Epidemiology of elderly dependency in Tunisia. HSHS study 7

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Published Dec 24, 2022
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Vol. 100 No. 12 (2022): Issue Dec.2022

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Hala Rouis
Asma Ben Abdelaziz
Youssef Zanina
Faten Ben Yahia
Mohamed Khelil
Chokri Zoghlami
Nabila Ben Rejeb
Asma Omezzine
Ali Bouslama
Ahmed Ben Abdelaziz

Abstract

Aim: Measure the functional autonomy of elderly people and identify its components and determinants in the HSHS (Hammam-Sousse
Sahloul Heart Study) population (phase 2009, Tunisia)

Methods: This study was concerned with the quality of life of elderly people aged 65 years or more, living at home from the HSHS cohort
divided into two groups: young-old (65-74 years old) and old-old (≥75 years old). The autonomy was assessed using the “Activities of Daily
Living” (ADL) scale ranging from 0 to 6, the “Instrumental Activities of Daily Living” (IADL) scale ranging from 0 to 8 and, the combined
scale ranging from zero to 14, iso-weighted at one point per activity. Autonomy in daily activities was retained for an ADL score=6, and
an IADL score (F=8; H=5). Subjects with an overall score (sum of ADL and IADL) of 10-14 points were considered globally autonomous.

Results: The population study was predominantly female (sex-ratio=0,6) with an important proportion of old-old (M=43%, F=37%). Autonomy rates were by ADL (M=57.4%, F=36.1%, p<10-2), IADL (M=16%, F=23.9%), and by combined score (M=60.6%, F=69%, p=NS). The
typology of dependency was dominated by transferring (M=35%, F=61%) and bathing (M=14%, F=19%) for ADL activities, and shopping
(M=36%, F=49%) and the use of means of transport (M=22%, F=43%) for IADL activities. After adjustment, autonomy in daily activities
was attributed to two independent factors: male sex (ORa=3.98, CI95% [1.328-11.971]) and age group 65-75 (ORa=4.04, CI95% [2.039-
8.025]). Autonomy in instrumental activities was associated with age group (ORa=31.5, CI95% [4.087-233.514]). Finally, overall autonomy
(current and instrumental) was associated independently after logistic regression, with four independent factors, two of which were not
modifiable: being female (ORa=3.1, CI95% [1.2-8.1]) and 65 to 75 years (ORa=6.2, CI95% [3.1-12.3]) and two modifiable factors: no
recent hospitalization (ORa=3.8, CI95% [1.4-10.4]) and a sufficient level of physical activity (ORa=2.6, CI95% [1.3-5.3]).

Conclusion: The physical dependency rate of the elderly is very high in Tunisia. The promotion of physical activity, the extension of similar
studies and the development of could improve the support of these people.

Keywords:

Activities of Daily Living - Aged - Disability - Prevalence - risk factors - multi-variable analysis - Tunisia

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