title: The severity and associated factors of participation restriction among community-dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF).
abstract: The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people's involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people.
  
  
  
  A cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework.
  
  
  
  Among all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants' status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants' participation restriction.
  
  
  
  Participation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature.
authors.affiliation: Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. justina.liu@polyu.edu.hk.
authors.forename: Justina Yat Wa
authors.initials: JY
authors.lastname: Liu
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology; D015444:Exercise / Q000523:psychology; D005239:Fear / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006801:Humans; D057187:Independent Living / Q000523:psychology* / Q000592:standards*; D064702:International Classification of Functioning, Disability and Health / Q000592:standards*; D008297:Male; D012307:Risk Factors; D058992:Social Participation / Q000523:psychology*; D014944:World Health Organization
keywords: Community-dwelling older people; Frailty; Participation restriction; WHO-ICF