Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults

Abstract

Introduction

Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.

Aims

To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.

Method

A secondary analysis including participants from the Longitudinal Survey on Senior’s Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.

Results

More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.

Conclusions

We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.

Implications for Rehabilitation

• By establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.

• Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.

• The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.

• Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.

• The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.

Keywords:

• Instrumental activities of daily living
• multimorbidity
• disabled persons
• longitudinal studies
• aging
• multiple chronic conditions

Acknowledgement

The authors gratefully acknowledge the contribution of the late Prof. Michel Préville as principal investigator of the Enquête sur la santé des aînés-Services study (cycle 1).

Disclosure statement

The authors report no conflicts of interest.

Data availability

The data that supported the findings of this study are not publicly available due to privacy or ethical restrictions related to the use of administrative provincial health data. Requests for access to full anonymized dataset should be addressed to the corresponding author. Participants were not requested to give informed consent for data sharing with other researchers outside the team.

Additional information

Funding

The ESA-S study was supported in part by a Quebec Health Research Fund (Fonds de la Recherche du Québec - Santé /FRQS) operating grant (ref: #16000; #22251). The corresponding author held a Canadian Institutes of Health Research (CIHR) Doctoral Research Award the Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Awards (CGSD) (ref: GSD 146258). Dr Vasiliadis held a FRQS Senior Research salary award at the time of the study. The funders had no role in the study design, data collection, analysis and interpretation, draft and revision of the paper nor in the decision to submit for publication.