Top

BMC Public Health

Published in:

Open Access 01-12-2010 | Research article

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

Authors: Noran N Hairi, Awang Bulgiba, Robert G Cumming, Vasi Naganathan, Izzuna Mudla

Published in: BMC Public Health | Issue 1/2010

Abstract

Background

The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries.

Methods

A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting).

Results

Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation.

Conclusions

The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.

Available only for authorised users

Kinsella KWH: U.S. Census Bureau. International Population Reports, P95/09-1, An Aging World 2008. US Government Printing Office, Washington DC. 2009

Population and Housing Census of Malaysia: Population Aging Trends in Malaysia. Monograph Series No.1. 2005, Malaysia DoS: Department of Statistics Malaysia

Institute for Public Health I: The Third National Health and Morbidity Survey (NHMS III) 2006, Executive Summary. 2008, Ministry of Health M

Chen PCY AG, Josef R, Chan KE, Arokiasamy JT: Health and Ageing in Malaysia. 1986, University Malaya, Kuala Lumpur

Jack MG, Luigi F: Assessing the building blocks of function: Utilizing measures of functional limitation. American journal of preventive medicine. 2003, 25 (3): 112-121. 10.1016/S0749-3797(03)00174-0.CrossRef

Fried L, Guralnik J: Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997, 45: 92-100.CrossRefPubMed

Lafortune GGB: Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications. OECD Health Working Papers, No 26, OECD Publishing. 2007, full_text.

Tinetti M: Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society. 1986, 34 (2): 119-126.CrossRefPubMed

Ferrucci L, Koh C, S B, Guralnik JM: Disability, Functional Status and Activities of Daily Living. Encyclopedia of Gerontology. Edited by: Birren JE. 2007, Amsterdam; Boston: Academic Press, 1: 427-436. full_text.CrossRef

10.

Wade DT, Collin C: The Barthel ADL Index: A standard measure of physical disability?. Disability & Rehabilitation. 1988, 10 (2): 64-67.

11.

Katz S, Downs TD, Cash HR, Grotz RC: Progress in Development of the Index of ADL. The Gerontologist. 1970, 10 (1 Part 1): 20-30.CrossRefPubMed

12.

Rose A, Hennis A, Hambleton I: Sex and the city: Differences in disease- and disability-free life years, and active community participation of elderly men and women in 7 cities in Latin America and the Caribbean. BMC Public Health. 2008, 8 (1): 127-10.1186/1471-2458-8-127.CrossRefPubMedPubMedCentral

13.

Carlos AR-O, Glenn VO, Martha P, Kenneth JO: Cross-national comparison of disability in Latin American and Caribbean persons aged 75 and older. Archives of gerontology and geriatrics. 2006, 42 (1): 21-33. 10.1016/j.archger.2005.06.006.CrossRef

14.

Zhe T, Hui-Xin W, Chen M, Xiao-Guang W, Kjerstin E, Bengt W, Jin-Jing P: The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese. Archives of gerontology and geriatrics. 1999, 29 (2): 115-125. 10.1016/S0167-4943(99)00026-6.CrossRef

15.

Shantibala K, Naorem B, Ak J, Ak B, E Vijaya D, Y Manihar S: Disability in ADL Among the Elderly in an Urban Area of Manipur. Indian Journal of Physical Medicine and Rehabilitation. 2007, 18 (2): 41-43.

16.

Jose CM-C, Javier T, Salvador P-F, Isabel G-A, Trinidad L, Teresa F-A, Ana M: Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Archives of gerontology and geriatrics. 50 (3): 306-310.

17.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of Illness in the Aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA. 1963, 185 (12): 914-919.CrossRefPubMed

18.

Nugegoda DB, Balasuriya S: Health and social status of an elderly urban population in Sri Lanka. Social Science & Medicine. 1995, 40 (4): 437-442.CrossRef

19.

Chen P, Yu E, Zhang M, et al: ADL dependence and medical conditions in Chinese older persons: a population-based survey in Shanghai, China. J Am Geriatr Soc. 1995, 43: 378-383.CrossRefPubMed

20.

Kua E-HK, S M: A questionnaire to screen for cognitive impairment among elderly people in developing countries. Acta Psychiatr Scand. 1992, 85: 119-122. 10.1111/j.1600-0447.1992.tb01454.x.CrossRefPubMed

21.

Yesavage JAB, T L. Rose TL, et al: Development and validation of a geriatric depression scale: a preliminary report. J Psychiatr Res. 1983, 17: 37-49. 10.1016/0022-3956(82)90033-4.CrossRef

22.

Congdon N, Friedman D, Lietman T: Important causes of visual impairment in the world today. JAMA. 2003, 290: 2057-2060. 10.1001/jama.290.15.2057.CrossRefPubMed

23.

Barros AHVN: Alternative for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate prevalence ratio. BMC Med Res Methdol. 2003, 3: 21-10.1186/1471-2288-3-21.CrossRef

24.

Spiegelman D, Hertzmark E: Easy SAS Calculations for Risk or Prevalence Ratios and Differences. Am J Epidemiol. 2005, 162 (3): 199-200. 10.1093/aje/kwi188.CrossRefPubMed

25.

Department of Statistics M: Population and Housing Census 2000. Edited by: Department of Statistics M. 2000, Department of Statistics, Malaysia

26.

Tengku-Azian H, Chai S, Jariah M, Nurizan Y: Socioeconomic Status and Health of Older Women in Malaysia. Asia-Pacific Journal of Public Health. 2006, 18 (S3): 42-51.

27.

Shahar S, Earland J, Abd Rahman S: Social and Health Profiles of Rural Elderly Malays. Singapore Med J. 2001, 42 (5): 208-213.PubMed

28.

Sherina M, Rampal L, Aini M, Norhidayati H: The prevalence of depression among elderly in an urban area of Selangor, Malaysia. The International Medical Journal. 2005, 4 (2): 57-63.

29.

Sherina M, Rampal L, Mustaqim A: Physical and Mental Health Problems of the elderly in a rural community of Sepang, Selangor. Malaysian Journal of Medical Sciences. 2004, 11 (1): 52-59.

30.

Zaiton A, Nor Afiah M, Latifah A: Functional status of the eldely residing in public shelter homes in Peninsular Malaysia. Asia-Pacific Journal of Public Health. 2006, 18 (S3): 60-63.

31.

Loh K, Khairani O, Norlaili T: The prevalence of functional impairment among elderly aged 60 years and above attending Klinik Kesihatan Batu 9, Ulu Langat, Selangor. The Medical Journal of Malaysia. 2005, 60 (4): 526-529.PubMed

32.

Shahar S, Ibrahim Z, Fatah ARA, Rahman SA, Yusoff NAM, Arshad F, Yassin Z, Adznam SNA: A multidimensional assesment of nutritional and health status of rural elderly Malays. Asia Pac J Cli Nutr. 2007, 16 (2): 346-353.

33.

Ng T-P, Niti M, Chiam P-C, Kua E-H: Prevalence and Correlates of Functional Disability in Multiethnic Elderly Singaporeans. Journal of the American Geriatrics Society. 2006, 54 (1): 21-29. 10.1111/j.1532-5415.2005.00533.x.CrossRefPubMed

34.

Federal Interagency Forum on Aging-Related Statistics: Older Americans 2008: Key Indicators of Well-Being. Edited by: Federal Interagency Forum on Aging-Related Statistics W. 2008, DC: U.S. Government Printing Office

35.

Guralnik JM, Fried LP, Salive ME: Disability as a Public Health Outcome in the Aging Population. Annual Review of Public Health. 1996, 17 (1): 25-46. 10.1146/annurev.pu.17.050196.000325.CrossRefPubMed

36.

Bergamini L, Burgoni M, Federzoni G, Goldoni C, Martini E, Neviani F, Neri M: Multidimensional evaluation of home-dwelling elderly: the impact of medical social factors on health status indices. Arch Gerontol Geriatr. 2007, 75-81. 10.1016/j.archger.2007.01.011. Suppl 1

37.

Tas U, Verhagen A, Bierma-Zeinstra S, Hofman A, Odding E, Pols H, Koes B: Incidence and risk factor of disability in the elderly: the Rotterdam Study. Prev Med. 2007, 44 (3): 272-278. 10.1016/j.ypmed.2006.11.007.CrossRefPubMed

38.

Dunlop D, Hughes S, Manheim L: Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health. 1997, 87: 378-383. 10.2105/AJPH.87.3.378.CrossRefPubMedPubMedCentral

39.

Lyons R, Crome P, Monaghan S, et al: Health status and disability among elderly in three UK districts. Age Ageing. 1997, 26: 203-209. 10.1093/ageing/26.3.203.CrossRefPubMed

40.

Kelly-Hayes M, Jette A, Wolf P, et al: Functional limitations and disability among elders in the Framingham Study. Am J Public Health. 1992, 82: 841-845. 10.2105/AJPH.82.6.841.CrossRefPubMedPubMedCentral

41.

Gill T, Williams C, Tinetti M: Assessing risk for the onset of functional deprendence among older adults: the role of physical performance. J Am Geriatr Soc. 1995, 43: 603-609.CrossRefPubMed

42.

Stuck A, Walthert J, Nikolaus T, Bula C, Hohmann C, Beck J: Risk factors for functional status decline in the community-living elderly people: a systematic literature review. Soc Sci Med. 1999, 48: 445-469. 10.1016/S0277-9536(98)00370-0.CrossRefPubMed

43.

Tas U, Verhagen A, Bierma-Zeinstra S, Odding E, Koes B: Prognostic factors of disability in older people: a systematic review. Br J Gen Pract. 2007, 57 (537): 319-323.PubMedPubMedCentral

44.

Koster A, Bosma H, Broese van Groenou M, Kempen G, Penninx B, van Eijk J, Deeg D: Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam. BMC Public Health. 2006, 6 (1): 244-10.1186/1471-2458-6-244.CrossRefPubMedPubMedCentral

45.

Kelly-Moore J, Ferraro K: The black/white disability gap: Persistent inequality in later life?. J Gerontol B Psychol Sci Soc Sci. 2004, 59B: 534-543.

46.

Kingston R, Smith J: Socioeconomic status and racial and ethnic differences in function status associated with chronic diseases. Am J Public Health. 1997, 87: 805-810. 10.2105/AJPH.87.5.805.CrossRef

47.

Gregg E, Beckles G, Williamson D, Leveille S, Langlois J, Engelgau M, Narayan K: Diabetes and physical disability among older US adults. Diabetes Care. 2000, 23 (9): 1272-1277. 10.2337/diacare.23.9.1272.CrossRefPubMed

48.

Jagger C, Matthews R, Matthews F, Spiers N, Nickson J, Paykel E, Huppert F, Brayne C, Function tMRCC, Study A: Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS). BMC Public Health. 2007, 7 (1): 156-10.1186/1471-2458-7-156.CrossRefPubMedPubMedCentral

49.

Dalle Carbonare L, Maggi S, Noale M, Giannini S, Rozzini R, Lo Cascio V, Crepaldi G, Group ftIW: Physical Disability and Depressive Symptomatology in an Elderly Population: A Complex Relationship. The Italian Longitudinal Study on Aging (ILSA). American Journal of Geriatric Psych. 2009, 17 (2): 144-154. 10.1097/JGP.0b013e31818af817. 110.1097/JGP.1090b1013e31818af31817CrossRef

50.

Rudberg M, Furner S, Dunn J, et al: The relationship of visual and hearing impairments to disability: An analysis using the longitudinal study of aging. J Gerontol. 1993, 48: M261-M265.CrossRefPubMed

51.

Melzer D, Parahyba MI: Socio-demographic correlates of mobility disability in older Brazilians: results of the first national survey. Age Ageing. 2004, 33 (3): 253-259. 10.1093/ageing/afh075.CrossRefPubMed

52.

Melzer D, Gardener E, Guralnik JM: Mobility disability in the middle-aged: cross-sectional associations in the English Longitudinal Study of Ageing. Age Ageing. 2005, 34 (6): 594-602. 10.1093/ageing/afi188.CrossRefPubMed

53.

Nagi S: An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc. 1976, 54: 439-467. 10.2307/3349677.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/10/492/prepub

Title: Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country
Authors: Noran N Hairi
Awang Bulgiba
Robert G Cumming
Vasi Naganathan
Izzuna Mudla
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-10-492

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

The population approach to falls injury prevention in older people: findings of a two community trial

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

Primary syphilis cases in Guangdong Province 1995-2008: Opportunities for linking syphilis control and regional development

Educational inequalities in mortality and associated risk factors: German- versus French-speaking Switzerland

Perceptions of primary healthcare professionals towards their role in type 2 diabetes mellitus patient education in Brazil

Association between smoking and chronic kidney disease: a case control study