Characteristics of disability in activity of daily living in elderly people associated with locomotive disorders

Tsutomu Iwaya, Tokuhide Doi, Atsushi Seichi, Yuichi Hoshino, Toru Ogata, Masami Akai, Tsutomu Iwaya, Tokuhide Doi, Atsushi Seichi, Yuichi Hoshino, Toru Ogata, Masami Akai

Abstract

Background: Ageing is associated with a decline of motor function and ability to perform daily activities. Locomotive disorders are one of the major disorders resulting in adverse health condition in elderly people. Concept of Locomotive syndrome (LoS) was proposed to tackle the problems and prolong healthy life expectancy of people with locomotive disorders. To develop intervention strategy for LoS it is mandatory to investigate impairments, functional disabilities which people with locomotive disorder experience and to examine relationships among these parameters. For this purpose we have developed Geriatric Locomotive Function Scale-25 (GLFS-25). Though several physical performance tests were reported for identification or monitoring the severity of LoS, there are few studies reported on characteristics of disability which people with locomotive disorders experience. The aim of this study was to report the characteristics of ADL disabilities in elderly people with locomotive disorders in terms of numbers and degree of activity limitations.

Methods: We organized a cohort study and recruited 314 participants aged 65 years and over from five orthopedic clinics or nursing care facilities. This was a cross-sectional study to use the baseline data of such cohort. ADL disabilities were assessed using GLFS-25 scale arranging the GLFS-25 scores in ordinal levels using "R language" program. Numbers and degrees of activity limitations were determined and compared among the levels. Frequency of limitation in activities regarding social activity, housework, locomotion, mobility and self-care was compared among across the disability level.

Results: The GLFS-25 score was mathematically categorized into 7 levels. The number of activity limitations and the degrees of each activity limitation were significantly greater in high GLFS-25 levels than in low levels. Difficulties in mobility appeared in less severe level, difficulties in domestic and social life appeared in moderately severe level, and difficulties in self-care appeared in advanced level.

Conclusions: High GLFS-25 score represented high degree of disability on ADLs. Concordant increase of numbers of activity limitation and severity progression in activity limitation may contribute to progression of disability. Activity limitation may occur in the following order: sports activity, walking, transferring, and self-care.

Keywords: Activity limitation; Degree of disability; Disablement process; Geriatric Locomotive Function Scale-25; Locomotive syndrome.

Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research regulations, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Written informed consent was obtained from all participants, and all study protocols were approved by the institutional review board of the National Rehabilitation Center for Persons with Disabilities (No. 21–77).

Consent for publication

Not applicable.

Competing interests

No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subjects of this article. The authors declare that they have no competing interest to disclose.

The correspondence, Masami Akai, is a member of the editorial board (Associate Editor) of BMC geriatrics.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of activity limitations of the GLFS-25 scores per participants by 7 levels. Test statistics on differences of item scores among the GLFS-25 total score levels. Kruskal Wallis tests and multiple comparison tests (Bonferroni’s correction) (level of significance KW tests: p

Fig. 2

An example result of Jonckheere-Terpstra…

Fig. 2

An example result of Jonckheere-Terpstra test on question ‘To what extent has it…

Fig. 2
An example result of Jonckheere-Terpstra test on question ‘To what extent has it been difficult to get up from a bed or lie down?’ Hypothesis that the distribution of response items is the same across categories of GLFS-25 level was rejected. The grade of difficulty in individual daily activity increased in accordance with the deterioration of ADL disability
Fig. 2
Fig. 2
An example result of Jonckheere-Terpstra test on question ‘To what extent has it been difficult to get up from a bed or lie down?’ Hypothesis that the distribution of response items is the same across categories of GLFS-25 level was rejected. The grade of difficulty in individual daily activity increased in accordance with the deterioration of ADL disability

References

    1. Cabinet Office, Government of Japan. White paper on the Aging Society. 2016. Accessed 12 Dec, 2016.
    1. Arai H, Ouchi Y, Toba K, Endo T, Shimokado K, Tsubota K, et al. Japan as the front-runner of super-aged societies: perspectives from medicine and medical care in Japan. Geriatr Gerontol Int. 2015;15(6):673–687. doi: 10.1111/ggi.12450.
    1. Ministry of Health, Labour and Welfare. Annual Report on the Long-term Care Insurance. 2013. Accessed 12 Dec, 2016.
    1. Ministry of Health, Labour and Welfare. Current State and Trends on the Elderly and their Environment. 2015. Accessed 12 Dec 2016.
    1. Ministry of Health, Labour and Welfare. Comprehensive Survey of Living Conditions. Table 16. (in Japanese) 2010. Accessed 12 Dec. 2016.
    1. Ministry of Health, Labour and Welfare. Comprehensive Survey of Living Conditions. Table 18. (in Japanese) 2013. Accessed 12 Dec 2016.
    1. Nakamura K. Locomotive syndrome: disability-free life expectancy and locomotive organ health in a “super-aged” society. J Orthop Sci. 2009;14(1):1–2. doi: 10.1007/s00776-008-1302-y.
    1. Nakamura K, Ogata T. Locomotive syndrome: definition and management. Clin Rev Bone Miner Metab. 2016;14:56–67. doi: 10.1007/s12018-016-9208-2.
    1. Seichi A, Kimura A, Konno S, Yabuki S. Epidemiologic survey of locomotive syndrome in Japan. J Orthop Sci. 2016;21(2):222–225. doi: 10.1016/j.jos.2015.12.012.
    1. Yoshimura N, Nakamura K. Epidemiology of locomotive organ disorders and symptoms: an estimation using the population-based cohorts in Japan. Clin Rev Bone Miner Metab. 2016;14:68–73. doi: 10.1007/s12018-016-9211-7.
    1. Japanese Orthopaedic Association. Pamphlet of Locomotive Syndrome. (in Japanese) 2015. Accessed 12 Dec 2016.
    1. Seichi A, Hoshino Y, Doi T, Akai M, Tobimatsu Y, Iwaya T. Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question geriatric locomotive function scale. J Orthop Sci. 2012;17(2):163–172. doi: 10.1007/s00776-011-0193-5.
    1. Ogata T, Muranaga S, Ishibashi H, Ohe T, Izumida R, Yoshimura N, et al. Development of a screening program to assess motor function in the adult population: a cross-sectional observational study. J Orthop Sci. 2015;20(5):888–895. doi: 10.1007/s00776-015-0737-1.
    1. Iizuka Y, Iizuka H, Mieda T, Tajika T, Yamamoto A, Takagishi K. Population-based study of the association of osteoporosis and chronic musculoskeletal pain and locomotive syndrome: the Katashina study. J Orthop Sci. 2015;20(6):1085–1089. doi: 10.1007/s00776-015-0774-9.
    1. Muramoto A, Imagama S, Ito Z, Hirano K, Ishiguro N, Hasegawa Y. Physical performance tests are useful for evaluating and monitoring the severity of locomotive syndrome. J Orthop Sci. 2012;17(6):782–788. doi: 10.1007/s00776-012-0283-z.
    1. Muramoto A, Imagama S, Ito Z, Hirano K, Tauchi R, Ishiguro N, et al. Waist circumference is associated with locomotive syndrome in elderly females. J Orthop Sci. 2014;19(4):612–619. doi: 10.1007/s00776-014-0559-6.
    1. Muramoto A, Imagama S, Ito Z, Hirano K, Ishiguro N, Hasegawa Y. Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women. J Orthop Sci. 2016;21(2):216–221. doi: 10.1016/j.jos.2015.12.016.
    1. Muramoto A, Imagama S, Ito Z, Hirano K, Tauchi R, Ishiguro N, et al. Threshold values of physical performance tests for locomotive syndrome. J Orthop Sci. 2013;18(4):618–626. doi: 10.1007/s00776-013-0382-5.
    1. Seichi A, Hoshino Y, Doi T, Akai M, Tobimatsu Y, Kita K, et al. Determination of the optimal cutoff time to use when screening elderly people for locomotive syndrome using the one-leg standing test (with eyes open) J Orthop Sci. 2014;19(4):620–626. doi: 10.1007/s00776-014-0581-8.
    1. Iwaya T, Akai M, Doi T. Clinical picture of locomotive syndrome with disabilities in elderly people. (in Japanese) J Jpn Orthop Assoc. 2015;89(5): 365–72.
    1. Tobimatsu Y. Locomotive syndrome: its clinical features and aggravation process. (in Japanese) Bone Joint Nerve. 2014; 4(3): 467–72.
    1. Tsutsui T, Muramatsu N. Care-needs certification in the long-term care insurance system of Japan. J Am Geriatr Soc. 2005;53(3):522–527. doi: 10.1111/j.1532-5415.2005.53175.x.
    1. Iwaya T, Doi T, Seichi A, Hoshino Y, Ogata T, Akai M. Relationship between physician-judged functioning level and self-reported disabilities in elderly people with locomotive disorders. Qual Life Res. 2017;26(1):35–43. doi: 10.1007/s11136-016-1377-4.
    1. Iwaya T, Doi T, Nakamura K, Akai M, Tobimatsu Y, Hoshino Y, et al. Operational definition of Locomotive syndrome. (in Japanese) J Jpn Orthop Assoc. 2014; 88(10): 731–8.
    1. Akai M, Doi T, Seichi A, Okuma Y, Ogata T, Iwaya T. Locomotive syndrome: operational definition based on a questionnaire, and exercise interventions on mobility dysfunction in elderly people. Clin Rev Bone Miner Metab. 2016;14:119–130. doi: 10.1007/s12018-016-9210-8.
    1. Aoki S. Transforming continuous variable data into categorical data with R language. (in Japanese) 2006. Accessed 12 Dec 2016.
    1. Aoki S. Search for optimal classification of the histogram using Akaike Information Criterion. (in Japanese) 2007. Accessed 12 Dec 2016.
    1. The Jonckheere-Terpstra test using SPSS Statistics. Accessed 12 Dec 2016.
    1. Vermeulen J, Neyens JCL, van Rossum E, Spreeuwenberg MD, de Witte LP. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011;11:33. doi: 10.1186/1471-2318-11-33.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–762. doi: 10.1016/S0140-6736(12)62167-9.
    1. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397. doi: 10.1016/j.jamda.2013.03.022.
    1. Kelaiditi E, Cesari M, Canevelli M, van Kan GA, Ousset PJ, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (IANA/IAGG) international consensus group. J Nutr Health Aging. 2013;17(9):726–734. doi: 10.1007/s12603-013-0367-2.
    1. Kempen GIJM, Suurmeijer TPBM. The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders. Gerontologist. 1990;30(4):497–502. doi: 10.1093/geront/30.4.497.
    1. Dunlop DD, Hughes SL, Manheim LM. Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health. 1997;87(3):378–383. doi: 10.2105/AJPH.87.3.378.
    1. Ferrucci L, Guralnik JM, Cecchi F, Marchionni N, Salani B, Kasper J, et al. Constant hierarchic patterns of physical functioning across seven populations in five countries. Gerontologist. 1998;38(3):286–294. doi: 10.1093/geront/38.3.286.
    1. Hardy SE, Dubin JA, Holford TR, Gill TM. Transitions between states of disability and independence among older persons. Am J Epidemiol. 2005;161(6):575–584. doi: 10.1093/aje/kwi083.
    1. Lawrence RH, Jette AM. Disentangling the disablement process. J Gerontol B Psychol Sci Soc Sci. 1996;51(4):S173–S182. doi: 10.1093/geronb/51B.4.S173.
    1. Shinkai S, Watanabe S, Kumagai S, Fujiwara Y, Amano H, Yoshida H, et al. Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing. 2000;29(5):441–446. doi: 10.1093/ageing/29.5.441.
    1. Ferrucci L, Guralnik JM, Simonsick E, Salive ME, Corti C, Langlois J. Progressive versus catastrophic disability: a longitudinal view of the disablement process. J Gerontol A Biol Sci Med Sci. 1996;51(3):M123–M130. doi: 10.1093/gerona/51A.3.M123.
    1. Guralnik JM, Ferrucci L. The challenge of understanding the disablement process in older persons: commentary responding to Jette AM. Toward a common language of disablement. J Gerontol A Biol Sci Med Sci. 2009;64(11):1169–1171. doi: 10.1093/gerona/glp094.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する