Consequences of chronic diseases and other limitations associated with old age - a scoping review
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Maresova et al. BMC Public Health (2019) 19:1431
https://doi.org/10.1186/s12889-019-7762-5
RESEARCH ARTICLE Open Access
Consequences of chronic diseases and
other limitations associated with old
age – a scoping review
Petra Maresova1, Ehsan Javanmardi1, Sabina Barakovic2, Jasmina Barakovic Husic3, Signe Tomsone4,
Ondrej Krejcar5 and Kamil Kuca5,6*
Abstract
Background: The phenomenon of the increasing number of ageing people in the world is arguably the most
significant economic, health and social challenge that we face today. Additionally, one of the major epidemiologic
trends of current times is the increase in chronic and degenerative diseases. This paper tries to deliver a more up to
date overview of chronic diseases and other limitations associated with old age and provide a more detailed
outlook on the research that has gone into this field.
Methods: First, challenges for seniors, including chronic diseases and other limitations associated with old age, are
specified. Second, a review of seniors’ needs and concerns is performed. Finally, solutions that can improve seniors’
quality of life are discussed. Publications obtained from the following databases are used in this scoping review:
Web of Science, PubMed, and Science Direct. Four independent reviewers screened the identified records and
selected relevant publications published from 2010 to 2017. A total of 1916 publications were selected. In all, 52
papers were selected based on abstract content. For further processing, 21 full papers were screened.”
Results: The results indicate disabilities as a major problem associated with seniors’ activities of daily living
dependence. We founded seven categories of different conditions - psychological problems, difficulties in mobility,
poor cognitive function, falls and incidents, wounds and injuries, undernutrition, and communication problems. In
order to minimize ageing consequences, some areas require more attention, such as education and training;
technological tools; government support and welfare systems; early diagnosis of undernutrition, cognitive
impairment, and other diseases; communication solutions; mobility solutions; and social contributions.
Conclusions: This scoping review supports the view on chronic diseases in old age as a complex issue. To prevent
the consequences of chronic diseases and other limitations associated with old age related problems demands
multicomponent interventions. Early recognition of problems leading to disability and activities of daily living (ADL)
dependence should be one of essential components of such interventions.
Keywords: Chronic diseases, Seniors’ needs, Elderly disability, activities of daily living
* Correspondence: kamil.kuca@uhk.cz
5
Center of Basic and Applied Research, Faculty of Informatics and
Management, University of Hradec Kralove, Rokitanskeho 62, 500 03 Hradec
Kralove, Czech Republic
6
Malaysia Japan International Institute of Technology (MJIIT), Universiti
Teknologi Malaysia Kuala Lumpur, Jalan Sultan Yahya Petra, 54100 Kuala
Lumpur, Malaysia
Full list of author information is available at the end of the article
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Maresova et al. BMC Public Health (2019) 19:1431 Page 2 of 17 Introduction community [23]. Recognising the needs of elderly indi- The phenomenon of the increasing ageing population is viduals suffering from chronic diseases and other con- one of the most important economic, social, and medical straints would fix many problems that patients face and issues of current times. Recent demographic trends out- results in an improved QoL, safety and overall health. line that the number of people of old age will continue Also, by investing in better QoL, safety and overall to rise dramatically. Today most people can expect to health in elderly, their productivity will rise as well live to age 60 and beyond [1]. Between 2000 and 2020, thereby contributing to the economic and social the fastest growing segment of the United States (US) opportunities. population will be individuals aged 65 years and older This paper will be presenting an up-to-date survey of [2]. By 2030, the number of people in the world aged 60 the limitations of seniors in connection with their years or over will increase by 56%, and by 2050, the glo- chronic diseases and helps to provide a more detailed bal population of senior persons is projected to more image of the research that has been done in this field. than double its size in 2015. The number of people aged Additionally, the paper underlines the main research 65 or older is about to grow to nearly 1.5 billion in 2050, areas within seniors’ needs in relation to chronic dis- with most of the increase in developing countries [3]. eases and the limitations associated as an informative These demographic transitions essentially require shift- summary for further research. To appreciate the scien- ing the global focus to cater for the preventive health- tific progress that has been made, with an emphasis on care and medical needs of the elderly population [4]. A the literature dedicated to the economic field, a system- wide gamut of determinants, such as social concerns and atic review has been conducted by using keywords such maltreatment of elderly individuals, poor knowledge and as elderly activities of daily living (ADLs), elderly QoL, awareness about the risk factors, food and nutritional re- and elderly instrumental activities of daily living quirements, psycho-emotional concerns, financial con- (IADLs). straints, health care system factors, and physical This paper is organized as follows: After the Introduc- correlates determine the medical problems and thus cast tion covering the background for this research given in a significant impact on the quality of life (QoL) of elderly the first section, section 2 describes in detail the used individuals [5–8]. methodology. The challenges faced by seniors with The ageing population tends to have a higher preva- chronic diseases and other limitations associated with lence of chronic diseases worldwide today [9]. For ex- old age are specified in section 3. After reviewing se- ample, six in ten adults in the US have a chronic disease niors’ needs and concerns, the solutions that can im- and four in ten adults have two or more [10], while prove their QoL are discussed in section 4. Finally, Sweden reports multiple chronic conditions of 56.3% section 5 concludes the paper and gives open research [11]. These chronic conditions are significant and pro- areas for the future activities. found economic issue for any person, the healthcare sys- tem, and society as a whole [12]. Such diseases account Methods for 86% of all medical costs in the US being even greater This scoping review is performed to identify and sum- worldwide [13]. The presence of multiple chronic condi- marise up-to-date conditions leading to ADLs depend- tions in the same individual has profound implications ency in relation to chronic diseases and other limitations for healthcare costs and utilisation [14]. For example, a associated with old age. “A 4-step systematic review was Swiss study estimated that the average total healthcare conducted using empirical studies: locating and identify- costs were 5.5 times higher in elderly patients with mul- ing relevant articles; screening located articles; examin- tiple chronic conditions as compared with elderly pa- ing full-text articles for inclusion or exclusion; and a tients without multiple chronic conditions [15]. The detailed examination of the 21 articles included.” combined cost savings from the health and productivity that results from a small reduction in the prevalence of Search strategy and eligibility criteria chronic disease cannot be ignored, resulting in a genuine In February 2018, four investigators performed a system- return on investment in a very small span of time [16]. atic literature search of the Web of Science, PubMed, Chronic diseases require a long period of treatment and Science Direct. The period of interest covered the that leads to the increase in demand for healthcare ser- years from 2010 to 2017, and the electronic search in- vices and changes its nature [17–21]. This need for cluded the following keywords: elderly and (Activities of long-term care can lead to a decline in the QoL of eld- daily living) ADLs, elderly QoL, elderly and (Instrumen- erly individuals [22]. This phenomenon will put pressure tal Activities of daily living) IADLs, senior and ADLs, on healthcare systems to adapt in order to meet these and senior and ADLs. changing demands. New and emerging technologies “In the Web of Science database, 829 publications have the potential to change healthcare at home and in were identified. Only two types of publications were
Maresova et al. BMC Public Health (2019) 19:1431 Page 3 of 17 considered eligible for the purpose of this study: ‘article’ after being checked. This resulted in the overall pool of and ‘review’, which includes the following: ‘review arti- studies being narrowed down to 52 papers and articles. cles’, ‘research articles’, ‘data articles’, ‘book reviews’, This set was then processed further, and the final num- ‘mini reviews’, ‘product reviews’, and ‘video articles’. This ber was brought down to 21 full length papers subse- criterion reduced the initial set of papers to a total of quent to the manual and semi-auto search. This 172 research articles, which were selected for further excluded papers that did not fall into the description processing. For PubMed and Science Direct, a semi- underscored in subsection 2.2. automated framework or aiding surveys was used [24]. The framework first used the search tools of the libraries with the aforementioned keywords. Next, after eliminat- Data extraction and study quality evaluation ing duplicate records from the retrieved papers, it ana- Each publication’s data was extracted – the main team lysed the title, abstract, and keywords section of each consisted of four researchers that worked to outline data paper to evaluate whether any of the following proper- individually. The following data was extracted: the coun- ties or their synonyms (listed in parenthesis) were men- try and type of study, the study’s author, and the study’s tioned: ADLs and IADLs. The paper distribution based title. A study was included if it qualified as per the fol- on property (keyword) is presented in Table 1.” lowing requirements: ADLs (or ADL) is a term used in healthcare to refer to people’s daily self-care activities. Common ADLs include Published after 2010; feeding, bathing, dressing, grooming, working, home- Focused on chronic diseases and other limitations making, cleaning after defecating, and leisure [25]. Adap- associated with old age; tive equipment and devices may be used to enhance and Posed questions concerning seniors’ needs; increase independence in performing ADLs. Basic ADLs Described diseases or specific needs of seniors; consist of self-care tasks that include but are not limited Discussed the limitations of seniors in connection to, bathing and showering, personal hygiene and groom- with their chronic diseases; ing, dressing, toilet hygiene, functional mobility, and Focused on elderly individuals’ QoL and ADLs; self-feeding. One way to think about basic ADLs is that Focused on older people’s community-dwelling; they are the things many people do when they get up in and the morning and get ready to go out of the house: get It was in English. out of bed, go to the toilet, bathe, dress, groom, and eat [26]. IADLs, such as cleaning and maintaining the house, A publication was not included if any of the following preparing meals, shopping, managing money, moving were true: within the community and many other activities are not necessary for fundamental functioning, but they let an It was not in English; individual live independently in a community [27].” It included a theoretical model; This paper includes 1916 publications that were ac- Focused on a technical description of the solution; quired based on a given set of properties from different Described systems for the diagnosis of the disease; databases. The publications were automatically analysed Described healthcare management systems; and and assessed, and then four properties were chosen to Focused on a disease rather than focusing on the be further processed from the existing pool. False posi- patient. tive papers that had the relevant properties but were not relevant to the study at hand were discarded manually Search process is described in Fig. 1. Table 1 Paper distribution by property Key words (used ‘AND’ between all words) WOS Science Direct PubMed ADLs (activities of daily living) 107 23 109 Elderly ADLs 1 3 14 Elderly quality of life 697 129 780 IADLs (instrumental activities of daily living) 22 4 24 Elderly IADLs 0 0 0 Senior ADLs 1 1 0 Senior IADLs 1 0 0 Total 829 160 927
Maresova et al. BMC Public Health (2019) 19:1431 Page 4 of 17
Fig. 1 Publication search process according to PRISMA
Results Communication problems are mentioned in one
Current research on ageing problems and seniors’ ADLs article.
dependency is described in Table 2. For each study, the
objectives, problems and diseases, main findings, and The prevalence and the number of comorbidities in-
limitations are described. Elderly persons will, as they crease with age, which might lead to ADL dependency
age, continue to progressively decline in terms of their [40]. Part of the potential causal pathway by which the
functional capacity. This will affect their frailty, worsen aforementioned problems directly or indirectly affect
dependency and add to their loss of autonomy [48]. Age- ADL in elderly people is presented in Fig. 2(a) and (b)
ing results in considerable and consistent change in an [34]. In Fig. 2(a), the findings of the selected studies re-
organism and results in a decline of or limited physical vealed that as a person ages, his/her psychological issues
function and an augmented level of comorbidity [40]. are intensified and s/he feels more unmet needs [31–33,
Identified major problems that cause seniors’ ADL de- 36, 44]. Furthermore, aging is a factor that could in-
pendency are classified as follows: crease the range of disabilities, reduce cognitive abilities,
and increase problems related to the teeth, swallowing
Disabilities and unmet needs are mentioned in 13 and nutrition [30, 34] –[42]. Along with these issues, as
articles. research has shown, older people find it more difficult to
Psychological problems are mentioned in six articles. perform everyday activities, move around, and commu-
Difficulties in mobility are mentioned in four nicate with others; meanwhile they are more likely to fall
articles. down, experience incidents, and suffer from wounds and
Poor insight and cognitive function are mentioned different types of injuries [29, 39, 41]. In Fig. 2(b), there
in four articles. is a conceptual model showing the mutual effects of
Falls and incidents are mentioned in four articles. some aging-related problems on activities of daily living
Wounds and injuries are mentioned in three articles. (ADLs). As this dynamic cause-effect diagram illustrates,
Prevalence of undernutrition and dysphagia are reduced cognitive abilities and oral hygiene mutually
mentioned in three articles. affect each other. Problems could lead to malnutrition inTable 2 Summary of studies
Authors (Year) Title Objective Problems and Sample Methods Results Limitations Comments
diseases
Velázquez “The link shared by assessing the Sarcopenia 90 women “Baumgartner’s “Patients with sarcopenia “cross-sectional design “Sarcopenia is associated
Alva et al. sarcopenia, physical association between in Mexico equation, The had a higher prevalence of that doesn’t allow with difficulties in mobility
(2013) [28] mobility, undernutrition, sarcopenia and City SENECA undernutrition and identifying causal links. and a higher prevalence of
and basic activities of daily mobility, and basic questionnaire, difficulty in climbing stairs Invalid Baumgartner’s undernutrition, particularly
living in the context of activities of daily living Katz index, -In terms of ADL, 64.9% of equation” difficulties in climbing
older women from Mexico (ADLs) of elderly linear patients had intermediate stairs.”
City” women regression independence.”
models”
Maresova et al. BMC Public Health
Haewon “The relationship between investigate the stroke 165 elderly, “using multiple “C-ADL had a significant “exclusion of patients “Some activity to enhance
Byeon et al. communication activities relationship between with stroke regression positive relationship with with severe aphasia, for stroke patients’
(2016) [29] of daily living and quality (C-ADL1) and quality of analysis SSQOL. It is necessary to whom test could not communication ability in
of life among the elderly life of elderly stroke between C- enhance stroke patients’ be conducted.” daily living to raise their
suffering from stroke” patients to enhance ADL and communication ability in QoL.”
the quality of life (QoL) SSQOL3” daily living to raise their
QoL.”
(2019) 19:1431
Charernboon, “Characteristic Profiles of “evaluating the dementia 90 “Spearman’s “IADL can be subtly demographic “Designing specific ADL
T. et al. Activities of Daily Living functional difference participants rank-order impaired in people with characteristics and assessment tools for MCI
(2016) [30] and Relationship with among normal correlation, MCI but markedly cultures that are similar would help in better
Cognitive Performance in cognitive elderly, the Mann– impaired in those with differential diagnosis and
Thai Elderly with Different (MCI2), and dementia; Whitney U-test, mild dementia. BADL1 prognosis for patients.”
Stages from Normal also, the relationship Multiple begins to decline in
Cognitive Function, Mild between cognitive regression moderate dementia and
Cognitive Impairment to performance and model” then reaches a level of
Dementia” functional abilities” severe impairment in
severe dementia.”
Chen Shen, “Unmet needs of activities “identify the prevalence disabled 303 older “Using the “93.1% of the disabled “collect more samples “government and
et al. of daily living among a and risk factors of elderly adults in Barthel Index people had at least one from different regions, caregivers should take
(2018) [31] community-based sample unmet needs among China (BI) and unmet need. The unmet find a better way to more action to prevent or
of disabled elderly people the disabled elderly in Functional needs were using vehicles, improve the precision reduce unmet needs
in Eastern China: a cross- China” Activities stairs, working on a hobby and multiplicity of among elderly individuals.”
sectional study” Questionnaire social interaction and analyses”
(FAQ), binary ambulating. The factors
logistic influencing unmet needs
regression were related to the degree
analysis” of disability in (IADL), the
relationship with
caregivers and the
monthly income of
caregivers.”
Costa, FA, “Contribution of chronic “assess the contribution chronic 10,537 “A multinomial “Contribution of chronic “a cross-sectional de- “orient health services to
et al. diseases to the prevalence of selected chronic diseases elderly additive diseases to prevalence of sign, which does not target specific groups,
(2018) [32] of disability in basic and diseases to the Brazilians hazards model disability was greater in allow for establishment considering age, sex, and
instrumental activities of prevalence of disability assesses the younger elderly and of a temporal current illnesses, aimed at
daily living in elderly in elderly” contribution” highlighting the relevance relationship” preventing disability in
Brazilians: the National of stroke and arthritis in elderly individuals.”
Health Survey” men, and arthritis,
hypertension, and diabetes
Page 5 of 17Table 2 Summary of studies (Continued)
Authors (Year) Title Objective Problems and Sample Methods Results Limitations Comments
diseases
in women.”
Farías- “Disability related to basic “estimate the Disability 1.451 “Poisson “Functional disability was “possible reverse “social policies need to
Antúsnez and instrumental activities prevalence of disability elderly in regression” associated with individuals causality bias in some adjust to the new reality
et al. of daily living: a related to basic and Brazil older than 80 with less associations” with the elaboration of
(2018) [33] population-based study instrumental activities schooling years and policies and programmes
with elderly in Pelotas, Rio of daily living” affected by multiple focused on the health of
Grande do Sul” morbidities.” elderly individuals.”
Maresova et al. BMC Public Health
Furuta, M, “Interrelationship of oral “examining direct and physical “286 elderly “the BI, the “Poor oral health status “a longitudinal study is “maintaining or improving
et al. health status, swallowing indirect relationships disabilities people Clinical and cognitive impairment needed to examine a oral health status and
(2013) [34] function, nutritional status, among oral health living at Dementia had a direct effect on temporal relationship.” swallowing function
and cognitive ability with status, swallowing home and Rating Scale, denture wearing, and the indirectly or directly
activities of daily living in function, nutritional receiving Path analysis to consequent dysphagia, in contribute to preventing a
Japanese elderly people status, cognitive ability, home care test pathways” addition to cognitive decline in ADL in elderly
receiving home care and ADL in elderly” services” impairment, was positively people who require home
(2019) 19:1431
services due to physical associated with care.”
disabilities” malnutrition.”
Genkai, S.et al. “Loss of occlusal support “clarifying whether the occlusal 322 elderly the Barthel “““Factors related to “small size of samples” “the absence of occlusal
(2015) [35] affects the decline in absence of occlusal support in four Index declines in ADL in elderly support was a significant
activities of daily living in support would lead to prefectures people receiving home risk factor for a decline of
elderly people receiving a decline in ADL in care were cognitive the ADL in elderly people
home care” elderly people function and occlusal receiving home care.”
receiving home care” support.”
Ha, E; Kim, K “Factors that influence “Identifying the factors dementia 152 elderly Using “Factors affecting ADL in “further refinement of “Multidisciplinary
(2013) [36] activities of daily living in that influence ADL in in South independent t- elderly individuals with the underlying model interventions are essential
the elderly with probable elderly individuals with Korea tests, Pearson’s probable dementia were is warranted.” to improve the ADL and
dementia” probable dementia” correlation and faecal incontinence, prevent deterioration of
stepwise mul- regularity of exercise, cognitive function in
tiple regression cognitive function, urinary elderly patients with
incontinence, and CVA probable dementia.”
history.”
Hesseberg, “Disability in Instrumental “The aim is to examine Mild 729 patients Multiple “Found an association “cross-sectional design “Problems with handling
K.et al. Activities of Daily Living in disability in (IADL) in Cognitive logistic between IADL and that does not allow to medication, shopping and
(2013) [37] Elderly Patients with Mild elderly persons” Impairment regression diagnosis, and a difference conclusion on preparing food are
Cognitive Impairment and and in the proportion of causality.” domains clinicians should
Alzheimer‘s Disease” Alzheimer‘s disability in IADL in be aware of regarding
Disease patients with MCI and AD.” IADL disability.”
Hou, C, et al. “Trends of activities of “Investigating the Stroke and 52,667 GEE5 models “Prevalence of ADL “association of some “these findings from this
(2018) [38] daily living disability cross-sectional trends cognitive participants with a logistic disability declined among important chronic study could provide
situation and association of prevalence and se- impairment in China link and the old population diseases such as information to develop
with chronic conditions verity of ADLs in old binominal without obeying a linear arthritis and depression preventive strategies and
among elderly aged 80 people and identifying distribution pattern. Temporal trends symptom, and the specific interventions for
years and over In China” the potential risk fac- of ADL disability mainly effects of severity of the reduction of disability
tors of disability” attributed to the change diseases on functional in the oldest Chinese
of low disability level disability were not population.”
prevalence. Stroke/CVD examined”
and cognitive impairment
Page 6 of 17Table 2 Summary of studies (Continued)
Authors (Year) Title Objective Problems and Sample Methods Results Limitations Comments
diseases
were the most common
risk factors of disability.
Vision impairment-caused
disability has become less
common.”
Masoudi Alavi “Dependency in Activities “evaluating elderly Limb Trauma 200 Chi-square test, “More than three-quarters “ISADL questionnaires “recommend continuing
N, et al. of Daily Living Following independence in ADLs traumatic One-way and of elderly individuals were were completed by patients’ follow-up for lon-
(2014) [39] Limb Trauma in Elderly following limb trauma patients in two-factor independent in ISADL be- phone call one to ger periods and interven-
Maresova et al. BMC Public Health
Referred to Shahid and its related factors Iran ANOVA, and fore the trauma, but three months after tional studies to improve
Beheshti Hospital, Kashan, in patients” Multiple regres- trauma in elderly patients trauma, which might ISADL following trauma in
Iran in 2013″ sion analysis. had a substantial negative affect the responses.” elderly.”
effect on patients’ ability
and ADL function.”
Okabe, T, “Age-specific risk factors “investigating risk incident 264 Student’s t-test “A different set of risk “included only women, “Age-specific screening
(2019) 19:1431
et al. for incident disability in factors for incident disability Japanese used for con- factors was associated these results cannot be and intervention strategies
(2017) [40] activities of daily living disability in ADL and women tinuous vari- with incident ADL generalised to men.” are necessary for effective
among middle-aged and determining whether ables, the χ2- disability among women prevention of incident ADL
elderly community- there are differences in test, and re- aged 40–64 years and disability.”
dwelling Japanese women risk factors according gression women aged ≥65 years.”
during an 8–9-year follow- to age groups” analysis.
up”
Orive, M; et al. “Changes in health-related “evaluating changes in hip fracture 150 Adults the BI and the “Hip fractures have small sample “The need for special
(2015) [41] quality of life and activities HRQoLe and the ability aged 65 or Lawton Brody profound effects on follow-up care of elderly
of daily living after hip to conduct ADL older Index for ADL, HRQoL and ADL in both hip fracture patients in the
fracture because of a fall in among patients with the non- men and women, immediate and late post
elderly patients: a pro- hip fracture because of parametric Wil- regardless of age.” fracture periods.”
spective cohort study” a fall” coxon test
Quail, JM, “Unmet Need for “examining the psychological 530 women multivariable “Receiving assistance to relied on self-reported “It is essential to provide
et al. Assistance to Perform possible association of distress in Canada linear meet IADL needs is disability, which may elderly persons with the
(2011) [42] Activities of Daily Living physical assistance regression associated with elevated have caused some mis- support they need and will
and Psychological Distress need with psychological distress. Not classification of accept to adapt both
in Community-Dwelling psychological distress” receiving assistance, disability. physically and mentally to
Elderly Women” however, is associated declining health and
with even greater distress.” function.”
Safa, A, et al. “Predictive Factors of “evaluating the Limb Trauma 200 the t-test and “Many factors, such as small sample “Knowing the predictive
(2016) [39] Dependency in Activities predictive factors of patients, in analysis of vari- gender, age, education, factors of dependence in
of Daily Living Following dependency in ADL Iran ance (ANOVA) type of trauma, and ADL after trauma may help
Limb Trauma in the following limb trauma and the mul- location of the injured health systems to design
Elderly” in elderly” tiple regression organ, may predict ADL effective and realistic
analysis following limb trauma.” strategies for rehabilitative
programmes.”
Silva, AD, “Association between the “determining whether leprosy 186 elderly the Statistical “Leprosy physical uses secondary data “The importance of early
et al. degree of physical physical impairment persons Package for the impairment grade is diagnosis and treatment of
(2014) [43] impairment from leprosy from leprosy is Social Sciences associated with leprosy to prevent physical
and dependence in associated with (SPSS) dependence for IADL, impairment and
activities of daily living dependence among creating the need for dependence in later years.”
Page 7 of 17Table 2 Summary of studies (Continued)
Authors (Year) Title Objective Problems and Sample Methods Results Limitations Comments
diseases
among the elderly in a elderly individuals” greater social support and
health unit in the State of systematic monitoring by
Minas Gerais” a multidisciplinary team.”
Takemasa S, “Interrelationship among ““examining the health- orthopaedic 27 elderly Using “For community-dwelling small sample. Did not “supporting community-
et al. the health-related and related and subjective females Spearman’s elderly females to maintain include men in the dwelling elderly females in
(2017) [44] subjective quality of life, QoL of community- rank good subjective and study orthopaedic outpatients to
daily life activities, instru- dwelling elderly fe- health-related QoL, con- improve their sense of
mental activities of daily males in orthopaedic trolling their pain is critical physical and mental well-
Maresova et al. BMC Public Health
living of community- outpatients, and how so that excruciating pain being, and prevent and re-
dwelling elderly females in such QoL correlates does not restrict their ac- duce their depression and
orthopaedic outpatients” with their ADL and tivities. They also need to physical pain, is required
IADL” maintain good health, feel to improve their QoL.”
happy and comfortable
and have more opportun-
ities for social interaction.”
(2019) 19:1431
Liu, Y, et al. “The Unmet Activities of “examining disabled disabled 6820 elders hierarchical “Highest percent of unmet majority of “social welfare expenditure
(2012) [45] Daily Living (ADL) Needs elders’ unmet ADL elders from linear ADL needs was for respondents were moderates unmet needs
of Dependent Elders and needs and the factors Taiwan modelling climbing stairs. The female by provision of services,
their Related Factors: An associated with those following factors as which means that the
Approach from Both an unmet needs” important: education level; positive effect of social
Individual- and Area-Level living arrangements; welfare services cannot be
Perspective” number of illnesses; ignored; the government
number of IADL should play a supervisory
limitations; caregiver’s age; role.”
the caregiver–patient
relationship; care burden;
household size.”
Putthinoi, S. “Performance in Daily “examining the ability caducity 32 home- cross-sectional “Elderly individuals small sample size “Individuals living with
et al. Living Activities of the of elderly in bound eld- survey communicated chronic health conditions,
(2016) [46] Elderly While Living at performing their daily erly people independently. They acted most subjects could not
Home or Being Home- activities while living at independently in independently perform
bound in a Thai Suburban home or being home- interpersonal interactions these activities;
Community” bound in the and relationships, but they transportation community
community” needed assistance from and, social and civic life.”
people or equipment in
some activities. Most of
the home-bound elderly
performed ADL independ-
ently, whereas elderly indi-
viduals living at home
were dependent when
using transportation and
driving.”
Ohri, P. et al. “A Study of Daily Living “assessing the daily caducity 215 elderly A cross- “Out of the total, 93% other parameters of “Education and
(2014) [47] Dependency Status living dependency sectional study individuals were geriatric age could be socioeconomic status had
among Elderly in an Urban status among elderly independent in their ADLs. evaluated, such as a positive effect on
Slum area of Dehradun” individuals” Maximum inability was nutritional status and independence. Male
Page 8 of 17Table 2 Summary of studies (Continued)
Authors (Year) Title Objective Problems and Sample Methods Results Limitations Comments
diseases
found in bathing and morbidities in elderly elderly showed a
dressing. In total, 70.7% of maximum dependency for
elderly were dependent cooking and laundry, while
on one or more IADLs, females showed a greater
female elderly being more dependency in using the
dependent than males.” telephone, managing
money, and travelling.”
1
Communication Activities of Daily Living
Maresova et al. BMC Public Health
2
Stroke-Specific Quality of Life
3
Mild cognitive impairment
4
Basic activities of daily living
5
Generalized estimating equation
6
Health-related quality of life
(2019) 19:1431
Page 9 of 17Maresova et al. BMC Public Health (2019) 19:1431 Page 10 of 17
Fig. 2 (a) Age, gender, and comorbid condition are factors that affect seniors’ conditions. (b) Part of the potential causal pathway by which
problems directly or indirectly affect ADL in elderly people. ADL in elderly individuals is impaired by several factors [34]
the elderly. The swallowing function, cognitive abilities, these conditions to disability. Stroke and arthritis were
and the quality of nutrition can directly affect ADLs. the diseases that contributed most consistently to dis-
Table 3 shows the various problems and their impacts ability, independent of sex and age bracket. Hyperten-
on the seniors’ ADL on the basis of selected articles. sion and heart disease showed only a significant
contribution to the prevalence of both levels of disability
Disabilities and unmet needs in women [32, 33]. Disabling effects of multimorbidity
Disability is one of the most common problems in se- increased in ADL dependency [38].”
niors that leads to ADL dependence; dependence in “Disabilities after stroke become chronic, and the in-
ADL and IADL is a critical “challenge for community- ability to independently perform ADLs, such as dressing
dwelling elderly people, regardless of whether their and eating, in a long run causes helplessness and depres-
needs are met or unmet. As the elderly population con- sion in stroke patients and inflicts emotional pain, such
tinues to grow, the challenges involved in addressing dis- as intellectual regression, despair, and anxiety. Func-
ability and unmet need will also grow [42]. Frailty tional disorders in daily life in long term are likely to
describes the condition of elderly persons with the high- cause deterioration in QoL of stroke patients and mal-
est risk of disability, institutionalisation, hospitalisation, adjustment in social relationships, changes in role, and
and death [49]. Chronic conditions have been confirmed economic difficulties [30].
as the main causes of disability [38].” “Having knee joint or back pain was significantly asso-
“Diseases show a greater contribution to the preva- ciated with a higher risk of incidence of ADL depend-
lence of more severe disability, that is, with impairment ency. Older adults with pain have a higher risk of
of basic ADL. Elderly patients with a diagnosis of arth- developing incident ADL dependency and commonly
ritis, stroke, or diabetes should be monitored more ef- have functional limitations. Speculation has indicated
fectively by considering the important contribution of that in mutual feedback loops in which pain andMaresova et al. BMC Public Health (2019) 19:1431 Page 11 of 17
Table 3 Problems of elderly people and the articles that refer to them
Authors (Year) Disabilities and Psychological Difficulties Poor insight and Falls and Prevalence of Wounds Communication
unmet needs problems in mobility cognitive function incident undernutrition and and problems
dysphagia injuries
Velázquez Alva * *
et al. (2013) [28]
Haewon Byeon * * *
et al.
(2016) [29]
Charernboon, T. *
et al.
(2016) [30]
Chen Shen, * *
et al.
(2018) [31]
Costa, FA, et al. * *
(2018) [32]
Farías-Antúşnez *
et al.
(2018) [33]
Furuta, M, et al. * * *
(2013) [34]
Genkai, S.et al. * *
(2015) [35]
Ha, E; Kim, K * *
(2013) [36]
Hesseberg, *
K.et al.
(2013) [37]
Hou, C, et al. *
(2018) [38]
Masoudi Alavi * * * *
N, et al.
(2014) [39]
Okabe, T, et al. * * *
(2017) [40]
Orive, M; et al. *
(2015) [41]
Quail, JM, et al. * *
(2011) [42]
Safa, A, et al. * * *
(2016) [39]
Silva, AD, et al. *
(2014) [43]
Takemasa S, *
et al.
(2017) [44]
Liu, Y, et al. *
(2012) [45]
Putthinoi, S. *
et al.
(2016) [46]
Ohri, P. et al. *
(2014) [47]Maresova et al. BMC Public Health (2019) 19:1431 Page 12 of 17 functional limitations are mutually reinforcing, pain ex- can help decrease the prevalence of reported diseases acerbates functional limitations and functional limita- at more advanced ages [32]. tions exacerbate pain. Age-specific screening and intervention strategies might be necessary for effective Psychological problems prevention of incident ADL dependency among elderly Unmet needs and disability can impact both mental and women [40]. physical health. They can also reduce existing level of Individuals living with chronic health conditions, could QoL and physical health in the context of elderly people. not independently perform transportation, to engage in Disability can cause or worsen anxiety and depression, community, social, and civic life; majority had physical the two main elements that make up psychological dis- disabilities as a limited ability to conduct ADLs indepen- tress. Both unmet and met IADL needs are linked to dently.”Most persons were independent regarding basic augmented mental distress. To put it simply, being IADL ADLs, for example, self-care activities such as drinking, dependent is linked with heightened distress [42]. Care- eating, dressing, and toileting. The activities reported as givers will often only focus on the physical needs of a most dependent were driving, looking after one’s health, patient that falls in an older age range. However, activ- and acquisition of goods and services, and assistance was ities such as social interaction or a hobby are often ig- required to perform more complex ADL tasks [46]. The nored, which is a problem. It has been observed that highest percent of unmet ADL needs was for climbing disabled elderly people will normally feel inferior and stairs, and the lowest pertained to eating [45]. lose their confidence in regard to talking to other people Dependency in ADL was found more in lower socio- [31]. Costa, FA, et al. in 2013 [32] showed that depres- economic classes compared with higher socioeconomic sion becomes more prevalent with age. The likelihood of classes. Compared with males, females are significantly a woman with a disability also showing signs of depres- more dependent regarding IADLs. Dependence signifi- sion is very high, and the opposite link is also true with cantly increased after 80 years of age. The dependence, an increase in age [32]. Ha and Kim pointed out that as however, was greater regarding IADL. Education and so- cognitive levels fall, even people that have no past his- cioeconomic status have a positive impact on depend- tory of mental issues are at risk for behaviour that stems ency status [47], mainly because learning opportunities from depression, including destructiveness, violence, agi- can help people develop the skills and confidence to tation [36]. adapt and attempt a healthier ageing process. Elderly At times, disabled people will not have a choice but to people who were working had a lower prevalence of dis- remain in their homes or room. Some even stay in bed ability for IADLs, which involve more complex activities, for a long period of time to avoid issues. However, not and functional disability in general because labour activ- being outdoors for longer periods of time has a detri- ity implies daily challenges that keep the worker active mental impact on a person’s mental health and can lead and contribute to the maintenance of their functional to psychological distress for the elderly [31]. Especially capacity. However, a critical assertion is that elderly indi- regarding disability that impedes the basic activity of viduals might not be working on the grounds of their urinating or evacuating, this finding is worrying and can disability [33]. lead elderly individuals to experience social isolation, in These elements found to be the most significant: the addition to leading to changes in their self-esteem and level of education, the arrangements for living, the num- self-image, reducing their QoL [33]. ber of IADL limiters, the number of diseases, the age of Quail, Wolfson, and Lippman in 2011 [44] believed the caregiver, the association of the patient with their that“there are differences in the severity of psychological caregiver, the size of the household, the burden of care, distress based upon the type of activity in which a the link between the service uptake and the welfare ex- woman is disabled (Personal Activities of Daily Living pense, and the link between number of IADL limiters (PADL) versus IADL) and whether the need for physical and welfare expense [45]. assistance is met or unmet. The unmet need to perform A person who has a mild dependency for care can an IADL is associated with increased psychological dis- change into a completely or severely dependent per- tress over and above the level of distress related to meet- son if the intervention does not take place at the ing the IADL need. For example, for many women of right time. Therefore, it is of utmost importance that older generations, cooking is a source of enjoyment. De- care be provided early and that elderly people are pendency in meal preparation, regardless of whether the monitored to ensure that their progression to need is met or unmet, may lead to distress because of complete dependency is slowed down as much as concerns about not wanting to be a burden, not being possible [31]. Approximately 93.1% of all disabled able to retain power to decide about meals, or not being people of older age had at least one need that is un- able to maintain routine in daily living [42]. Elderly met [31]. The results indicate that early intervention people need to maintain good health, feel happy and
Maresova et al. BMC Public Health (2019) 19:1431 Page 13 of 17
comfortable and have more opportunities for social or lack of access to food, hence leading to malnutrition
interaction. To improve the QoL of community-dwelling [34].”
elderly individuals in their communities, supporting Differences in cultural and social background can have
them to improve their sense of physical and mental an effect on functional assessment. For instance, family
well-being and prevent and reduce their depression and structure in many nations consists of not just the imme-
physical pain is required [44].” diate family but also the extended family. Therefore, pa-
tients with impairments of a cognitive nature typically
Difficulties in mobility live with their partners and children, in addition to their
Malnutrition and cognitive impairment are associated siblings and their partners and children. In this situation,
with reduced physical performance and poor muscle it could prove difficult for the caregiver to actually deter-
strength, leading to disability and reducing the ability to mine how hindered a patient is in regard to performing
perform basic ADLs [34]. Walking ability has a critical a given activity. Furthermore, a good number of people
role in the ADL independence of older people [40]. Alva might not even know enough about the symptoms of de-
et al. in 2013 [28] described that women who are older mentia, or its side effects. They think that many symp-
and afflicted with sarcopenia find it more difficult to be toms are simply normal for older people, including
physically mobile. This is particularly true when the try forgetfulness and ADL decline [30].
to climb stairs. The loss of skeletal muscle mass is linked
to their decreased physical ability. Elderly women with Falls and incidents
sarcopenia, compared with those without sarcopenia, are Taking a fall could be a marker for “normal” changes
approximately twice as likely to develop difficulties in that an older person goes through. With age, a person’s
using stairs [28]. strength, gait and vision change. The most significant
Masoudi Alavi, Safa, and Kalahroudi showed in 2014 problem that one faces is the fractures that may result
[39] that people with fractured hips have poor recovery, from a fall. Geriatric trauma injuries are also normally
and this may impact their mobility, making the issue the result of a fall [39].“Decreased rapid walking speed
more permanent [39]. increases the risk for falls and therefore increases ADL
Another aspect was highlighted by Genkai et al. in disability, either from the fracture or post-fall syndrome,
2013 [35], who said that occlusal support absence re- in community-dwelling older adults [40].”
sulted in decreased mobility and physical activity. Any kind of fracture can have a terrible effect on
Muscle strength and a person’s balance are extremely ADLs; however, hip fractures are the worst. This shows
linked with their mobility. Strength in the lower extrem- that special follow up in the case of such patients is ex-
ities is normally higher in older people in good health as tremely needed, and this is true for both the postfracture
opposed to those who are not. People who have main- period and the immediate time after it has occurred
tained good occlusal support are normally going to have [41]. Elders can be trained to not get up too quickly in
better mobility. In effect, the findings show that occlusal the morning and spend the first couple of minutes sit-
support is essential if one is to preserve the ability to ting on the edge so that they do not cause a fall or top-
walk. Maintaining this ability has been linked with ADL. ple over [49].
The research reviewed shows that occlusal support
maintenance is an effective strategy to ensure that one’s Wounds and injuries
walking ability is also maintained [35]. Trauma, wounds and injuries in older people have a
considerable negative impact on their ability and ADL
Poor insight and cognitive function function [39]. The leprosy physical impairment grade is
“Elderly individuals with cognitive impairment may dem- linked with IADL dependence, establishing the require-
onstrate minimal impairment in some complex IADLs. ment for more social support and proper monitoring
For example, tasks often found to be impaired in MCI conducted by a multidisciplinary team. “There is a hier-
usually include finances, telephoning, keeping appoint- archy in the process of frailty. First, independence is lost
ments, driving and transportation, shopping, food prep- in advanced ADLs, and this loss is followed by a loss of
aration, and responsibility for medication [30, 37].” independence in IADLs and, finally, BADLs. The follow-
“Cognitive function is a critical factor that affects up and rehabilitation of these patients are essential [43].
ADL. Early detection of cognitive disorders is a critical
strategy for lowering morbidity. The factors affecting Prevalence of undernutrition and dysphagia
ADL in elderly individuals are faecal incontinence, regu- “Undernutrition in elderly individuals is a common and
larity of exercise, cognitive function, urinary incontin- important clinical entity that should be diagnosed early;
ence, and CVA history [36]. Cognitive impairment for example, elderly individuals with sarcopenia had a
causes potential problems related to the inability to eat higher prevalence of undernutrition [28]. Additionally,Maresova et al. BMC Public Health (2019) 19:1431 Page 14 of 17
swallowing function, cognitive ability, and nutritional mentioned in the results section), such problems, apart
status had direct effects on ADL. Having fewer teeth from the developmental time-specific categories, could
leads to wearing dentures, but severe cognitive impair- be further divided into two other types: physical needs
ment disrupts denture wearing because of problems and psychological (mental) needs. As the majority of the
with, for example, accessing dental care. Chewing diffi- papers report, most of the age-related disabilities leave a
culties resulting from having fewer teeth and no den- negative psychological impact on old people, along with
tures can lead to dysphagia. Also cognitive impairment the limitations that affect the physical aspects of their
can cause potential problems related to the inability to lives. In Fig. 3, old people’s needs are illustrated based
eat or insufficient access to food, leading to malnutrition on the distinction between categories of physical needs
[34, 35].” and psychological needs. As Fig. 3 clarifies, the prob-
lems/needs mutually affect each other. Physical prob-
Communication problems lems could intensify psychological ones, while
“Communication is likely to have a significant effect on psychological disorder could in turn affect physical well-
QoL, considering that it is an ability necessary for instru- being. Such problems can reinforce one another’s impact
mental daily life. In particular, stroke patients experience though the relationships they have in dynamic circles.
deterioration of social functions due to communication Finally, all of these needs/problems lead to limitations in
limitations, and when they have difficulty in understand- performing ADLs.
ing the meaning of what another party says, or in produ- The needs related to mobility, disabilities, and cogni-
cing speech, even when they have clear consciousness, it tion are significant because such dimensions control
is highly possible that they feel extreme frustration and many everyday life human activities [31, 32]. Such limi-
depression [29].” tations increase the probability of falling, injury and frac-
ture cases, while preventing the individual from
Discussion attending open urban spaces or from participating in so-
Based on the reviewed articles, reducing the problems cial activities. This negative experience could deeply
and improving the conditions of elderly people can be affect old people psychologically [36, 42]. Therefore, one
divided into three sections: First, the stage before disabil- of the specifically important concerns in this regard is
ity, disease, and their associated problems. Second, the focusing on the solutions that help the elderly to reduce
identification and timely diagnosis of disease and prob- the impacts of disabilities, especially in the case of im-
lems in elderly people. Finally, the improvement of the paired motor skills [50–52].
conditions of elderly people with disabilities, chronic ill- Furthermore, cognitive disorders, along with the needs
nesses, and problems. arising from such disorders, represent another important
Given the issues raised in the papers and the categor- concern [53–55]. Cognitive disorders, besides generating
ies of the problems experienced by the elderly (as numerous problems for old people in their ADLs, could
Fig. 3 Seniors’ needs based on the distinction made between psychological and physical needsMaresova et al. BMC Public Health (2019) 19:1431 Page 15 of 17
even result in malnutrition [30, 34], or injures and Abbreviations
fractures. ADLs: Activities of daily living; IADLs: Instrumental activities of daily living;
QoL: Quality of life; WHO: World Health Organization
Many studies have mentioned losing independence,
pride and confidence as the most serious psychological Acknowledgements
issues in the elderly. Not being able to do basic activities The authors would like to hereby acknowledge COST Action CA16226 for
could isolate old people and undermine their self-esteem their networking support. The Indoor Living Space Improvement: Smart
Habitat for the Elderly played a role of networking platform for knowledge
[29]. A wide diversity of studies have shown that the sharing and interchanging ideas for joint research and publication, what was
ability to do many activities (e.g. procuring food and the base for creating this study. Based on CA16226 project LTC18035 INTER
cooking) brings about a pleasant sense of independence COST was proposed for national funding support of COST ACTION
Framework. COST is a funding agency that helps innovation and research
for the elderly; therefore it would be remarkably import- networks. Our Action was instrumental in connecting research programmes
ant to pay attention to needs that can improve an old in- throughout the EU region. Their contribution has made it possible for
dividual’s independence in addressing his/her personal scientists to connect with each other and share their ideas and findings. This
allows for more research and better innovation. More information can be
affairs [34]. Along with these concerns, methods inspir- found at www.cost.eu. The authors would also like to acknowledge the
ing old people to participate in social activities can prove Excellence 2019 internal research project, Faculty of Informatics and
to be highly important, because depression is one of the Management, University of Hradec Kralove, Czech Republic.
consequences of social isolation and limited social inter-
action [44]. Authors’ contributions
PM suggested the design of the study and wrote the methodology,
supervised whole research; E. searched the databases and prepared the
Conclusion tables; OK, KK, PM interpretation of data and validation of results,
Chronic diseases can result to ADLs dependency in old visualization; SB, JBH, ST drafted the manuscript; PM, OK, KK, reviewed and
revised the paper according to reviewers comments; PM, OK, KK. Project
age. The major issues that lead to ADLs malfunction in administration and funding acquisition; All authors approved this version of
the elderly are disability, psychological disorders, mobility the paper.
problems, poor cognitive functioning, falling and inci-
dents, wounds and injuries, malnutrition, and communi- Funding
This work supported in part by the LTC INTER COST, Evaluation of the
cation problems. Within interrelated cycles, old people’s
Potential for Reducing Health and Social Expenses for Elderly People Using
problems are interrelated, and each problem can result in the Smart Environment, through the Ministry of Education, Youth and Sports,
other disorders in such people and finally leave a negative Czech Republic, under Project LTC18035; and in part by the project of
Excellence, University of Hradec Kralove, FIM, Czech Republic (ID: 2205–2019).
impact on their QoL. On this account, the needs of the
First author – Petra Maresova is principle investigator of LTC18035 INTER
elderly are divided into two categories, namely the psycho- COST project, from which Petra Maresova, Ondrej Krejcar and Kamil Kuca are
logical and the physical. Psychological needs include com- funded for all expenses including personal costs. Ehsan Javanmardi is funded
from project of Excellence ID: 2205–2019 for personal costs. Sabina
munication, cognitive and psychological needs. Physical
Barakovic, Jasmina Barakovic Husic and Signe Tomsone are members of
needs are associated with disability, mobility, nutrition, in- COST ACTION 16226 of which also Petra Maresova and Ondrej Krejcar are
cidents, and wounds. Overall, it would be specifically im- paticipants, while this article also ACKnowledge this project CA16226.
portant to pay attention to methods that can enhance old
people’s cognitive abilities, and to methods that can im- Availability of data and materials
The datasets and material used and/or analysed during the current study are
prove their mobility- and disability-related issues; mean- available from the corresponding author upon reasonable request.
while establishing conditions inspiring the elderly to take
part in social activities could significantly help to improve Ethics approval and consent to participate
their life conditions. Not applicable.
This scoping review supports the view on chronic
diseases in old age as a complex issue and to prevent Consent for publication
Not applicable.
the related problems demands multicomponent inter-
ventions which includes early recognition of problems
Competing interests
leading to disability and ADL dependence. Education The authors declare that they have no competing interests.
and training for health professionals and the general
public, can prevent many problems at different levels. Author details
1
Department of Economics, Faculty of Informatics and Management,
Government support and welfare systems should be University of Hradec Kralove, Rokitanskeho 62, 500 03 Hradec Kralove, Czech
designed counting complex needs of elderly people. Republic. 2Faculty of Traffic and Communications, University of Sarajevo,
Additionally, the new, upcoming age will be digital Sarajevo, Bosnia and Herzegovina. 3Faculty of Electrical Engineering,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina. 4Faculty of
and technology based and therefore technology needs Rehabilitation, Riga Stradinš University, Riga, Latvia. 5Center of Basic and
to be oriented to solve this problems, which are Applied Research, Faculty of Informatics and Management, University of
grouped by this review in eight categories. Satisfying Hradec Kralove, Rokitanskeho 62, 500 03 Hradec Kralove, Czech Republic.
6
Malaysia Japan International Institute of Technology (MJIIT), Universiti
of elderly people will improve their QoL, which Teknologi Malaysia Kuala Lumpur, Jalan Sultan Yahya Petra, 54100 Kuala
should be the ultimate goal. Lumpur, Malaysia.You can also read
