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Physical activity, participation and self-rated health among older community-dwelling Icelanders: a population-based study
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
2010 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes.

Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study.

Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships.

Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.

sted, utgiver, år, opplag, sider
Umeå: Umeå university , 2010. , s. 95
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1361
Emneord [en]
Aging, older people, physical activity, participation, self-rated health, balance confidence, rural, urban, residence, International Classification of Functioning Disability and Health (ICF), Rasch measurement, standardized assessment
HSV kategori
Forskningsprogram
sjukgymnastik
Identifikatorer
URN: urn:nbn:se:umu:diva-35823ISBN: 978-91-7459-054-8 (tryckt)OAI: oai:DiVA.org:umu-35823DiVA, id: diva2:349396
Disputas
2010-10-01, Aulan, Vårdvetarhuset, Umeå universitet, Byggnad 15, Umeå Universitet, Umeå, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2010-09-10 Laget: 2010-09-07 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Delarbeid
1. Are rural older Icelanders less physically active than those living in urban areas?: a population-based study
Åpne denne publikasjonen i ny fane eller vindu >>Are rural older Icelanders less physically active than those living in urban areas?: a population-based study
2009 (engelsk)Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 4, s. 409-417Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Older people in rural areas have been labelled as physically inactive on the basis of leisure-time physical activity research. However, more research is needed to understand the total physical activity pattern in older adults, considering all domains of physical activity, including leisure, work, and domestic life. AIMS: We hypothesised that: (a) total physical activity would be the same for older people in urban and rural areas; and (b) urban and rural residency, along with gender and age, would be associated with differences in domain-specific physical activities. METHODS: Cross-sectional data were collected in Icelandic rural and urban communities from June through to September 2004. Participants were randomly selected, community-dwelling, 65-88 years old, and comprised 68 rural (40% females) and 118 urban (53% females) adults. The Physical Activity Scale for the Elderly (PASE) was used to obtain a total physical activity score and subscores in leisure, during domestic life, and at work. RESULTS: The total PASE score was not associated with rural vs. urban residency, but males were, in total, more physically active than females, and the 65-74-year-olds were more active than the 75-88-year-olds. In the leisure domain, rural people had lower physical activity scores than urban people. Rural males were, however, most likely of all to be physically active in the work domain. In both urban and rural areas, the majority of the physical activity behaviour occurred in relation to housework, with the rural females receiving the highest scores. CONCLUSIONS: Older Icelanders in rural areas should not be labelled as less physically active than those who live in urban areas. Urban vs. rural living may, however, influence the physical activity patterns among older people, even within a fairly socioeconomically and culturally homogeneous country such as Iceland. This reinforces the need to pay closer attention to the living environment when studying and developing strategies to promote physical activity.

HSV kategori
Forskningsprogram
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-35784 (URN)10.1177/1403494809102776 (DOI)19237433 (PubMedID)
Tilgjengelig fra: 2010-09-02 Laget: 2010-09-02 Sist oppdatert: 2018-06-08bibliografisk kontrollert
2. Application of rasch analysis to examine psychometric aspects of the activities-specific balance confidence scale when used in a new cultural context
Åpne denne publikasjonen i ny fane eller vindu >>Application of rasch analysis to examine psychometric aspects of the activities-specific balance confidence scale when used in a new cultural context
2010 (engelsk)Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 91, nr 1, s. 156-163Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context. OBJECTIVE: To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context. DESIGN: Cross-sectional, population-based, random selection from the Icelandic National Registry. SETTING: Community-based. PARTICIPANTS: Icelanders (N=183), 65 to 88 years old, and 48% women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale. RESULTS: Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested. CONCLUSIONS: Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.

HSV kategori
Forskningsprogram
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-31108 (URN)10.1016/j.apmr.2009.09.010 (DOI)000277417300023 ()20103411 (PubMedID)
Tilgjengelig fra: 2010-01-29 Laget: 2010-01-29 Sist oppdatert: 2018-06-08bibliografisk kontrollert
3. Participation frequency and perceived participation restrictions at older age: applying the International Classification of Functioning, Disability and Health (ICF) framework
Åpne denne publikasjonen i ny fane eller vindu >>Participation frequency and perceived participation restrictions at older age: applying the International Classification of Functioning, Disability and Health (ICF) framework
2011 (engelsk)Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, nr 23-24, s. 2208-2216Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Purpose: To identify variables from different components of International Classification of Functioning, Disability and Health (ICF) associated with older people's participation frequency and perceived participation restrictions. Method: Participants (N = 186) were community-living, 65-88 years old and 52% men. The dependent variables, participation frequency (linear regression) and perceived participation restrictions (logistic regression), were measured using The Late-Life Function and Disability Instrument. Independent variables were selected from various ICF components. Results: Higher participation frequency was associated with living in urban rather than rural community (beta = 2.8, p < 0.001), physically active lifestyle (beta = 4.6, p < 0.001) and higher cognitive function (beta = 0.3, p = 0.009). Lower participation frequency was associated with being older (beta = -0.2, p = 0.002) and depressive symptoms (beta = -0.2, p = 0.029). Older adults living in urban areas, having more advanced lower extremities capacity, or that were employed had higher odds of less perceived participation restrictions (adjusted odds ratio [OR] = 5.5, p = 0.001; OR = 1.09, p < 0.001; OR = 3.7, p = 0.011; respectively). In contrast, the odds of less perceived participation restriction decreased as depressive symptoms increased (OR = 0.8, p = 0.011). Conclusions: Our results highlight the importance of capturing and understanding both frequency and restriction aspects of older persons' participation. ICF may be a helpful reference to map factors associated with participation and to study further potentially modifiable influencing factors such as depressive symptoms and advanced lower extremity capacity.

sted, utgiver, år, opplag, sider
Informa Healthcare, 2011
Emneord
Participation, elderly, ICF, rural, residence, depressive symptoms, lower extremity capacity
HSV kategori
Forskningsprogram
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-35817 (URN)10.3109/09638288.2011.563818 (DOI)000296499500007 ()21446857 (PubMedID)
Eksternt samarbeid:
Tilgjengelig fra: 2010-09-07 Laget: 2010-09-07 Sist oppdatert: 2018-06-08bibliografisk kontrollert
4. Self-rated health: a valid outcome in geriatric physical therapy?
Åpne denne publikasjonen i ny fane eller vindu >>Self-rated health: a valid outcome in geriatric physical therapy?
(engelsk)Artikkel i tidsskrift (Fagfellevurdert) Submitted
HSV kategori
Forskningsprogram
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-35819 (URN)
Tilgjengelig fra: 2010-09-07 Laget: 2010-09-07 Sist oppdatert: 2018-06-08bibliografisk kontrollert

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