title: Impairment in the activities of daily living in older adults with and without osteoporosis, osteoarthritis and chronic back pain: a secondary analysis of population-based health survey data.
abstract: BACKGROUND
  Independence in performing activities of daily living (ADLs) is a central aspect of functioning. Older adults frequently experience impairments and limitations in functioning in various life areas. The aim of this survey was to explore the limitations in the ADLs in older adults in a population-based survey in Austria.
  
  
  METHODS
  A population-based cross-sectional study in 3097 subjects aged ≥65 years who were included in the Austrian health interview survey was performed. Descriptive statistics were used to calculate frequencies of problems in the ADLs. A principal component analysis was applied to analyze the main dimensions of 19 ADL items. Binary logistic regression models were used with the ADL dimensions as the dependent variables and osteoarthritis, chronic back pain, osteoporosis, sex, education level, anxiety or depression, age and pain intensity as independent variables.
  
  
  RESULTS
  People with musculoskeletal conditions were significantly more often affected by ADL problems than people without these diseases. The ADL domain which caused problems in the highest proportion of people was "doing heavy housework" (43.9 %). It was followed by the ADL domains "bending or kneeling down" (39.3 %), "climbing stairs up and down without walking aids" (23.1 %), and "walking 500 m without walking aids" (22.8 %). The principal components analysis revealed four dimensions of ADLs: (1) intense "heavy burden" ADLs, (2) basic instrumental ADLs, (3) basic ADLs and (3) hand-focused ADLs. The proportion of subjects who had problems with the respective dimensions was 58.2, 29.2, 23.0, and 9.2 %. Anxiety/depression (greatest effect), followed by the chronic musculoskeletal disease itself, female sex, higher age and pain intensity were significant predictors of ADL problems.
  
  
  CONCLUSIONS
  This population-based survey indicates that older people have considerable ADL problems. More attention should be paid to the high impact of pain intensity, anxiety and depression on ADLs.
authors.affiliation: Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna and Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. tanja.stamm@meduniwien.ac.at.
authors.forename: Tanja Alexandra
authors.initials: TA
authors.lastname: Stamm
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Pieber
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Crevenna
authors.affiliation: Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas Ernst
authors.initials: TE
authors.lastname: Dorner
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D001317:Austria / Q000453:epidemiology; D001416:Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D016009:Chi-Square Distribution; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010003:Osteoarthritis / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010024:Osteoporosis / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D025341:Principal Component Analysis; D012307:Risk Factors
keywords: Activities of daily living; Occupational therapy; Population-based study