SUBGROUPS OF FUNCTIONAL INDEPENDENCE IN COMMUNITY-DWELLING OLDER PEOPLE; A CLUSTER ANALYSIS

E. Molenaar^1,2, D.-J. Barten¹, A. de Hoop^1,2,3, N. Bleijenberg^4,5, N. de Wit^4,5, C. Veenhof^1,2

¹Utrecht University of Applied Sciences, Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht, Netherlands, ²University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, Utrecht, Netherlands, ³University of Applied Sciences Utrecht, Research Group Innovative Testing in Life Sciences and Chemistry, Research Center for Healthy and Sustainable Living, Utrecht, Netherlands, ⁴University Medical Center Utrecht, Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands, ⁵Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands

Background: The concept of Functional Independence (FI) plays an important role in maintaining functional ability in older persons. It is defined as ‘functioning physically safe and independent from other persons, within one’s context”. FI is a dynamic and complex concept in which physical capacity, coping style, health literacy, fall history, and receiving professional help are related. The Core Outcome Set Functional Independence (COSFI) was recently developed to determine older persons’ levels of FI. It has shown that there are large individual differences in the level of FI between older persons which challenges healthcare professionals to adapt their support to older persons’ personal needs. Insight into clinically relevant subgroups of FI could be a first step in providing personalized support to community-dwelling older persons to maintain their level of FI.

Purpose: To identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older persons and subsequently describe them according to individual characteristics.

Methods: This study has an observational, cross-sectional design. Previously collected data within the overarching research project on the assessment of FI in community-dwelling older persons in the city of Utrecht, the Netherlands was used for secondary analysis. Agglomerative hierarchical cluster analysis, based on the COSFI scores, was used to identify clusters of FI in community-dwelling older persons. In addition, to validate the cluster solution, we compared COSFI outcomes between subgroups of FI. Additionally, a sensitivity analysis based on descriptive characteristics of the older persons identified by the distinctive clusters was performed to validate these clusters to clinically relevant subgroups of FI. A one-way ANOVA was used to examine differences in population characteristics between subgroups of FI. A p<0.05 was indicated as a statistical difference between the subgroups.

Results: A total of 153 community-dwelling older persons were included for analysis. Cluster analysis identified four distinctive clusters: 1. Physically strong, well Informed and educated, independent, non-faller, with limited reflective coping style, 2. Physically strong however a limited versatility coping style and health literacy level, 3. Physically somewhat limited, sufficient coping styles, however, do receive professional help, 4. Physically limited, insufficient coping styles, receives professional help. Least level of functional independence in total. Comparison between these subgroups showed significant differences in COSFI outcomes. Additionally sensitivity analysis on descriptive characteristics (age, gender, educational level, presence of co-morbidity) showed significant differences between subgroups.

Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain or domains are (most) affected.

Implications: By providing insight into the affected domain(s) of each FI subgroup this study encourages the development of adequate healthcare policy, tailor treatment, and supports interprofessional collaboration.

Funding acknowledgements: Funding is not applicable

Keywords:
(Functional) Independence
Older persons
Prevention

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Older people
Primary health care

Did this work require ethics approval? Yes

Institution: Utrecht University of Applied Sciences

Committee: Research Ethics Committee of Utrecht University of Applied Sciences

Ethics number: 85_000_2019