Multidimensional evaluation of home-dwelling elderly: the impact of medical and social factors on health status indices

Since 1980 the WHO has proposed at least tree indices to characterize health status (impairment, disease, disability). Their relationships have been examined in some chronic diseases, but little is known about elderly at risk of frailty. We studied the influence of gender, age and living conditions on these indices and on their relationships. A sample of 100 home-dwelling elderly subjects underwent a multidimensional assessment at home to collect biological, symptomatic and functional measures. The sample consists of 48 males and 47 females, their mean age was 80.2 years, the mean schooling was 4.7 years. Living at home alone 14%, with spouse 60%, other 26%. Applying a MANOVA that considered the above mentioned items as factors and the biological, symptomatic and functional measures as dependent variables, no significant difference was found in biological measures, whereas the interaction of (i) gender and living conditions, (ii) gender and age classes showed differences in affective symptoms. Moreover, gender alone resulted a significant source of differences in instrumental activities of daily living (IADL). To assay the impact of biological, symptomatic scores on disability, a backward linear regression was applied. The principal index of postural control, Tinetti scale score, alone explained 50% of variance in activities of daily living (ADL), this index together with the measures, respectively, of cognitive functioning (Camcog score) and behavioral profile neuropsychological inventory (NPI) score resulted to be the main sources of the IADL variance. These preliminary data allow us to identify both medical and social factors able to enhance the risk of frailty; is worth wile to stress that prevention programs could be targeted on possible modification of these factors.