1. Engagement with Activity and Functional Status among Older Adults
Thomas Dombrowsky PhD, RN
University of Texas at Arlington
College of Nursing and Health Innovation
Instruments
Engagement in Meaningful Activity Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002)
Functional Comorbidity Index (FCI) (Groll, To, Bombardier, & Wright, 2005)
Geriatric Depression Scale – Short Form (GDS-SF) (Wall, Lichtenberg, MacNeill, Walsh, & Deshpande, 1999)
Katz Index of Independence in Activities of Daily Living (Katz) (Katz & Akpom, 1976)
Lawton-Brody Instrumental Activities of Daily Living Scale (Lawton-Brody) (Lawton & Brody, 1969).
Abstract
Ninety-two older adults were surveyed to examine the relationship between engagement with activity and functional status. Covariates were age, comorbidity, and depression. Functional status was measured using two different instruments, the Katz and the Lawton-Brody. Logistic regression models were fit using each of the two as dependent variables. There were no significant predictors in the Katz model. Age was negatively associated (O.R , ) and engagement was positively associated (O.R , ) with functional status in the Lawton-Brody model.
Discussion
Age and EMAS score were predictive in the Lawton-Brody model, but not in the Katz model. Both the Katz and the Lawton-Brody had ceiling effects. For each one point increase in the EMAS a participant’s odds of getting a perfect Lawton-Brody score increased 18.3%. For each additional year of age a participant had an 18.1% increase in the odds of getting an imperfect Lawton-Brody score.
Neither depression nor comorbidity was a significant predictor of functional status. In the case of depression, this was probably due to the generally low depression scores for this sample. Only two participants had GDS-SF scores greater than five.
The lack of significance for the comorbidity variable contrasts with the findings of Marengoni et al. (2009) who found that one comorbidity multiplied the odds for functional decline by 1.4 and two or more comorbidities multiplied them by 6.2. The Marengoni study had a much larger sample than the present study and also was longitudinal, with three years of data. Further research is needed to explain this discrepancy.
Sample Characteristics
Introduction
The rate of functional disability ranges from about 2% in the general population to 9% among those over 75 (Adams et al., 2008). Annual long term care costs in the US are about billion dollars annually (Kaye, Harrington, & LaPlante, 2010). Functional status is an important component of quality of life for older adults and their caregivers (Simone & Haas, 2013).
Previous research has established a positive relationship between functional status and physical exercise (Bonnefoy et al., 2012), solitary intellectual activity (Treiber et al., 2011) and social activity (Chen et al., 2013). The relationship between functional status and productive activity is complex. One study found that paid work among older adults is associated with lower mortality, but unpaid childcare is associated with higher mortality among older women (Hsu, 2007). Volunteer political activity is associated with slower functional decline among older men. Other factors associated with functional status include age (Yorston, Kolt, & Rosenkranz, 2012), comorbidity (Huang, Chang, Liu, Lin, & Chen, 2013), and depression (Luo et al., 2015).
Engagement has three components: motivation, participation, and commitment (Lequerica & Kortte, 2010). Meaningful activity is a closely related concept which consists of actions which the individual considers important (Eakman, Carlson, & Clark, 2010). Engagement is a person’s inner predisposition to activity. The purpose of this study was to examine the relationship between engagement with activity and functional status among older adults while controlling for age, comorbidity, and depression.
Characteristic n %
Female 68
74%
Assisted living 2 2%
Male 24
26%
Independent living (senior center) 57
62%
White 88
96%
Community dweller 33
36%
Black
Divorced 17
18%
American Indian 1 1%
Married 42
46%
Did not answer race question
Single 4 4%
Hispanic
Widowed 37
40%
Not Hispanic 69
75%
No answer to marital question
No answer to Hispanic question 22
24%
Limitations
Limitations of this study include its use of a convenience sample and the fact that it was cross sectional. The functional status variable was measured with self report data only. Future studies should strengthen this by including objective measures of functional status. The sample was overwhelmingly White/Caucasian and may not be representative of other groups.
Results
Several of the predictor variables were skewed, and there were also problems with heteroscedasticity, so multiple regression could not be used. The Katz and Lawton-Brody scores were dichotomized such that 1 represented a perfect score, and 0 was anything less than perfect. Two models were then fit, one using the dichotomized Katz and the other using the dichotomized Lawton-Brody as the dependent variable.
Conclusion
This study demonstrated a positive relationship between engagement with activity and functional status. It is unclear whether the participants had better functional status because they were engaged or were more engaged because they had better functional status. Only a longitudinal study can answer that question. Nurses working with older adults should consider facilitating engaged activity for their patients. They should also consider assessing their patients’ levels of engagement, whether by using formal tools such as the EMAS or by qualitatively observing patients’ levels of commitment, motivation, and participation.
Dichotomized Katz model
Dichotomized Lawton-Brody model
Crude OR
Adjusted OR p
Age
1.002 ( )
0.985 ( )
0.66
0.860 ( )
0.847 ( )
<0.001
EMAS Score
0.926 ( )
0.922 ( )
0.18
1.087 ( )
1.183 ( )
0.018
FCI Score
0.850 ( )
0.837 ( )
0.115
0.927 ( )
0.889 ( )
0.37
GDS Score
1.063 ( )
1.204 ( )
0.286
0.902 ( )
1.090 ( )
0.587