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Engagement with activity and functional status among older adults

Thomas Dombrowsky

College of Nursing, The University of Texas at Arlington, USA

E-mail : aa

DOI: 10.15761/NFHC.1000101

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Do higher levels of activity protect against functional decline? If so, what types of activity are effective? There is good evidence for a protective relationship in the case of physical exercise [1,2]. Previous research has demonstrated that functional status is related to age [3], comorbidity [4], cognitive function [5], social support [6], and depression [7].  There is an association between cognitive exercises and slower mental decline among Alzheimer’s patients [8]. Social engagement has also been found to be protective against functional decline [9].

Functional status is the ability to do daily self-care activities independently [10]. Functional status is a major component of quality of life for older adults and their families [11,12]. The total annual cost of care for functional decline in the United States is estimated to be 426 billion dollars [13]. Activity theory postulates that older adults generally wish to maintain activity related to their previous roles in society as long as possible, and that it is beneficial both for them both physically and mentally to maintain such activity [14].

Dombrowsky [15] found that engagement with activity is an independent predictor of functional status after controlling for age, comorbidity, and depression. Engagement is a construct that involves participation, commitment, and motivation for a specific activity [16]. It is unclear whether the more engaged participants were more engaged because they had better functional status or whether they had better functional status because they were more engaged. Longitudinal studies are needed to answer that question.

Functional status is often measured using the Katz Activities of Daily Living Index [17] and the Lawton-Brody Instrumental Activities of Daily Living Scale [18]. These two instruments are well suited for hospitalized patients, but suffer from a ceiling effect when used with community dwelling research participants [15]. They also fail to capture the contextual nature of functional status [19]. The practical meaning of functional status depends on the circumstances of one’s life. It is one thing to manage one’s money using a computer application and another thing to walk to the bank, withdraw money, and make rounds paying various bills. Whether or not one needs to manage money oneself depends on social context. The Katz and Lawton-Brody instruments do not capture this contextual characteristic of functional status and also fail to capture the distinction between functional capacity and functional performance. Functional capacity is what one could do if necessary. Functional performance is the level of functional activity one does in daily practice.

Just as existing measures of functional status are limited by ceiling effects and failure to capture all the dimensions of functional status, instruments for measuring engagement such as the Engagement with Meaningful Activities Survey [20] and the Meaningful Activities Participation Assessment [21] suffer from similar limitations. A comprehensive measure of engagement would evaluate all dimensions of engagement based on theory, such as that of Lequerica and Korrte [16].

In response to the gaps mentioned in the preceding paragraphs, my current research focus is on the development of more sensitive and more comprehensive instruments for measuring functional status and engagement. My longer-term focus is on longitudinal studies of the relationship between engagement and functional status. Specifically, my research focus is on the question of whether increased levels of engagement with physical, social, cognitive, and productive activity correlate with better functional status at later time points.

References

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Publication History

Received: August 20, 2018
Accepted: August 25, 2018
Published: August 28, 2018

Copyright

©2018 Dombrowsky T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Dombrowsky T (2018) Engagement with activity and functional status among older adults. Nurs Fam Health Care 1: DOI: 10.15761/NFHC.1000101

Corresponding author

Thomas Dombrowsky

College of Nursing, The University of Texas at Arlington, USA, Tel: 817-272-6881

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