Factors that determine dependence in daily activities: A cross-sectional study of family practice non-attenders from Slovenia

Abstract

Background: Independence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others.

Objective: We focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence.

Design: Cross-sectional observational study.

Settings and participants: Data was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication.

Results: The final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model.

Conclusions: A considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status.

Fig 1. The distribution of the level of dependence in daily activities in dependent participants.

Fig 2. Predicted probability of dependence in daily activities (black line) with 95% confidence intervals (grey area) in the multivariate logistic model (Table 3).

The figure shows the quadratic effects of age (left panel), feelings of loneliness (middle panel), and self-assessment of current health (right panel), where the other variables in the model are fixed to values indicating a healthy individual according to the variables in the model, except risk of falling (set to increased), gender to female, and age to its median of 61.5.