Aging Clinical and Experimental Research

, Volume 24, Issue 1, pp 56–61 | Cite as

Prevalence, correlates and perceived causes of limitations in activities of daily living among older Singaporeans

  • Chetna MalhotraEmail author
  • Angelique Chan
  • Rahul Malhotra
  • Truls Østbye
Original Article


Aims: To describe the prevalence of limitations in Activities of Daily Living (ADL) among older Singaporeans, examine the association of ADL limitations with various self-reported health conditions, assess perceived causes of ADL limitations, and compare prevalence of health conditions among those who perceive only ‘old age’ vs those who perceive at least one specific health condition as the cause of their limitations. Methods: Data from a national survey of Singaporeans 60 years and over was used. The association between ADL limitations and health conditions was assessed through logistic regression. Those with ADL limitations were asked about the perceived cause/s of their limitation/s. Any significant difference in the prevalence of health conditions between those attributing their ADL limitations only to old age and those attributing to at least one specific health condition was ascertained. Results: Overall prevalence of ADL limitations was 9.7%. Joint/nerve pain, stroke, pelvic/femoral fractures, heart diseases, diabetes, osteoporosis, chronic respiratory illness and renal/urinary tract illness were significantly associated with ADL limitations, and the most common perceived cause was ‘old age’ (33%). The prevalence of most health conditions was similar in older adults attributing their limitations to only ‘old age’ and to at least one specific health condition. Conclusion: Clinical suspicion is called for if individuals with ADL limitations attribute them solely to ‘old age’.

Key words

Aging disability epidemiology 


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  1. 1.
    Kinsella KG, He W. An Aging World: 2008. Washington DC: US Government Printing Office, 2009.Google Scholar
  2. 2.
    Yong V, Saito Y, Chan A. Changes in the prevalence of mobility limitations and mobile life expectancy of older adults in Singapore, 1995–2005. J Aging Health 2010; 22: 120–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee KS, Tan TC. Functional status of the elderly in Singapore — the trend over a decade. Ann Acad Med Singapore 1997; 26: 727–30.PubMedGoogle Scholar
  4. 4.
    Ng TP, Niti M, Chiam PC, Kua EH. Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. J Am Geriatr Soc 2006; 54: 21–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Ofstedal MB, Zimmer Z, Hermalin AI et al. Short-term trends in functional limitation and disability among older Asians: a comparison of five Asian settings. J Cross Cult Gerontol 2007; 22: 243–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Verbrugge LM, Jette AM. The disablement process. Soc Sci Med 1994; 38: 1–14.PubMedCrossRefGoogle Scholar
  7. 7.
    World Health Organization. International Classification of Impairments, Disabilities, and Handicaps: A Manual of Classification Relating to Consequences of Disease. Geneva, Switzerland: World Health Organization, 1980.Google Scholar
  8. 8.
    Friedman B, Wamsley BR, Liebel DV, Saad ZB, Eggert GM. Patient satisfaction, empowerment, and health and disability status effects of a disease management-health promotion nurse intervention among Medicare beneficiaries with disabilities. Gerontologist 2009; 49: 778–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Lorig KR, Sobel DS, Stewart AL et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37: 5–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Phelan EA, Williams B, Penninx BW, LoGerfo JP, Leveille SG. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. J Gerontol A Biol Sci Med Sci 2004; 59: 838–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Sarkisian CA, Liu H, Ensrud KE, Stone KL, Mangione CM. Correlates of attributing new disability to old age. Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 2001; 49: 134–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Valderrama-Gama E, Damian J, Ruigomez A, Martin-Moreno JM. Chronic disease, functional status, and self-ascribed causes of disabilities among noninstitutionalized older people in Spain. J Gerontol A Biol Sci Med Sci 2002; 57: M716–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Williamson JD, Fried LP. Characterization of older adults who attribute functional decrements to “old age”. J Am Geriatr Soc 1996; 44: 1429–34.PubMedGoogle Scholar
  14. 14.
    Ettinger WH Jr, Fried LP, Harris T, Shemanski L, Schulz R, Robbins J. Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group. J Am Geriatr Soc 1994; 42: 1035–44.PubMedGoogle Scholar
  15. 15.
    Leventhal EA, Prohaska TR. Age, symptom interpretation, and health behavior. J Am Geriatr Soc 1986; 34: 185–91.PubMedGoogle Scholar
  16. 16.
    Gjorup T, Hendriksen C, Lund E, Stromgard E. Is growing old a disease? A study of the attitudes of elderly people to physical symptoms. J Chronic Dis 1987; 40: 1095–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Rakowski W, Hickey T. Mortality and the attribution of health problems to aging among older adults. Am J Public Health 1992; 82: 1139–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Chan A, Malhotra C, Malhotra R, Ostbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. Int J Geriatr Psychiatry 2011; 26: 630–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ho HK, Matsubayashi K, Wada T, Kimura M, Kita T, Saijoh K. Factors associated with ADL dependence: A comparative study of residential care home and community-dwelling elderly in Japan. Ger Gerontol Intl 2002; 2: 80–6.CrossRefGoogle Scholar
  20. 20.
    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: 1082–6.PubMedGoogle Scholar
  21. 21.
    Ng T-P, Niti M, Chiam P-C, Kua E-H. Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. J Am Geriatr Soc 2006; 54: 21–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Kington R, Smith J. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. Am J Public Health 1997; 87: 805.PubMedCrossRefGoogle Scholar
  23. 23.
    Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health 2004; 94: 1406–11.PubMedCrossRefGoogle Scholar
  24. 24.
    Verbrugge LM. Marital Status and Health. J MarrFam 1979; 41: 267–85.Google Scholar
  25. 25.
    Singapore Department of Statistics. Home ownership and equity of HDB households 2003. Singapore, 2005.Google Scholar
  26. 26.
    Dunlop DD, Hughes SL, Manheim LM. Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health 1997; 87: 378–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Jagger C, Arthur AJ, Spiers NA, Clarke M. Patterns of onset of disability in activities of daily living with age. J Am Geriatr Soc 2001; 49: 404–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Zhu L, Fratiglioni L, Guo Z, Aguero-Torres H, Winblad B, Viitanen M. Association of stroke with dementia, cognitive impairment, and functional disability in the very old: a populationbased study. Stroke 1998; 29: 2094–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ. Predicting disability in stroke — a critical review of the literature. Age Ageing 1996; 25: 479–89.PubMedCrossRefGoogle Scholar
  30. 30.
    Al Snih S, Markides KS, Ray L, Goodwin JS. Impact of pain on disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci 2001; 56: M400–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Al Snih S, Fisher MN, Raji MA, Markides KS, Ostir GV, Goodwin JS. Diabetes mellitus and incidence of lower body disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci 2005; 60: 1152–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Oka H, Yoshimura N, Kinoshita H, Saiga A, Kawaguchi H, Nakamura K. Decreased activities of daily living and associations with bone loss among aged residents in a rural Japanese community: the Miyama Study. J Bone Miner Metab 2006; 24: 307–13.PubMedCrossRefGoogle Scholar
  33. 33.
    Miravitlles M, Soriano JB, Garcia-Rio F et al. Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax 2009; 64: 863–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Guccione AA, Felson DT, Anderson JJ et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994; 84: 351–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Rowe JW, Kahn RL. Human aging: usual and successful. Science 1987; 237: 143–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Straughan PT, Seow A. Fatalism reconceptualized: a concept to predict health screening behavior. J Gender Culture Health 1998; 3: 85–100.CrossRefGoogle Scholar
  37. 37.
    Prohaska TR, Keller ML, Leventhal EA, Leventhal H. Impact of symptoms and aging attribution on emotions and coping. Health Psychol 1987; 6: 495–514.PubMedCrossRefGoogle Scholar
  38. 38.
    Morgan R, Pendleton N, Clague JE, Horan MA. Older people’s perceptions about symptoms. Br J Gen Pract 1997; 47: 427–30.PubMedGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2012

Authors and Affiliations

  • Chetna Malhotra
    • 1
    Email author
  • Angelique Chan
    • 1
    • 2
  • Rahul Malhotra
    • 1
  • Truls Østbye
    • 1
    • 3
  1. 1.Program in Health Services and Systems ResearchDuke-National University of Singapore Graduate Medical SchoolSingaporeSingapore
  2. 2.Department of SociologyNational University of SingaporeSingaporeSingapore
  3. 3.Department of Community and Family MedicineDuke UniversityDurhamUSA

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