Factor analysis of activities of daily living scores: culturally determined versus vegetative components

Abstract

Certain components of the Wakari activities of daily living (ADL) scale change over a period of rehabilitation. The data from two studies using this tool were reanalysed using factor analysis to define these components. Study 1 assessed the stress among the caregivers of people admitted to a geriatric assessment and rehabilitation unit (A&R unit) from the community, and included 94 selected patients. Study 2 included all patients admitted over a four-month period to the A&R unit, and studied 205 people. Patients were divided into those who were discharged to the community (group 1) and those who were discharged to a rest home or hospital (group 2). Admission and discharge ADL scores were significantly higher in group 2 than group 1.

ADL abilities which are required for survival have been called 'vegetative', while those acquired in response to the needs of society have been called 'cultural'. Factor analysis of ADL scores on admission revealed two factorial groupings: nursing time, mobility and dressing were called 'cultural', while feeding and rationality were called 'vegetative'. The factor components of discharge scores were similar in the cultural area (nursing time, mobility and dressing), but the vegetative included rationality, feeding, dressing and continence of both urine and faeces. The cultural components improved during the rehabilitation period; vegetative components did not, apart from feeding in some subjects discharged to the community. We suggest that many elderly patients were unable to improve vegetative abilities due to frailty and cognitive impairment.

Combining the studies, 25 subjects with low dependency scores below nine were discharged to rest homes or hospitals, while six of 31 with very high scores of more than 18 were discharged to live with a caregiver. The contribution of admission and discharge ADL scores to decisions about discharge placement is significant, but factors unrelated to patient dependence have a major effect on discharge placement. We suggest that interventions such as education and the development of coping skills should be directed toward the caregiver if one is present, and that more attention be given to interventions dealing with vegetative aspects of the patient's ADL ability.