disability.

Conclusion: a performance-based measure, such as PPT, may detect a functional limitation before it becomes measurable by traditional self-reported BADL and IADL scales.

Keywords: activities on daily living, chronic disease, elderly people physical performance

Introduction

The main cause of disability in elderly people is deteriorating health due to chronic disease. The relationship between disease, impairment, functional limitation and disability[1] is still unclear. The variability in the disease severity, the frequent concurrence of chronic conditions and the effect of non-medical factors confound the causal pathway from a specific disease to the development of disability[2-5]. Some chronic conditions have a direct impact on disability, which is easily detectable by self-reported instruments. Others are associated with a mild functional limitation (e.g. taking longer to complete a task): at this stage the subject may be unaware of the difficulty and the condition may escape detection by the commonly used self-reported measures of disability, which measure completion of daily functions independently of the required time[6, 7].

This stage, which can be defined as `prechnical', may be predictive of subsequent overt disability[8, 9]. Furthermore,, this condition may be detected only by using objective performance-based tests of physical or cognitive impairment[10, 11]. Performance-based instruments tap a stage in the causal path from disease to disability which is closer to the domain of `disease' than is seen from self-reported instruments that assess behaviours in basic (B) and instrumental (I) activities of daily living (ADL)[8, 12]. Thus, from a clinical perspective, the information gathered using these instruments may increase our knowledge about the mechanisms by which chronic conditions influence function. Such instruments may then be used in the development of rational programmes of secondary and tertiary prevention in older people.

The aim of this study was to verify whether a performance-based measure of physical functions is more sensitive than a self-reported measure of ADL disability, in the detection of the disabling effects of common chronic conditions.

Methods

The data in this survey were obtained in a multi-dimensional study carried out in 1992 in a community-dwelling population aged 70 and over living in the rural city of Ospitaletto, Brescia, northern Italy. Six hundred and thirteen community-dwelling subjects aged over 70 were recorded in the local registry office. Thirty-seven refused to participate and 27 were contacted but did not complete the interview. Thus, valid questionnaires were available for 549 subjects (89.6% of the eligible population).

The data were collected in the subjects' homes by previously trained community researchers.

Questionnaire

The questionnaire was intended to evaluate a large number of social and medical factors, including demographic data (gender, age, years of education) and the following variables.

Mental status

Cognition was evaluated by the Mini-Mental State Examination (MMSE)[13] and mood with the short version of the Geriatric Depression Scale (GDS)[14]. Cognitive deterioration was defined by MMSE score <24 and depression by GDS score >5.

Chronic conditions

The presence/absence of each of the following chronic conditions was assessed by self-report: heart disease, hypertension, anaemia, diabetes mellitus, chronic obstructive pulmonary disease, previous bone fractures, liver diseases, parkinsonism, previous stroke, cancer, degenerative joint disease and visual and hearing loss.

Functional status

Self-reported basic and instrumental activities of daily living (BADL and IADL) were assessed by the Katz[15] and Lawton and Brody[16] scales respectively. The Katz BADL scale assesses six functions: bathing, dressing, toileting, mobility, continence and feeding. The Lawton and Brody IADL scale assesses eight functions: using the telephone, using transport, managing money, shopping, taking drugs, cooking food, housekeeping and doing laundry. The last three were not considered for older men living with a spouse or with others or for women who had the housekeeping done by somebody else.

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The effect of chronic diseases on physical function. Comparison between activities of daily living scales and the Physical Performance Test

Age and Ageing, July, 1997 by Renzo Rozzini, Giovanni B. Frisoni, Luigi Ferrucci, Piera Barbisoni, Bruno Bertozzi, Marco Trabucchi

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