Using structural equation modeling in the understanding of functional disability in older adults.
Darlene Mara Dos Santos Tavares, Nayara Gomes Nunes Oliveira, Flavia Aparecida Dias Marmo and 1 others
PMID 34190942WHAT IT FOUND
Older adults had more difficulty with complex social activities than daily tasks or self-care.
Frailty, depression, low schooling and long sitting were linked to lower function. More illnesses were associated with lower function through these factors.
Key findings
01Across the age groups, advanced activity capacity was directly associated with instrumental activity capacity, and instrumental activity capacity was directly associated with basic activity capacity.
02Lower schooling, more frailty components and more depressive symptoms were directly associated with lower advanced activity participation, and a higher number of morbidities was indirectly associated with lower advanced activity participation through frailty and depressive symptoms.
03Frailty and sedentary behavior were directly associated with greater dependence in instrumental activities, and sedentary behavior was directly associated with greater dependence in basic activities among the younger age groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The study is cross-sectional, so it cannot show whether factors caused disability or disability caused them. Sedentary behavior and physical activity were self-reported. The study excluded people with cognitive decline, severe stroke sequelae or severe unstable Parkinson's disease, so it may not apply to those patients. Participants were urban older adults from one Brazilian health macro-region, so results may not transfer to rural or other populations. The models were re-specified by removing non-significant trajectories, so the reported paths are selected from tested models.
Declared interests
The paper lists CNPq and FAPEMIG grants as support and gives no commercial sponsor or author conflict.
The easy way to misread this
Do not read the structural model as proof that changing one factor will prevent disability. The study is cross-sectional, so it shows associations, not cause and effect, and some effects were mediated by frailty, depression or sitting time.