title: Factors associated with increasing functional decline in multimorbid independently living older people.
abstract: OBJECTIVE
  With increasing age the levels of activities of daily living (ADL) deteriorate. In this study we aimed to investigate which demographic characteristics and disorders are associated with ADL disabilities in multi-morbid older people.
  
  
  METHODS
  We performed a cross-sectional study with baseline patient data from a large Dutch trial in independently living multi-morbid older people combined with the reimbursed healthcare data for the same subjects.
  
  
  METHODS
  The primary outcome of our study was the level of independence of activities of daily living (ADL) as assessed with the Modified Katz Activities of Daily Living (KATZ-15) scale.
  
  
  RESULTS
  In our study we were able to include 1187 persons (63.0% female) for whom both questionnaire data and reimbursed healthcare data was available. In total, 59% had a Katz-15 score of 1 or higher. The strongest associations with ADL disabilities in women were psychiatric disorders, with prevalence rate (PR) estimates of 1.37 (95% confidence interval (CI): 1.17-1.60) and transient ischaemic attacks and cerebrovasculair accidents in men, with PR estimates of 1.94 (95% CI: 1.41-2.66). Although univariate analysis seemed to also reveal associations with socio-demographic factors such as living together with a partner or the socio-economic status, these factors were not independently associated with ADL disabilities.
  
  
  CONCLUSIONS
  In this cross-sectional study we found that 71% of the multi-morbid female elderly had a sub-optimal level of activities of daily living, as assessed with the Katz-15 scale. The results of our study show that multiple disorders are associated with ADL disabilities in multi-morbid older men and women. We found socio-demographic characteristics not to be independently associated ADL disabilities.
authors.affiliation: Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Wijnand
authors.initials: W
authors.lastname: Laan
authors.forename: Nienke
authors.initials: N
authors.lastname: Bleijenberg
authors.forename: Irene
authors.initials: I
authors.lastname: Drubbel
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living / Q000523:psychology; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires