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elderly people ; functional ability ; family home ; nursing home
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INTRODUCTION The problems of aging and old age have become the subject of many studies and publications in recent years. Great interest in this area results from the dynamics of the process of aging of societies and a rapid increase in the percentage of old people. From the point of view of the care of the elderly, the study of the functional capacity of the elderly is an important element, necessary for planning care, as well as adapting medical services to the condition of the elderly. The increase in the elderly population poses a challenge to the health and social care system but to the economy and the state as well. So far, the studies conducted in the field of assessment of functional capacity of the elderly have included sociodemographic variables. However, there are few studies assessing psychosocial variables and the presence of comorbidities. Also, the number of publications on the functional capacity of older people living in nursing homes is also still insufficient. PURPOSE OF THE WORK The purpose of this study is to compare the functional performance and selected psychosocial factors of persons over 65 years of age living in a nursing home and a family home. MATERIAL AND METHODS The study included 500 people, including 250 living in Nursing Homes (study group) and 250 living in a family home (comparison group). The study was conducted from March 2016 to Novem ; ber 2018, preceded by a pilot study. a diagnostic survey method was used to collect data using standardized research tools: Abbreviated Mental Capacity Test (AMTS), Groningen Activity Restriction Scale (GARS), Social Support List in the Elderly Population in Poland SSL 12-I, Geriatric Depression Scale (GDS), Satisfaction with Life Scale (SWLS), a scale to measure loneliness, a scale to assess health status (5-point balanced comparison scale) and the author's survey questionnaire. Analysis of the collected data was performed in the program R, version 3.6.3. Analysis of quantitative variables was performed by calculating the mean, standard deviation, median, quartiles, minimum and maximum. Analysis of qualitative variables was performed by calculating the number and percentage of occurrences of each value. Comparison of the values of qualitative variables across groups was performed using the chi-square test (with Yates' correction for 2x2 tables) or Fisher's exact test where low expected numbers appeared in the tables. Comparisons of values of quantitative variables in the two groups were made using the Mann-Whitney test. Comparison of values of quantitative variables in three or more groups was performed using the Kruskal-Wallis test. When statistically significant differences were detected, post-hoc analysis with Dunn's test was performed to identify statistically significan ; tly different groups. Correlations between quantitative variables were analyzed using Spearman correlation coefficient. a significance level of α=0.05 (p < 0.05) was used in the analysis. RESULTS Higher performance in general ability to perform activities of daily living was presented by subjects living in the family home. Scores on the GARS and subscales ADL and IADL were significantly lower in the group of subjects living in the family home, which indicates greater functional freedom in performing general, simple and complex activities of daily living in this group (p<0.001). Statistical analysis showed a statistically significant relationship between the level of functional fitness and self-rated health status (p<0.001). Respondents with higher level of functional ability presented higher self-assessment of health status. Individuals living in the family home were significantly more likely to rate their health status higher than the nursing home residents (p˂0.001, r˃0). Those with higher levels of functional ability in both study groups were statistically significantly more likely to be free of depressive symptoms (p˂0.001, r˃0). Respondents living in the family home, who showed higher levels of functional ability in general, simple and complex activities of daily living, were statistically significantly more likely to receive higher levels of social support than the nur ; sing home residents (p˂0.001, r˃0). The study showed that subjects with higher levels of functional ability in general simple and complex activities of daily living were statistically significantly more likely to present higher levels of life satisfaction (p˂0.001, r<0). In the group of people living in the nursing homes in terms of complex daily activities, the relationship was not statistically significant (p˃0.05, r<0). It was shown that the subjects living in the family home presenting a higher level of functional ability showed lower feelings of loneliness (p<0.001, r˃0). The group of the nursing residents showed no significant relationship in this regard (p˃0.05, r˃0). Statistical analysis showed a relationship between the level of functional ability of the subjects and selected socio-demographic variables. Statistical analysis showed a relationship between the level of functional fitness of the subjects and selected sociodemographic variables. The age of the subjects had an impact on the functional ability of the study group. Respondents residing in a nursing home presented a higher functional ability in general and basic daily activities in the group of people aged 75-89, while the ability to perform complex daily activities was higher in the group of people 65-74 years of age. This relationship was not statistically significant (p˃0.05). Functional ability of the resp ; ondents living in the family home in each range of activities was significantly higher in the group of people aged 65-74 than in other groups (p<0.05). In the group of people living in the family home, the higher the education the respondents had the higher the fitness they showed (p˂0.05). In the study group of people living in a nursing home, no such relationship was shown. In the group of people living in the family home, education had no effect on the functional capacity of the respondents. In the analyzed group no correlation was found between the number of diseases in the nursing home residents and their level of functional ability (p>0.05). In the subjects living in the family home, the number of co morbidities was found to correlate significantly (p˂0.05) and positively (r˃0) with GARS, ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living). Gender had no effect on the functional ability of the subjects (p>0.05). CONCLUSIONS The elderly living in the family home are more independent in performing simple and complex activities of daily living compared to residents of nursing homes. They present higher self-assessment of health, higher level of life satisfaction, lower scores in geriatric depression rating scale, lower level of loneliness, higher level of received social support in everyday life, in difficult situations and higher self-ass ; essment of their value as a person providing support. The functional ability of the subjects is dependent on comorbidities, age and education. Improving functional ability and maintaining independence in care for people over 65 years of age requires systemic measures in the area of medical and social care aimed at healthy lifestyles and social support.
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Rada Dyscypliny Nauki o zdrowiu