Date Presented 04/04/19
This study used a cross-sectional design to determine which health and sociodemographic variables predicted IADL performance in adults with type 2 diabetes. Using stepwise multiple linear regression, the final model revealed that number of medications, presence of depression, and number of nights spent in the hospital predicted frequency of IADL performance. This information will assist OTs in understanding the underlying factors that impact IADL performance.
Primary Author and Speaker: Tara Klinedinst
Additional Authors and Speakers: Matt Malcolm
RATIONALE AND PURPOSE: People with type 2 diabetes (T2DM) are at greater risk for impairment in instrumental activities of daily living (IADL) compared to individuals without T2DM (Chiu, Mau, Tasi, Hsieh, & Liu, 2004). Diminished IADL performance (e.g., meal preparation, medication management) has been associated with poor quality of life, low self-efficacy, and high healthcare utilization (HCU) (Spillman, 2004). Though Malcolm and colleagues (2018) found a significant association between IADL performance and HCU in adults with T2DM, the relationship between other underlying health and socioeconomic variables (HSV) and IADL performance requires further examination. The purpose of this research is to examine the relationships among HSV and IADL performance, thus enabling increased understanding of occupational engagement for adults with T2DM.
DESIGN: This was a cross-sectional study of 93 adults with T2DM who were recruited from a large safety-net primary care clinic (PCC). Inclusion criteria were previous diagnosis of T2DM, age ≥ 18 years, patient status at the PCC, and ability to understand instructions on questionnaires.
METHOD: HSV (age, gender, minority status, HbA1C, body mass index; number of medications, comorbidities; presence of depression, recent fall; and number of physician’s visits, emergency department visits, and nights in the hospital over the last six months) were collected by self-report questionnaire, except for HbA1C, which was obtained from the participant medical record. The Frenchay Activities Index (FAI) was used to assess IADL. The FAI assesses frequency of 15 activities in three domains: domestic (e.g. housework, meal preparation), outdoor (e.g. gardening, walking outside) and leisure/work (e.g. pursuing hobbies and gainful work).
ANALYSIS: Stepwise multiple linear regression was performed with total FAI score as the dependent variable and the HSV as predictor variables. All variables were included in the original model, and manual backward elimination was used to further refine the model until all predictor variables had individual p-values < .05.
RESULTS: A test of the full model was significant (F
11,65 = 4.920, p < .001, R
2 = .45). After removing non-significant predictors, the final model (F
3,88 = 17.88, p < .001, R
2 = .38) included number of medications (B = -.514, p < .001), presence of depression (B = -.834, p < .001), and total nights spent in the hospital over the last 6 months (B = -.159, p = .002).
CONCLUSION: The final regression model demonstrates that those who take more medications, have depression, and have spent more nights in the hospital experience lower frequency of IADL performance. Increasing awareness of the factors that influence IADL performance in adults with T2DM is an important first step in identifying potential occupational therapy interventions that promote health and independence while reducing disability.
IMPACT STATEMENT: Occupational therapists working with individuals with T2DM should consider and evaluate how medication use, depression, and hospital use relate to an individual’s IADL performance. Such information would assist the clinician and patient in treatment planning, goal setting, and intervention.
References
Chiu, H. C., Mau, L. W., Tasi, W. L., Hsieh, Y. H., & Liu, H. W. (2004). Chronic medical conditions as predictors of functional disability in an older population in Taiwan. Australasian Journal on Ageing, 23(1), 19-24.
Malcolm, M. P., Atler, K. E., Schmid, A. A., Klinedinst, T. C., Grimm, L. A., Marchant, T. P., & Marchant, D. R. (2018). Relating Activity and Participation Levels to Glycemic Control, Emergency Department Use, and Hospitalizations in Individuals With Type 2 Diabetes. Clinical Diabetes, cd170118.
Spillman, B. C. (2004). Changes in elderly disability rates and the implications for health care utilization and cost. The Milbank Quarterly, 82(1), 157-194.
