Paper
Friday, July 23, 2004
Relationship Among Chronic Illness, Functional Limitations, and Health Outcomes in Community-Dwelling Older Adults
Elizabeth Kay Tanner, PhD, RN, Johns Hopkins School of Nursing, Baltimore, MD, USA
| Learning Objective #1: Identify the relationship among health status, functional limitations, social support, and depression in community-dwelling older adults |
| Learning Objective #2: Analyze predictor models that explain depression in community-dwelling older adults |
Design: The research design was correlational and data collection occurred over five years. Sample: Participants included 535 homebound, community-dwelling adults living in rural areas. The sample was 76.1 % female and 71.8 % white, and the mean level of education was 7.9. The mean age was 78.5 years, and 61.5% of the sample lived alone. Medicaid was the primary method of financing health care (56.8%). Chronic diseases included hypertension (74.6%), arthritis (72.3 %), heart disease (51.5%), diabetes mellitus (31.8%) and respiratory disease (26.8%;). Measures: Data collection included: socio-demographic variables; history of chronic diseases, functional status (ADLs and IADLs), and psychosocial variables, including depression, perceived loneliness, social isolation, and family support (Tanner Family Support Scale-TFSS). Methods: Participants were interviewed in their homes by registered nurses who were trained in interviewing techniques. Findings: Forty-two per cent reported functional independence, while 77.5% reported loneliness, and only 54.5% reported having someone to call for help. The TFSS was used to determine satisfaction with family support, and Cronbach’s alpha was high for the scale (0.87). Depression correlated with TFSS (inversely), social isolation and loneliness (positively). Using Logistic Regression, adjusted odds ratios indicated that those who were depressed were more likely to be lonely, less independent with ADLs, less satisfied with family support (TFSS) and diabetic than those who were not depressed. Conclusions: Older adults who are socially isolated and less satisfied with family support are more likely to be depressed. Diabetes, limitations in ADLs, loneliness and negative perceptions of family support are important predictors of depression. Implications: Dissatisfaction with social relationships is recognized as stressful and is associated with disability in relation to health outcomes. Facilitating satisfactory family support by introducing health-counseling interventions directed at the client and family offers a logical strategy for assisting older adults to manage health outcomes
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Sigma Theta Tau International
July 22-24, 2004