Factors associated with disability in basic and instrumental activities of daily living in Costa Rican residents aged 60 and over

Factors associated with disability in basic and instrumental activities of daily living in Costa Rican residents aged 60 and over





Disability, factors, activities of daily living, instrumental activities of daily living, older people


Introduction: Disability has been considered as a difficulty in carrying out activities necessary for life. Objective: To identify factors associated with disability in basic and instrumental activities of daily living in people aged 60 and over residing in Costa Rica. Methods: The study included 2238 people participating in the Costa Rica project: Longevity and Healthy Aging Study. Logistic regression models were estimated and odds ratios were calculated in order to identify factors associated with disability. Results: Factors that influence disability in combined activities are the presence of pain, the lack of physical activity and C-reactive protein. The factors with the greatest impact on basic activities were the presence of pain, the lack of physical activity and the presence of chronic disease. For instrumental activities, negative self-rated health and pain had the greatest impact, after physical activity. In addition, conditions such as diabetes affect activities of daily living. Conclusion: Pain, not performing physical activity, self-rated health and other sociodemographic factors cause functional difficulties that affect the quality of life of people aged 60 and over.


American Diabetes Association, (2021). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care, 44(Suppl. 1), S15–S33. https://doi.org/10.2337/dc21-S002

Andrews, J. S., Cenzer, I. S., Yelin, E., & Covinsky, K. E. (2013). Pain as a risk factor for disability or death. Journal of the American Geriatrics Society, 61(4), 583–589. https://doi.org/10.1111/jgs.12172

Arokiasamy, P., Uttamacharya, Kowal, P., & Chatterji, S. (2016). Age and Socioeconomic Gradients of Health of Indian Adults: An Assessment of Self-Reported and Biological Measures of Health. Journal of cross-cultural gerontology, 31(2), 193–211. https://doi.org/10.1007/s10823-016-9283-3

Backholer, K., Wong, E., Freak‐Poli, R., Walls, H. L., & Peeters, A. (2012). Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta‐analysis. Obesity Reviews, 13(5), 456-468. https://doi.org/10.1111/j.1467-789X.2011.00970.x

Bahat, G., Tufan, F., Saka, B., Akin, S., Ozkaya, H., Yucel, N., Erten, N., & Karan, M. A. (2012). Which body mass index (BMI) is better in the elderly for functional status? Archives of Gerontology and Geriatrics, 54(1), 78-81. https://doi.org/10.1016/j.archger.2011.04.019

Balzi, D., Lauretani, F., Barchielli, A., Ferrucci, L., Bandinelli, S., Buiatti, E., Milaneschi, Y., & Guralnik, J. M. (2010). Risk factors for disability in older persons over 3-year follow-up. Age and Ageing, 39(1), 92–98. https://doi.org/10.1093/ageing/afp209

Bolaños, S.M., & Helo, G.F. (2015). Depresión en el adulto mayor costarricense y su relación con la autopercepción del estado de salud y desempeño funcional. Revista Clínica de la Escuela de Medicina de la Universidad de Costa Rica, 5(4), 78-87. https://revistas.ucr.ac.cr/index.php/clinica/article/view/20777

Brinkley, T. E., Leng, X., Miller, M. E., Kitzman, D. W., Pahor, M., Berry, M. J., Marsh, A. P., Kritchevsky, S. B., & Nicklas, B. J. (2009). Chronic inflammation is associated with low physical function in older adults across multiple comorbidities. The journals of gerontology. Series A, Biological sciences and medical sciences, 64(4), 455–461. https://doi.org/10.1093/gerona/gln038

Cawthon, P. M., Fink, H. A., Barrett-Connor, E., Cauley, J. A., Dam, T. T., Lewis, C. E., Marshall, L. M., Orwoll, E. S., Cummings, S. R., & Osteoporotic Fractures in Men Research Group (2007). Alcohol use, physical performance, and functional limitations in older men. Journal of the American Geriatrics Society, 55(2), 212–220. https://doi.org/10.1111/j.1532-5415.2007.01062.x

Chanti-Ketterl, M., Gamaldo, A., Andel, R., & Thorpe, R. J., Jr (2018). The Association Between Lipoproteins, Disability, and Physical Function Among Older Costa Rican Adults. Journal of aging and health, 30(5), 758–777. https://doi.org/10.1177/0898264317690866

Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Jr., Roccella, E. J., & the National Heart Blood Institute Joint National Committee on Prevention. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA, 289(19), 2560–2572. https://doi.org/10.1001/jama.289.19.2560

Chung, H. Y., Cesari, M., Anton, S., Marzetti, E., Giovannini, S., Seo, A. Y., Carter, C., Yu, B. P., & Leeuwenburgh, C. (2009). Molecular inflammation: underpinnings of aging and age-related diseases. Ageing Research Reviews, 8(1), 18–30. https://doi.org/10.1016/j.arr.2008.07.002

Cohen-Mansfield J. (2016). Predictors of Smoking Cessation in Old-Old Age. Nicotine & Tobacco Research, 18(7), 1675–1679. https://doi.org/10.1093/ntr/ntw011

Connolly, D., Garvey, J., & McKee, G. (2017). Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA). Disability and rehabilitation, 39(8), 809–816. https://doi.org/10.3109/09638288.2016.1161848

Covinsky, K. E., Lindquist, K., Dunlop, D. D., & Yelin, E. (2009). Pain, functional limitations, and aging. Journal of the American Geriatrics Society, 57(9), 1556–1561. https://doi.org/10.1111/j.1532-5415.2009.02388.x

Ćwirlej-Sozańska, A., Wiśniowska-Szurlej, A., Wilmowska-Pietruszyńska, A., & Sozański, B. (2019). Determinants of ADL and IADL disability in older adults in southeastern Poland. BMC geriatrics, 19(1), 297. https://doi.org/10.1186/s12877-019-1319-4

Fong J. H. (2019). Disability incidence and functional decline among older adults with major chronic diseases. BMC Geriatrics, 19(1), 323. https://doi.org/10.1186/s12877-019-1348-z

Fong, T. G., Gleason, L. J., Wong, B., Habtemariam, D., Jones, R. N., Schmitt, E. M., de Rooij, S. E., Saczynski, J. S., Gross, A. L., Bean, J. F., Brown, C. J., Fick, D. M., Gruber-Baldini, A. L., O'Connor, M., Tabloski, P. A., Marcantonio, E. R., & Inouye, S. K. (2015). Cognitive and Physical Demands of Activities of Daily Living in Older Adults: Validation of Expert Panel Ratings. PM&R: The Journal of Injury, Function, and Rehabilitation, 7(7), 727–735. https://doi.org/10.1016/j.pmrj.2015.01.018

Francisco, P. M. S. B., Marques, P. D. P., Borim, F. S. A., Torres, S. F., & Neri, A. L. (2018). Disability relating to instrumental activities of daily living in the elderly with rheumatic diseases. Revista Brasileira de Geriatria e Gerontologia, 21, 570-578. https://doi.org/10.1590/1981-22562018021.180089

Haas, A. L., Eng, C., Dowling, G., Schmitt, E., & Hall, S. M. (2005). The relationship between smoking history and current functioning in disabled community-living older adults. Annals of Behavioral Medicine, 29(3). https://doi.org/10.1207/s15324796abm2903_2

Haghgoo, H. A., Pazuki, E. S., Hosseini, A. S., & Rassafiani, M. (2013). Depression, activities of daily living and quality of life in patients with stroke. Journal of the Neurological Sciences, 328(1-2), 87–91. https://doi.org/10.1016/j.jns.2013.02.027

Haren, M. T., Malmstrom, T. K., Miller, D. K., Patrick, P., Perry, H. M., 3rd, Herning, M. M., Banks, W. A., & Morley, J. E. (2010). Higher C-reactive protein and soluble tumor necrosis factor receptor levels are associated with poor physical function and disability: a cross-sectional analysis of a cohort of late middle-aged African Americans. The journals of gerontology. Series A, Biological sciences and medical sciences, 65(3), 274–281. https://doi.org/10.1093/gerona/glp148

Himes, C. L., & Reynolds, S. L. (2012). Effect of obesity on falls, injury, and disability. Journal of the American Geriatrics Society, 60(1), 124-129. https://www.maxwell.syr.edu/uploadedFiles/Himes%20study.pdf

Hootman, J. M., Helmick, C. G., & Brady, T. J. (2012). A public health approach to addressing arthritis in older adults: the most common cause of disability. American journal of public health, 102(3), 426–433. https://doi.org/10.2105/AJPH.2011.300423

Hu, Y., Pikhart, H., Malyutina, S., Pajak, A., Kubinova, R., Nikitin, Y., Peasey, A., Marmot, M., & Bobak, M. (2015). Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: Results from the HAPIEE study. Age and Ageing, 44(1), 84-89. https://doi.org/10.1093/ageing/afu083

Hung, W. W., Ross, J. S., Boockvar, K. S., & Siu, A. L. (2012). Association of chronic diseases and impairments with disability in older adults: a decade of change? Medical Care, 50(6), 501–507. https://doi.org/10.1097/MLR.0b013e318245a0e0

James, B. D., Boyle, P. A., Buchman, A. S., & Bennett, D. A. (2011). Relation of late-life social activity with incident disability among community-dwelling older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(4), 467–473. https://doi.org/10.1093/gerona/glq231

Kalyani, R. R., Saudek, C. D., Brancati, F. L., & Selvin, E. (2010). Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Diabetes Care, 33(5), 1055-1060. https://doi.org/10.2337/dc09-1597

Kuo, H. K., Bean, J. F., Yen, C. J., & Leveille, S. G. (2006). Linking C-reactive protein to late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(4), 380-387. https://doi.org/10.1093/gerona/61.4.380

León-Muñoz, L. M., Guallar-Castillón, P., García-Esquinas, E., Galán, I., & Rodríguez-Artalejo, F. (2017). Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults. Clinical Nutrition, 36(3), 831–838. https://doi.org/10.1016/j.clnu.2016.05.005

Lin, S. F., Beck, A. N., Finch, B. K., Hummer, R. A., & Masters, R. K. (2012). Trends in US older adult disability: exploring age, period, and cohort effects. American Journal of Public Health, 102(11), 2157–2163. https://doi.org/10.2105/AJPH.2011.300602

Martin, L. G., Zimmer, Z., & Hurng, B. S. (2011). Trends in late-life disability in Taiwan, 1989-2007: the roles of education, environment, and technology. Population Studies, 65(3), 289–304. https://doi.org/10.1080/00324728.2011.604730

Millán-Calenti, J. C., Tubío, J., Pita-Fernández, S., González-Abraldes, I., Lorenzo, T., Fernández-Arruty, T., & Maseda, A. (2010). Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Archives of gerontology and geriatrics, 50(3), 306-310. https://doi.org/10.1016/j.archger.2009.04.017

Palmer, R. F., Espino, D. V., Dergance, J. M., Becho, J., & Markides, K. (2012). The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans. Age and Ageing, 41(6), 752-758. https://doi.org/10.1093/ageing/afs106

Patel, R., Srivastava, S., Kumar, P., Chauhan, S., Govindu, M. D., & Simon, D. J. (2021). Socio-economic inequality in functional disability and impairments with focus on Instrumental Activity of Daily Living: A Study on Older Adults in India. BMC Public Health, 21, 1541. https://doi.org/10.1186/s12889-021-11591-1

Rosero-Bixby, L., Dow, W.H., & Fernández, X. (2013). CRELES: Costa Rican Longevity and Healthy Aging Study. Methods, Wave 1. Berkeley, CA: Department of Demography, University of California, Berkeley. http://www.creles.berkeley.edu/pdf/Methods_w1.pdf

Sousa, A. C., Zunzunegui, M. V., Li, A., Phillips, S. P., Guralnik, J. M., & Guerra, R. O. (2016). Association between C-reactive protein and physical performance in older populations: results from the International Mobility in Aging Study (IMIAS). Age Ageing, 45(2), 274-280. https://doi.org/10.1093/ageing/afv202

Spira, A. P., Covinsky, K., Rebok, G. W., Punjabi, N. M., Stone, K. L., Hillier, T. A., Ensrud, K. E., & Yaffe, K. (2012). Poor sleep quality and functional decline in older women. Journal of the American Geriatrics Society, 60(6), 1092–1098. https://doi.org/10.1111/j.1532-5415.2012.03968.x

Spira, A. P., Kaufmann, C. N., Kasper, J. D., Ohayon, M. M., Rebok, G. W., Skidmore, E., Parisi, J. M., & Reynolds, C. F., 3rd (2014). Association between insomnia symptoms and functional status in U.S. older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 69(1), S35–S41. https://doi.org/10.1093/geronb/gbu116

Stenholm, S., Kronholm, E., Sainio, P., Borodulin, K., Era, P., Fogelholm, M., Partonen, T., Porkka-Heiskanen, T., & Koskinen, S. (2010). Sleep-related factors and mobility in older men and women. The journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 65(6), 649–657. https://doi.org/10.1093/gerona/glq017

Tak, E., Kuiper, R., Chorus, A., & Hopman, M. (2013). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Research Reviews, 12(1), 329–338. https://doi.org/10.1016/j.arr.2012.10.001

Tas, U., Verhagen, A. P., Bierma-Zeinstra, S. M., Odding, E., & Koes, B. W. (2007). Prognostic factors of disability in older people: a systematic review. The British Journal of General Practice, 57(537), 319–323. https://bjgp.org/content/bjgp/57/537/319.full.pdf

Thompson, W. W., Zack, M. M., Krahn, G. L., Andresen, E. M., & Barile, J. P. (2012). Health-related quality of life among older adults with and without functional limitations. American Journal of Public Health, 102(3), 496–502. https://doi.org/10.2105/AJPH.2011.300500

Tomioka, K., Kurumatani, N., & Hosoi, H. (2017). Self-rated health predicts decline in instrumental activities of daily living among high-functioning community-dwelling older people. Age and Ageing, 46(2), 265–270. https://doi.org/10.1093/ageing/afw164

Tsou, M. T. (2013). Prevalence and risk factors for insomnia in community-dwelling elderly in northern Taiwan. Journal of Clinical Gerontology and Geriatrics, 4(3), 75-79. https://doi.org/10.1016/j.jcgg.2013.02.002

Ulate, X. R., & Sánchez, M. B. (2015). Identificación de los factores más importantes que influyen en el nivel de independencia de los nonagenarios y centenarios costarricenses. Revista Clínica de la Escuela de Medicina de la Universidad de Costa Rica, 5(4), 88-100. https://revistas.ucr.ac.cr/index.php/clinica/article/view/20778

Vaish, K., Patra, S., & Chhabra, P. (2020). Functional disability among elderly: A community-based cross-sectional study. Journal of Family Medicine and Primary Care, 9(1), 253–258. https://doi.org/10.4103/jfmpc.jfmpc_728_19

Verghese, J., Holtzer, R., Lipton, R. B., & Wang, C. (2012). High-sensitivity C-reactive protein and mobility disability in older adults. Age Ageing, 41(4), 541-545. https://doi.org/10.1093/ageing/afs038

Vermeulen, J., Neyens, J. C., van Rossum, E., Spreeuwenberg, M. D., & de Witte, L. P. (2011). Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatrics, 11, 33. https://doi.org/10.1186/1471-2318-11-33

Woods, J. A., Wilund, K. R., Martin, S. A., & Kistler, B. M. (2012). Exercise, inflammation and aging. Aging and Disease, 3(1), 130–140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320801/

Zhang, Y., Xiong, Y., Yu, Q., Shen, S., Chen, L., & Lei, X. (2021). The activity of daily living (ADL) subgroups and health impairment among Chinese elderly: a latent profile analysis. BMC geriatrics, 21(1), 1-13. https://doi.org/10.1186/s12877-020-01986-x



How to Cite

Aguilar Fernández, E., & Carballo Alfaro, A. M. . (2022). Factors associated with disability in basic and instrumental activities of daily living in Costa Rican residents aged 60 and over. UNED Research Journal, 14(1), e3838. https://doi.org/10.22458/urj.v14i1.3838



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