Functional Capacity and Difficulties in Activities of Daily Living From a Cross-National Perspective

Abstract

Objectives: This study investigated whether physical and cognitive functioning predicts developing difficulties in basic or instrumental activities of daily living (ADL/IADL), and whether country-level factors moderated the associations. Methods: 69,227 adults aged 50+ from 19 countries were followed for up to 14 years. Cox regression and meta-regression analyses were used. Results: Higher grip strength was associated with a 45% lower risk of developing ADL limitations and a 47% lower risk of IADL limitations. The corresponding values were 22% and 23% for peak flow, 20% and 23% for word recall, and 20% and 24% for temporal orientation. The associations were similar and statistically significant in most countries, but some associations were weaker in countries with lower GDP and lower service coverage. Discussion: Good physical and cognitive functional capacity protects from ADL and IADL limitations consistently across Western countries. The associations may be stronger in countries with more resources.

Keywords: aging; cognitive function; disability; health; physical function.

Figure 1.

Flow of the Participants.

Figure 2.

Association Between Grip Strength (a), Peak Flow (b), Word Recall (c), and Temporal Orientation (d) and ADL Limitations. Hazard Ratios With 95% Confidence Intervals Adjusted for Baseline Age, Gender, Education, Marital Status, Chronic Diseases, Depression, Height (Grip Strength and Peak Flow), And Weight (Grip Strength). The Marker Sizes are Proportional to the Study Weights.

Figure 3.

Association Between Grip Strength (a), Peak Flow (b), Word Recall (c), and Temporal Orientation (d) and IADL Limitations. Hazard Ratios With 95% Confidence Intervals Adjusted for Baseline Age, Gender, Education, Marital Status, Chronic Diseases, Depression, Height (Grip Strength and Peak Flow), and Weight (Grip Strength). The Marker Sizes are Proportional to the Study Weights.