Social participation and independence in activities of daily living: a cross sectional study

BACKGROUND: It is today widely accepted that participation in social activities contributes towards successful ageing whilst, at the same time, maintaining independence in the activities of daily living (ADLs) is the sine qua non for achieving that end. This study looks at people aged 65 and over living in an urban area in Spain who retain the ability to attend Social Centres providing recreational facilities. The aim of this paper is to quantify independence and identify the risk factors involved in its deterioration. METHODS: The sample size was calculated using the equation for proportions in finite populations based on a random proportional sample type, absolute error (e) = 0.05, α = 0.05, β = 0.1, p = q = 0.5. Two-stage sampling was used. In the first place, the population was stratified by residence and a Social Centre was randomly chosen for each district. In the second stage, individuals were selected in a simple random sample without replacement in proportion to the number of members at each social centre. A multivariate logistical regression analysis takes functional ADL capacity as the dependent variable. The choice of predictive variables was made using a bivariate correlation matrix. Among the estimators obtained, Nagelkerke's R(2 )coefficient, and the Odds ratio (CI 95%) were considered. Sensitivity and 1-specificity were adopted to present the results in graphic form. RESULTS: Out of this sample, 63.7% were fully capable of carrying out ADLs, while the main factors contributing to deterioration, identified on the basis of a logistic regression model, are in order of importance, poor physical health, poor mental health, age (above 75 years) and gender (female). The model employed has a predictive value of 88% and 92% (depending on the age range considered) with regard to the independence in ADLs. CONCLUSION: A review of the few Spanish works using similar methodology shows that the percentage of non-institutionalised persons who are independent enough to carry out ADLs is considerably lower than that found in this study of socially-active persons. Participation in recreational activities as part of a community may delay the onset of the dependence associated with ageing.