Caring for the Elderly

Informal arrangements like familial support can go a long way in addressing the needs of the older persons vis-à-vis the Activities of Daily Living
BY DR SUNEELA GARG & DR ARCHANA RAMALINGAM

Many senior citizens are able to live a meaningful and independent life, but at the same time the fact remains that there are others who are unable to do so. The notion of functionality among elderly involves the ability to perform self-care, self- maintenance and physical activity. Under the International Classification of Functioning, Disability and Health (ICF), which has its theoretical underpinnings in social models of disability, physical functioning and disability are considered outcomes of interactions between health conditions and contextual factors.

 

The Activities of Daily Living

The Activities of Daily Living (ADL) is an umbrella term relating to self-care, comprising those activities that people undertake routinely in their everyday life. There are other types of activities which are domestic and community activities or Instrumental ADL (IADL).

The ADL and IADL have emerged as the most common approaches in empirical assessments of functionality among the elderly and are considered to be befitting the ICF framework.

The Activities of Daily Living or AD Lsare the basic tasks of everyday life such as feeding, bathing, dressing, toileting, mobility (i.e., getting in and out of a bed or chair) and continence (controlling bladder and bowel movement). When people are unable to perform  these  activities,  they  need assistance either from others or from mechanical devices or both. Apart from providing objective assessments of the ability of the elderly to execute basic daily activities and the level of difficulty in executing such tasks, ADLs have been found as an important predictor of home or institutional care, living arrangements, health expenses and mortality.

Functional disabilities in terms of ADLs, when assessed through household surveys also provide understanding of socio-economic and demographic disparities in such functional limitations; the extent of familial support to those unable to execute the ADL functions gives an idea about how such informal arrangements   can   be   expected   to address the care needs.

A survey conducted by UNFPA (United Nations Population Fund) found that around eight per cent of the elderly require assistance to perform one of the activities. The study also found that one per cent of the elderly requires assistance in all the ADL activities. Among activities, the highest percentage of the elderly faces some difficulty in bathing. The next in order is toileting, dressing and mobility. Invariably, women perform poorer than men in performing all the ADLs. The rural elderly appear to be facing more difficulty with ADL activities than the urban elderly.

Instrumental activities of daily living Apart from ADLs, the ‘Instrumental Activities of Daily Living’ (IADLs) constitute an important dimension of functionallimitations or disability among the elderly. The IADLs are designed to involve a more complex set of functioning than the ADL-based functional disability measures; they require more skill, judgement and independence than the ADLs. Accordingly, it is believed that IADL disabilities – in one or more dimensions – are more widely prevalent than ADL disabilities. Lawton        and       Brody,       geriatric researchers, had specified eight domains

A survey conducted by UNFPA (United Nations Population Fund) found that around eight per cent of the elderly require assistance to perform one of the activities.  The study also found that one per cent of the elderly requires assistance in all the ADL activities of functions under IADL. The eight domains, all of which were covered in the household survey, included the ability to telephone, go shopping, food preparation, housekeeping, doing laundry, travelling, responsibility for own medication and ability to handle finances.

In a survey done by UNFPA it was found that nearly 5% of elderly could not perform any of the activities of IADL.

Any loss or abnormality of psychological, physiological or anatomical structure or function is impaired. Disability is any restriction or lack of ability to perform an activity in a manner or within the range considered normal for a human being. The single most important disability seen among 60% of the elderly is visual disability.

(The writers are Director, Professor/ Senior Resident at Department of Community Medicine, Maulana Azad Medical College, New Delhi)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dimensions – are more widely prevalent than ADL disabilities.

Lawton        and       Brody,       geriatric researchers, had specified eight domains

 

A survey conducted by UNFPA (United Nations Population Fund) found that around eight per cent of the elderly require assistance to perform one of the activities.  The study also found that one per cent of the elderly requires assistance in all the ADL activities

of functions under IADL. The eight domains, all of which were covered in the household survey, included the ability to telephone, go shopping, food preparation, housekeeping, doing laundry, travelling,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr Suneela Garg                                      Dr Archana Ramalingam

 

address the care needs.

A survey conducted by UNFPA (United Nations Population Fund) found that around eight per cent of the elderly require assistance to perform one of the