Do Elderly People at More Severe IADL Limitation Stages Fall More 11_1_11Presentation Transcript
Instrumental Activities of Daily Living (IADLs) limitation staging is a tool that demonstrates the ways in which an elderly person’s cognitive and physical limitations influence interactions with the environment when attempting to live independently. It is currently being investigated in association with falls. We hypothesize that as IADL stages increase, history of a fall and history of more than one fall will increase in parallel.
Setting was a nationally representative sample from the Second Longitudinal Survey of Aging (LSOA II).
Participants included 7,401 community-dwelling persons 70 years of age and older.
Stages reflect IADL tasks in an ontological order of using the telephone, managing money, preparing meals, doing light housework, shopping for groceries, and doing heavy housework. Limitation stages follow an expected hierarchy where at stage 0, the individual has no limitation, stage I mild, stage II moderate, stage III severe, and at stage IV complete limitations in IADL tasks.
The proportions of people who stated they fell once and those who stated that they fell more than once (not conditional on having fallen once) within the 12 months prior to the time of questionnaire administration were compared across five stages of increasing IADL limitation.
After sample weights were applied:
9.4% of persons at stage 0, 13.9% at stage I, 18.5% at stage II, 17.5% at stage III, and 5.9% at stage IV recalled a recent fall within the past 12 months (P<0.0001).
5.0%, 13.3%, 23.6%, 24.3%, and 25.8% recalled having had more than one fall within the past 12 months at stages 0, I, II, III, and IV, respectively (P<0.0001).
Do Elderly People at More Severe IADL Limitation Stages Fall More? Janice C. Brown, MD, MPH, John T. Henry-Sanchez, MD, Dawei Xie, PhD, Qiang Pan, MA, Jibby E. Kurichi, MPH, Margaret G. Stineman, MD University of Pennsylvania, School of Medicine Figure 1. IADL staging - a model STAGE THRESHOLDS 0 to IV- MUST BE ABLE TO PERFORM EXPECTED LIMITATIONS (MAY HAVE VARIOUS LEVELS OF DIFFICULTY OR INABILITY TO PERFORM) Figure 2. Percentage of respondents by IADL stages who recalled a fall Figure 3. Percentage of respondents by IADL stages who fell more than once
Statistically significant associations were found between IADL limitation stages and history of a fall among elderly community-dwelling persons.
A history of a fall peeked at stage II, formed a plateau at stages II and III then dropped at stage IV, contrary to our proposed hypothesis.
In contrast, history of more than one fall increased between stages I and II then remained at a plateau thereafter.
Stages could represent a powerful tool for screening patients in the US elderly population according to history of recent falls.
Supported in part through the National Institute of Aging (NIA) of the NIH (AG032420-01A1). The views of the author do not necessarily reflect those of the funding organization.
Stineman MG, et al. Activity of Daily Living Staging Chronic Health Conditions and Perceived Lack of Home Accessibility Features among Elderly People Living in the Community. Journal of the American Geriatric Society. 2011; 59:454-462.
Lawton MP, et al. Assessment of older people : self-maintaining and instrumental activities of daily living. The Gerontologist. 1969; 9(3):179-186.
Stage 0 - All IADL’s Stage I - Telephone, manage money, prepare meals, do light housework Stage II - Telephone, manage money, prepare meals, do light housework, shop, do heavy housework At least 1 ADL No IADL No limitations Mild limitations - Shop, do heavy housework Moderate limitations - Prepare meals, do light housework, shop, do heavy housework Severe limitations - Telephone, manage money, prepare meals, do light housework, shop, do heavy housework Complete limitations - all IADL’s