Abstract
Background
As one of the challenges of aging, older adults with disabilities are often overlooked in remote areas of many develo** countries, including southwest China. Similar populations would undoubtedly benefit from a representative, high-quality survey of large samples, which would also enrich global disability data. This study aims to assess the prevalence of disability and associated factors among urban and rural older adults in a typical representative region.
Method
A large-scale baseline survey was conducted between March and September 2020 using face-to-face interviews with a multistage stratified random sample of 16,536 participants aged ≥ 60 years. Disability was assessed using the BI scale, with a score of 100 representing normal status, 65–95 as mild disability, 45–60 as moderate disability, and 0–40 as severe disability. The prevalence of disability was estimated by demographics and health characteristics, and their associations were explored by robust Poisson regression analysis.
Results
The prevalence of disability among older adults was 19.4%, and the prevalence of mild, moderate, and severe disability was 16.8%, 1.5%, and 1.1%, respectively. All variables, including older age, residence in a rural area, higher number of hospitalizations, comorbidities, poor self-rated health, falls, cognitive impairment, mental impairment, and alienation from friends and relatives, were shown to be associated with a higher adjusted prevalence of disability. Only formal education can reduce the risk of disability.
Conclusion
The prevalence of disability among older adults is high in both urban and rural settings in southwest China, and a number of important factors associated with disability have been identified. In addition to increased attention to the health status of older adults, further research on scientific management and effective disability interventions is needed.
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Background
The term disability was first defined by Nagi in the 1960s [1]. The World Health Organization (WHO) has developed an updated framework [2] in 2002, which considers the term as an umbrella term for impairments, activity limitations and participation restrictions, and emphasizes that disability is a long-term interaction between the person and the overall environment in which the person lives. This implies that disability is a complex and multifactorial state involving multiple risk factors. Currently, there are no uniform standards and methods for assessing and classifying disability in older adults. In order to obtain comparable global health data, various tools for measuring disability have been developed [3,4,5,6,7]. The most commonly used one is the Barthel Index (BI) [8], which can evaluate the ability of older adults to perform daily living activities. It is characterized by its simplicity of operation, good reliability and sensitivity [9].
Human life expectancy has reached an all-time high and is on the rise [10], which will lead to the emergence of a large number of older adults with different degrees of disability [11]. Disability not only affects the quality of life and health outcomes of those people, but also significantly increases the cost of care [12]. Collecting data from representative studies in 37 countries, WHO reports that 14% of the 514 million older people (60 years and older) lack the basic skills to lead a meaningful and dignified life [10]. By the end of 2015, China's elderly population had reached 40.63 million, accounting for 18.3% of older adults in the same period [13]. It is conceivable that China, as the largest develo** country globally, is facing a great socioeconomic burden.
Previous studies have explored a range of factors that may affect the physical functioning, activity, and social participation of older adults, including but not limited to sociodemographic characteristics, social networks, self-perceived health, cognitive functioning, mental health, disease burden, and repeat hospitalizations [14,15,16,17,18]. Since 2005, many similar studies have been conducted in most regions of China, but few studies have been conducted in the Southwest [19,20,50]. However, follow-up cohort studies are still needed to elucidate the specific trajectory of disability. Aging poses a number of psychiatric problems in older adults that are caused by many factors, including: 1) decreased sensory function [51]; 2) decreased adaptability to environmental changes and social roles and status; and 3) increased likelihood of exposure to negative life events, such as retirement and death of a relative. In this study, 8.2% of the elderly screened positive for mental disorders, and the rates of positive depression and anxiety-depression comorbidity were significantly higher in the disabled elderly. In addition, less interaction with family and friends increased the incidence of disability. However, alienation from family alone did not have a statistically significant effect on disability, which may be related to the current situation of empty nesters in China. Older adults rely more on interactions with friends than the next generation who are busy with work. According to the meta-analysis, the prevalence of depression among Chinese empty nesters was 38.6% [54]; while, these hospitals do not provide community mental health services that can provide long-term care and support. As early as 2004, China attempted to establish a comprehensive community mental health system; however, the system continues to face significant challenges due to low national awareness of the need for mental health services, lack of specialized physicians, and financial difficulties [55]. This study will provide a reference for regional epidemiological data on mental disorders in the elderly, and also call for relevant authorities to pay attention to the mental health problems of the elderly.
Consistent with previous studies [56], our findings suggest a strong association between cognitive function and disability. The survey showed that 1,179 elderly people had positive dementia screening results, and the proportion of dementia in the disabled population was 4.8 times higher than that in the non-disabled population, which fully indicates that dementia is an important cause of loss of self-care in the elderly. As the country with the largest number of dementia patients in the world [57], China has not yet established a service system specifically for dementia. Early detection of cognitive impairment is not possible due to low public awareness of dementia and the lack of routine screening mechanisms in most medical facilities. Many people with dementia rely on home care, which is increasingly being incorporated into long-term care. However, the lack of caregivers with spiritual and professional background makes it difficult to improve the quality of life of these elderly [58]. Therefore, the following steps should focus on increasing public awareness of dementia, earlier identification and prevention of cognitive impairment, and the establishment of a joint disability service system for dementia.
Statistically significant differences in disability were observed between genders, and the older women were more prone to experience functional impairment. However, after adjusting for other variables, the incidence of disability became similar between genders following adjustment of other variables, which might be explained by higher rates of chronic diseases such as osteoarthritis, dementia, falls, and mental disorder in women [59], as well as differences in body composition and life expectancy gaps [60]. For social factors, the analysis showed that older adults who live in urban areas and have formal education are better able to maintain their abilities, as has been well documented in many studies. This may be because they have access to health knowledge and resources from a variety of sources [61] as well as a range of social and recreational activities, which can help them maintain good mental health [62]. Despite China's increasing spending on healthcare and health, inefficiencies and uneven distribution of resources persist. Because of the differences in economics, healthcare, urbanization, and population density between the east and west, it is difficult to see a boom in care services and elderly care in the rural west anytime soon [63]. This study will offer policy implications and help local elder population to improve the quality of life.
This study has several strengths. First, this large sample study can provide high-quality and rich information for existing disability research, and the findings are important for follow-up studies and the global literature on the disability process and its associated factors. Second, comprehensive training of professional bodies and various quality control measures yielded reliable data. Finally, the study results provide a scientific basis for government policies and resource allocation to enable local older adults to have a higher quality of life and gradually achieve healthy aging. Several limitations should be taken into account when interpreting this study. As this study is a cross-sectional study, the results failed to determine a causal relationship between influencing factors and disability. Therefore, although many factors influencing disability were identified in this study, it cannot be denied that disability may also influence related factors to some extent. Further cohort studies are needed to determine the causal relationships. Some of the data on health characteristics and ADL items were self-reported, and biases in recall and reporting may have affected the information. Future studies should add more objective indicators and try to assess disability in multiple dimensions, rather than just selecting ADL as the only criterion for determining disability. This study served as a baseline investigation for our project, and more follow-up and exploration of interventions are needed in the future.
Conclusions
A higher prevalence of disability was found among urban and rural older adults in Sichuan, where disability was strongly associated with aging, lower education levels, living in rural areas, hospitalization, co-morbidities, self-rated poor health, falls, cognitive impairment, psychological problems, and changes in social networks. The findings underscore the need for early screening for disability, effective prevention policies, smaller urban–rural disparities, and age-friendly society.
Availability of data and materials
The datasets generated and analysed during the current study are not publicly available due to this is a newly database which are confidential and the authors do not have permission to share data. But this dataset is also available from the corresponding author on a reasonable request.
Abbreviations
- ADL:
-
Activities of Daily Living
- WHO:
-
The World Health Organization
- EDC:
-
Electronic Data Capture
- BI:
-
The Barthel Index
- MCI:
-
Mild cognitive impairment
- GAD-2:
-
The 2-item Generalized Anxiety Disorder scale
- PHQ-2:
-
The 2-item Patient Health Questionnaire depression module
- LSNS-6:
-
The abbreviated Lubben Social Network Scale
- SD:
-
Standard deviation
- CI:
-
Confidence interval
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Acknowledgements
We would like to thank all teamworkers and interviewers for their great work.
Funding
This work was supported by the Health Commission of Sichuan Province, the National Key R&D Program of China [grant numbers 2018YFC2002400], 1.3.5 project for disciplines of excellence (West China Hospital,Sichuan University) [grant numbers ZYGD20010], Study on the Long-term Care insurance status in Chengdu and the evaluation of policy effect [grant numbers ZX2020002], Sichuan Science and Technology Program [grant numbers 2020YFS0319], and Chengdu Science and Technology Bureau Major Science and Technology Application Demonstration Project [grant numbers 2019YF0900083SN].
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RQ contributed to conceptualization, methodology, formal analysis, investigation, data curation, writing original draft, review and editing of the paper. SJ contributed to data curation, validation, review and editing of the paper. WZ contributed to methodology, review and editing of the paper. XX contributed to data curation, formal analysis, visualization of the paper. QS contributed to the revision of the paper. LH contributed to methodology, supervision of the paper. DL contributed to supervision, project administration of the paper. FH contributed to investigation, data curation of the paper. BD contributed to conceptualization, methodology, funding acquisition, project administration, supervision, review and editing of the paper. All authors saw and approved the final version of the manuscript.
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Qiao, R., Jia, S., Zhao, W. et al. Prevalence and correlates of disability among urban–rural older adults in Southwest China: a large, population-based study. BMC Geriatr 22, 517 (2022). https://doi.org/10.1186/s12877-022-03193-2
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DOI: https://doi.org/10.1186/s12877-022-03193-2