Status And Influencing Factors Of Activities Of Daily Living Among Rural Elderly People In Western Yunnan Province

ObjectivesActivities of daily living(ADL)has become one of the major health problems of older people due to increased life expectancy and population ageing.Therefore,this study was to examine the status and influencing factors of activities of daily living(ADL)among rural elderly people in western Yunnan and to analyze the paths and effect of the influencing factors,and to prevent the loss of ADL and improve the quality of life of the elderly in rural areas.MethodsThe participants of the survey were 2287 rural elderly people(≥60 years old)recruited with multistage random cluster sampling in Dali,Baoshan and Lincang.The demographic characteristics,life style,prevalence,psychological status,social support status,height,weight,waist circumference and blood pressure of the elderly were collected.The ADL of the elderly were evaluated by using the ADL scale.ADL includes basic activities of daily living(BADL)and instrumental activities of daily living(IADL).The statistical analysis was carried out with the software of SPSS 23.0and AMOS 26.0.The difference of ADL,BADL and IADL impairment rate was compared byχ~2test,the influencing factors were analyzed by Logistic regression model,and the path and effect of influencing factors were analyzed by structural equation model.Results1.The proportions of participants identified as with overall,instrumental,and physical ADL impairment were 30.74%,24.70%,and 10.80%,respectively,with13.95%and 10.06%of the participants reporting difficulty in cell phone use and walking.2.Logistic regression analysis showed that age≥80 years old(OR=3.48,95%CI:2.56～4.74),sleep disorder(OR=1.49,95%CI:1.23～1.81),anxiety(OR=2.42,95%CI:1.20～4.89),low level of social support(OR=1.32,95%CI:1.09～1.60)and number of diseases≥2(OR=1.52,95%CI:1.14～2.02)were risk factors of ADL impairment in the elderly.Junior high school education(OR=0.38,95%CI:0.28～0.52),non-farmer occupation(OR=0.43,95%CI:0.30～0.61),living alone(OR=0.46,95%CI:0.28～0.76)and drinking tea(OR=0.74,95%CI:0.60～0.91)were the protective factors of ADL impairment in the elderly.Age≥80 years(OR=3.39,95%CI:2.27～5.06),ethnic minorities(OR=1.54,95%CI:1.15～2.06),sleep disorder(OR=2.46,95%CI:1.82～3.31),low level of social support(OR=3.11,95%CI:2.33～4.15),number of diseases≥2(OR=2.60,95%CI:1.61～4.19)and central obesity(OR=1.56,95%CI:1.17～2.08)were risk factors for BADL impairment in the elderly.Non-farmer occupation(OR=0.47,95%CI:0.28～0.80)was the protective factor of BADL impairment in the elderly.Age≥80 years(OR=3.55,95%CI:2.56～4.92),non-partner(OR=1.27,95%CI:1.00～1.61)and anxiety(OR=3.68,95%CI:1.81～7.48)were risk factors for IADL impairment in the elderly.Ethnic minorities(OR=0.76,95%CI:0.61～0.96),junior high school education(OR=0.29,95%CI:0.21～0.41),non-farmer occupation(OR=0.45,95%CI:0.30～0.67)and living alone(OR=0.36,95%CI:0.20～0.64)were the protective factors of IADL impairment in the elderly.3.The structural equation model showed that socio-economic status and health status had a direct impact on ADL,with path coefficients of-0.29 and 0.07,and lifestyle had an indirect impact on ADL through health status,the path coefficient is-0.03.Socio-economic status,health status and social support have direct and indirect effects on BADL,with total path coefficients of-0.08,0.27 and 0.14.Socio-economic status has indirect effects on BADL through social support,health status had an indirect effect on BADL through psychological status,social support had an indirect effect on BADL through psychological status,and life style had an indirect effect on BADL through health status with a path coefficient of-0.07.Socio-economic status and psychological status had a direct impact on IADL,with a path coefficient of-0.32and 0.06,respectively,while health status had an indirect impact on IADL through psychological status,with a path coefficient of 0.02,social support has an indirect effect on IADL through psychological status,and the path coefficient is 0.02.Conclusions1.The rate of impaired ADL was 30.74%of the rural elderly in western Yunnan,especially in terms of IADL.2.Age,education level,occupation,living alone,tea drinking,sleep disorder,anxiety,social support and the number of diseases were the influencing factors of ADL impairment.The influencing factors of BADL and IADL were not exactly the same.Age,nation and occupation were the common influencing factors of them.Sleep disorder,social support,central obesity and the number of diseases were the influencing factors of BADL impairment,Marital status,education level,living alone and anxiety were the influencing factors of IADL impairment.3.Socio-economic status and health status have a direct impact on ADL,and lifestyle has an indirect impact on ADL through health status.The path of BADL and IADL was not exactly the same.Socio-economic status and psychological status have a direct impact on BADL and IADL,health status and social support have an indirect impact through psychological status on BADL and IADL,socio-economic status also has an indirect impact on BADL through social support,and lifestyle has an indirect impact on BADL through health status,but the impact path on IADL is not significant.Lifestyle,health status,psychological status and social support had the greatest influence on BADL,while socio-economic status had the greatest influence on IADL.