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Determinants of perceived physical environment barriers among community-dwelling elderly in Taiwan

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The journal of nutrition, health & aging

Abstract

Objectives

To test the hypothesis that mobility, activities of daily living, and the interaction between them can play a key role in determining perceived physical environment barriers among community-dwelling elderly.

Design

Cross-sectional.

Setting

Community.

Participants

One hundred and ninety-seven community-dwelling elderly with more than 7 points on the Short Portable Mental State Questionnaire and less than 7 points on the Geriatric Depression Scale (15 items).

Intervention

None.

Measurements

Time Get-up and Go test (TUG), the subscales of basic activity of daily living (BADL)/instrumental activities of daily living (IADL) of the Hierarchy of Care Required (HCR), and the physical/structural subscale of the Craig Hospital Inventory of Environmental Factors in Community-dwelling Elderly in Taiwan were used to measure mobility, activities of daily living and perceived physical environment barriers, respectively. Hierarchical linear regression analyses were used to test the study hypothesis.

Results

Significant and positive relations were found to exist between perceived physical environment barriers and (1) the TUG time (β=.300, p<.05), and (2) the IADL score for the HCR (β=.322, p<.05), respectively. A significant and negative relation existed between perceived physical environment barriers and the interaction term (the TUG time and the IADL score for the HCR) (β=−.211, p<.05).

Conclusion

Mobility, IADL and the interaction between them are found to be significant determinants of perceived physical environment barriers in the community-dwelling elderly under consideration. Strategies targeting the enhancement of mobility among community-dwelling elderly are suggested to lead to improvements in the degree to which physical environment barriers are perceived. This beneficial effect could be greater in the case of elderly individuals with better IADL function.

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References

  1. Ministry of Health and Welfare. The physically and mentally disabled population by aged and grade, 1997–2012. Department of Statistics, Taipei, Taiwan, 2013

    Google Scholar 

  2. Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M,..., Murray CJ. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2013;381:1987–2015

    Article  PubMed  Google Scholar 

  3. Abizanda P, Romero L, Sánchez-Jurado PM, Atienzar-Nünez P, Esquinas-Requena JL, García-Nogueras I. Association between functional assessment instruments and frailty in older adults: The FRADEA Study. J Frailty Aging 2012;1(4):162–168.

    Google Scholar 

  4. Applegate WB, Blass JP, Williams TF (1990) Instruments for the functional assessment of older patients. N Engl J Med 1990;322:1207–1214

    Article  CAS  PubMed  Google Scholar 

  5. López-Teros T, Gutiérrez-Robledo LM, Pérez-Zepeda MU. Gait speed and handgrip strength as predictors of incident disability in Mexican older adults. J Frailty Aging 2014;3(2):109–112

    Google Scholar 

  6. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993;342:1032–1036

    Article  CAS  PubMed  Google Scholar 

  7. Abizanda P, Romero L, Sánchez-Jurado PM, Martínez-Reig M, Alfonso-Silguero SA, Rodríguez-Mañas L. Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults? J Nutr Health Aging 2014;18(6):622–7.

    Article  CAS  PubMed  Google Scholar 

  8. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–M94

    Article  CAS  PubMed  Google Scholar 

  9. Tavassoli N, Guyonnet S, Abellan Van Kan G, Sourdet S, Krams T, Soto ME, Subra J, Chicoulaa B, Ghisolfi A, Balardy L, Cestac P, Rolland Y, Andrieu S, Nourhashemi F, Oustric S, Cesari M, Vellas B; Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability Team. Description of 1,108 older patients referred by their physician to the «Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability» at the gerontopole. J Nutr Health Aging 2014;18(5):457–64.

    Article  CAS  PubMed  Google Scholar 

  10. Lin YH, Yen CH, Kuo MS, Hu MH, Wang CY. The Cutoff Values of Performance Tests to Separate Community-Dwelling Older Adults with and without Physical Disability. Taiwan Geriatr Gerontol 2012;7(3):160–174

    Google Scholar 

  11. World Health Organization. International classification of functioning, disability and health. Geneva: WHO, 2001

    Google Scholar 

  12. Grill E, Müller M, Quittan M, Strobl R, Kostanjsek N, Stucki G. Brief ICF Core Set for patients in geriatric post-acute rehabilitation facilities. J Rehabil Med. Jan; 2011;43(2):139–144. doi: 10.2340/16501977-0618

    Article  PubMed  Google Scholar 

  13. Almborg AH, Welmer AK. Use of the International Classification of Functioning, Disability and Health (ICF) in social services for elderly in Sweden. Disabil Rehabil. 2012;34(11):959–964. doi: 10.3109/09638288.2011.628739

    Article  PubMed  Google Scholar 

  14. Lowry KA, Vallejo AN, Studenski SA. Successful aging as a continuum of functional independence: lessons from physical disability models of aging. Aging Dis. Feb; 2012;3(1):5–15

    PubMed Central  PubMed  Google Scholar 

  15. Ustün TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M. The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil. 2003Jun 3–17;;25(11–12):565–571

    Article  PubMed  Google Scholar 

  16. Farin E, Fleitz A. The development of an ICF-oriented, adaptive physician assessment instrument of mobility, self-care, and domestic life. Int J Rehabil Res. 2009;Jun;32(2):98–107. doi: 10.1097/MRR.0b013e3283112979

    Article  PubMed  Google Scholar 

  17. Fougeyrollas P. Documenting environmental factors for preventing the handicap creation process: Quebec contributions relating to ICIDH and social participation of people with functional differences. Disabil Rehabil. Apr- 1995;Jun;17(34):145–153

    Article  CAS  PubMed  Google Scholar 

  18. Chang KH, Lin YN, Liao HF, Yen CF, Escorpizo R, Yen TH, Liou TH. Environmental effects on WHODAS 2.0 among patients with stroke with a focus on ICF category e120. Qual Life Res, 2014;doi:10.1007/s11136-014-0624-9

    Google Scholar 

  19. Hoyle M, Gustafsson L, Meredith P, Ownsworth T. Participation After Stroke: Do We Understand All the Components and Relationships As Categorised in the ICF?. Brain Impairment, 2012;13, pp 4–15. doi:10.1017/BrImp.2012.9

    Google Scholar 

  20. Whiteneck GG, Harrison-Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers. Arch Phys Med Rehabil. 2004;Aug;85(8):1324–1335

    Article  PubMed  Google Scholar 

  21. Han CW, Yajima Y, Lee EJ, Nakajima K, Meguro M, Kohzuki M. Validity and utility of the Craig Hospital Inventory of Environmental Factors for Korean community-dwelling elderly with or without stroke. Tohoku J Exp Med. 2005;May;206(1):41–49

    Article  PubMed  Google Scholar 

  22. Liao LR, Lau RW, Pang MY. Measuring environmental barriers faced by individuals living with stroke: development and validation of the Chinese version of the Craig Hospital Inventory of Environmental Factors. J Rehabil Med. 2012;Sep;44(9):740–746. doi: 10.2340/16501977-1014

    Article  PubMed  Google Scholar 

  23. Whiteneck GG, Gerhart KA, Cusick CP. Identifying environmental factors that influence the outcomes of people with traumatic brain injury. J Head Trauma Rehabil. 2004;May-Jun;19(3):191–204

    Article  PubMed  Google Scholar 

  24. Whiteneck G, Meade MA, Dijkers M, Tate DG, Bushnik T, Forchheimer MB. Environmental factors and their role in participation and life satisfaction after spinal cord injury. Arch Phys Med Rehabil. Nov;85(11):1793–1803

  25. Lien WC, Guo NW, Chang JH, Lin YC, Kuan TS. Relationship of perceived environmental barriers and disability in community-dwelling elderly in Taiwan—a population-based study. BMC Geriatrics 2014;14:59. doi:10.1186/1471-2318-14-59

    Article  PubMed Central  PubMed  Google Scholar 

  26. Wang JJ. Psychological abuse and its characteristic correlates among elderly Taiwanese. Arch Gerontol Geriatr 2006;42(3):307–318

    Article  PubMed  Google Scholar 

  27. Wang JJ. Prevalence and correlates of depressive symptoms in the elderly of rural communities in southern Taiwan. J Nurs Res. 2001;Jun;9(3):1–12

    Article  PubMed  Google Scholar 

  28. Podsiadlo D, Richardson S. The timed «Up & Go»: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39(2):142–148

    Article  CAS  PubMed  Google Scholar 

  29. Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;Feb;82(2):128–137

    PubMed  Google Scholar 

  30. Bohannon RW. Reference values for the timed up and go test: a descriptive metaanalysis. J Geriatr Phys Ther 2006;29:64–68

    Article  PubMed  Google Scholar 

  31. Chen HT, Chen SI, Guo NW, Lin JH, Yeh SH, Chang JJ, Liu CK, Yu PW. Developing an assessment tool for determining the degree of required care in longterm care (Project code: DOH89-TD-1106) Ministry of Health and Welfare, Taipei, Taiwan, 1990

    Google Scholar 

  32. Chen HT, Liu CK, Chen SI, Guo NW, Lin JH, Yeh SH, Chang JJ, Yu PW. The development of the Hierarchy of the Care Required. Ministry of Health and Welfare, Taipei, Taiwan, 2000

    Google Scholar 

  33. Rasch G. Probabilistic models for some intelligence and attainment tests. Chicago: Univ Chicago Pr, 1980

    Google Scholar 

  34. Heinemann, A. W., Linacre, J. M., Wright, B. D., Hamilton, B. B., & Granger, C. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil 1993;74(6), 566–573

    Article  CAS  PubMed  Google Scholar 

  35. Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil 1994;75(2);127–132

    CAS  PubMed  Google Scholar 

  36. Kleinbaum DG, Kupper LL, Nizam A, Muller KE (2007) Applied regression analysis and other multivariate methods. 4th ed. Pacific Grove: Duxbury Pr, 2007

    Google Scholar 

  37. Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S, Montes F, Brownson RC; Lancet Physical Activity Series Working Group. Evidence-based intervention in physical activity: lessons from around the world. Lancet. 2012;Jul 21;380(9838):272–281. doi: 10.1016/S0140-6736(12)60816-2

    Article  PubMed  Google Scholar 

  38. Arango CM, Páez DC, Reis RS, Brownson RC, Parra DC. Association between the perceived environment and physical activity among adults in Latin America: a systematic review. Int J Behav Nutr Phys Act. 2013;Oct 31;10:122. doi: 10.1186/1479-5868-10-122

    Article  Google Scholar 

  39. Jia Y, Usagawa T, Fu H. The Association between Walking and Perceived Environment in Chinese Community Residents: A Cross-Sectional Study. PLoS One. 2014;Feb 27;9(2):e90078. doi: 10.1371/journal.pone.0090078

    Article  PubMed Central  PubMed  Google Scholar 

  40. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–561

    Article  CAS  PubMed  Google Scholar 

  41. Fujiwara Y, Yoshida H, Amano H, Fukaya T, Liang J, Uchida H, Shinkai S. Predictors of improvement or decline in instrumental activities of daily living among community-dwelling older Japanese. Gerontology. 2008;54(6):373–380. doi: 10.1159/000151221

    Article  PubMed  Google Scholar 

  42. Shinkai S, Kumagai S, Fujiwara Y, Amano H, Yoshida Y, Watanabe S, Ishizaki T, Suzuki T, Shibata H. Predictors for the onset of functional decline among initially non-disabled older people living in a community during a 6-year follow-up. Geriatr Gerontol Int 2003;3:31–39

    Article  Google Scholar 

  43. Alexandre TS, Corona LP, Nunes DP, Santos JL, Duarte YA, Lebrão ML. Disability in instrumental activities of daily living among older adults: gender differences. Rev Saude Publica 2014;48(3):379–89.

    Article  PubMed Central  Google Scholar 

  44. Han CW, Yajima Y, Lee EJ, Nakajima K, Meguro M, Kohzuki M. Validity and utility of the Craig hospital inventory of environmental factors for Korean community-dwelling elderly with or without stroke. Tohoku J Exp Med 2005;206(1):41–49.

    Article  PubMed  Google Scholar 

  45. Elliot AJ, Mooney CJ, Douthit KZ, Lynch MF. Predictors of Older Adults’ Technology Use and Its Relationship to Depressive Symptoms and Well-being J Gerontol B Psychol Sci Soc Sci 2014;69(5):667–677

    Article  PubMed Central  PubMed  Google Scholar 

  46. Huang CQ, Zhang XM, Dong BR, Lu ZC, Yue JR, Liu QX. Health status and risk for depression among the elderly: a meta-analysis of published literature. Age Ageing 2010;39 (1): 23–30

    Article  CAS  Google Scholar 

  47. Cotton SR, Ford G, Ford S, Hale TM. Internet Use and Depression Among Retired Older Adults in the United States: A Longitudinal Analysis J Gerontol B Psychol Sci Soc Sci 2014;69(5):763–771

    Article  Google Scholar 

  48. Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999;48(4):445–469.

    Article  CAS  PubMed  Google Scholar 

  49. Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A. Physical Exercise Interventions for Improving Performance-Based Measures of Physical Function in Community-Dwelling, Frail Older Adults: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2014Apr;95(4):753–769.e3. doi: 10.1016/j.apmr.2013.11.007

    Article  PubMed  Google Scholar 

  50. Bohannon RW. Reference values for the timed up and go test: a descriptive metaanalysis. J Geriatr Phys Ther 2006;29:64–68.

    Article  PubMed  Google Scholar 

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Lien, W.C., Chang, J.H., Guo, N.W. et al. Determinants of perceived physical environment barriers among community-dwelling elderly in Taiwan. J Nutr Health Aging 19, 575–582 (2015). https://doi.org/10.1007/s12603-015-0473-4

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  • DOI: https://doi.org/10.1007/s12603-015-0473-4

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