Factors influencing living space utilization among older Afro-Colombian adults.

OBJECTIVES: Investigate the factors influencing life space utilization in older Afro-descendant adults residing in Tumaco, Colombia - a marginalized region of the country. DESIGN: This cross-sectional study included 388 Afro-descendant older adults. The study assessed living space using the Life Space Assessment (LSA) scale and collected demographic data. Cognitive levels were measured with the Mini-Mental State Examination (MMSE), and depressive symptoms were assessed using the Yesavage scale. Socio-emotional indicators were determined with the Medical Outcomes Study (MOS). The research employed linear and logistic regression models for data analysis. RESULTS: On average, participants scored 27.0 on the LSA scale. A lack of perceived income resulted in a 10.44-point decrease on the LSA scale. For each unit increase in the MOS-Instrumental Dimension score, the LSA score increased by 0.52 points (95% CI 0.17-0.87). As for cognitive performance (MMSE scale), each one-point increase resulted in a 0.69 decrease in the LSA score (95% CI -1.25 to -0.12). CONCLUSION: Socioeconomic disadvantages limit living space utilization, particularly in the Afro-descendant population. Yet, social support can enhance living space use despite environmental and economic constraints.

Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia.

INTRODUCTION: Ethnicity in Latin America is a factor of poverty and social exclusion. Like in developed countries, demographic, medical, psychosocial, global cognitive, and functional variables interact in a complex relationship on the elderly population. Such interaction should be considered to determine cognitive and functional performance using screening tests. The aim of this study was to evaluate the demographic, medical, and psychosocial factors affecting global cognitive performance as well as functional activities. METHODS: The study was conducted in a Colombian elderly indigenous population which included a sample of 518 adults. This research employed a structural model of latent factors to assess the effects of demographic, medical, and psychosocial factors on cognitive and functional performance. The model was estimated by least squares and used a maximum-likelihood procedure, and it was determined RMSEA, TLI, and CFI to assess the model's goodness of fit. The categorical variables used in the model were as follows: (1) demographics, (2) psychosocial factors, (3) medical condition, (4) global cognition, and (5) functional factors. RESULTS: Demographics, in addition to medical and psychosocial factors, were related to global cognition and functional factors (RMSEA = 0.051, CI 90% 0.045-0.057, CFI = 0.901, and TLI = 0.881). CONCLUSION: These results provide strong evidence about the complex relationships among demographics, medical conditions, and psychosocial factors and their influence on global cognition and functional performance in Colombian indigenous elderly population.

Una herramienta de intervención eficaz en el adulto mayor institucionalizado

Introducción: El proceso de envejecimiento afecta el equilibrio y la movilidad de los adultos mayores institucionalizados, los cuales pueden adquirir independencia funcional gracias al ejercicio. Objetivo: Determinar el efecto de un programa de ejercicios anticaídas y desempeño físico funcional de los adultos mayores institucionalizados. Métodos: Se realizó un estudio de casos múltiples, de tipo preexperimental, prospectivo y longitudinal; además, un muestreo no probabilístico de 12 adultos mayores institucionalizados con registro de caídas durante 2015. La medición de equilibrio y desempeño físico se hizo antes y después de la aplicación del programa de ejercicios. Los datos se analizaron con el programa SPSS 22.0 y la prueba Shapiro-Wilk determinó la normalidad de las variables. Los test T de student y Wilcoxon verificaron el nivel de significancia y estadístico. D de Cohen midió la magnitud del efecto sobre la aplicación clínica. Para las características sociodemográficas y clínicas se utilizó un análisis bivariado exploratorio; y los análisis multivariados emplearon ANOVA y estadístico ETA 2. Resultados: Se determinaron cambios estadísticamente significativos en equilibrio y frecuencia de caídas con p = 0,05 y 0,008; y magnitudes del efecto grande d = 2,150 y d = 1,16, respectivamente. Las características sociodemográficas y clínicas no intervinieron en el efecto del programa sobre el equilibrio y el desempeño físico funcional. Conclusiones: La aplicación del programa anticaídas mejoró el equilibrio y disminuyó las caídas en adultos mayores institucionalizados.

Introduction: The aging process affects the balance and mobility of older adults living in an institution, who can acquire functional independence thanks to exercise. Objective: To determine the effect of a program of anti-fall exercises and functional physical performance of older adults living in an institution. Methods: A multi-case, pre-experimental, prospective and longitudinal study was carried out in a non-probabilistic sampling of 12 older adults living in an institution with a record of falls during 2015. Balance and physical performance were measured before and after the use of this program of exercises. The data was analyzed with SPSS 22.0 program and Shapiro-Wilk test determined the normality of the variables. Student's and Wilcoxon's T tests verified the level of significance and statistics. Cohen's D measured the magnitude of the effect on clinical application. For sociodemographic and clinical characteristics, an exploratory bivariate analysis was used, and the multivariate analyzes used ANOVA and ETA 2 statistic. Results: Statistically significant changes in balance and frequency of falls were determined with p = 0.05 and 0.008; and large effect sizes d = 2.150 and d = 1.16, respectively. Sociodemographic and clinical characteristics did not intervene in the effect of the program on balance and functional physical performance. Conclusions: The use of the anti-fall program improved balance and decreased falls in older adults living in an institution.

Síndrome de caídas y factores asociados en personas mayores indígenas de nariño, colombia

Objetivo: Determinar los factores asociados al síndrome de caída en un grupo de personas mayores indígenas. Material y Método: Estudio descriptivo transversal, realizado con 518 indígenas mayores de 60 años, que estimó la prevalencia del síndrome de caída durante el año 2019. Los instrumentos utilizados fueron entrevista demográfica y antecedentes médicos, Evaluación Mini Nutricional (MNA por su sigla en inglés) para evaluar estado nutricional, Mini Examen del Estado Mental (MMSE por su sigla en inglés) y The Rowland Universal Dementia Assessment Scale (RUDAS) para determinar nivel cognitivo; la sintomatología depresiva se evaluó con la Escala de Depresión Geriátrica de Yesavage; el nivel funcional se valoró con la escala de Actividades Instrumentales de la Vida Diaria IADL. Se utilizaron modelos de regresión logística multivariable para examinar la asociación entre las variables sociodemográficas y la presencia de morbilidades. Se construyeron perfiles de riesgo entre individuos para estimar la probabilidad de caer a través del análisis de clases latentes. Resultados: 35,9% de los participantes presentó al menos una caída. Hombres (OR 0,55 IC del 95%: 0,38-0,80), personas con hipertensión arterial (OR 3,4 IC del 95%: 1,4-8,2), enfermedad coronaria (OR 2,5 IC del 95%: 1,3 -5,0), artritis o artrosis (OR 1,5 IC del 95%: 1,0-2,0), personas con quejas de memoria (OR 1,6 95% CI 1,1-2,5) y dependencia funcional (OR 1,6 95% CI 1,1-2,2), mostraron una asociación con este síndrome. El perfil de riesgo mostró que los sujetos con mayor número de comorbilidades tenían mayor probabilidad de caídas (0,163). Conclusiones: La prevalencia del síndrome de caídas es similar a la reportada en estudios previos. Comorbilidades propias de la vejez mostraron relación con un mayor riesgo de caídas. Se observa una relación directamente proporcional entre la cantidad de comorbilidades y mayor riesgo de caídas.

Objective: To determine the factors associated with the fall syndrome in a group of indigenous older adults. Materials and Methods: Cross-sectional descriptive study carried out with 518 indigenous people over 60 years of age that estimated the prevalence of the fall syndrome during the year 2019. Research instruments included demographic interview and medical history, Mini Nutritional Assessment (MNA) to assess nutritional status, Mini-Mental State Examination (MMSE) and RUDAS to determine cognitive performance; depressive symptomatology was assessed with the Geriatric Depression Scale by Yesavage; functional level was assessed using Instrumental Activities of Daily Living scale (IADL). Multivariate logistic regression models were used to examine the association between sociodemographic variables and the presence of morbidities. Between-individual risk profiles were set up to estimate the probability of falling, using latent class analysis. Results: 35.9% of participants had at least suffered one fall. Men (OR 0.55 95% CI 0.38-0.80), people with high blood pressure (OR 3.4 95% CI 1.4-8.2), coronary heart disease (OR 2.5 95% CI 1.3 -5.0), arthritis or osteoarthritis (OR 1.5 95% CI 1.0-2.0), people with memory complaints (OR 1.6 95% CI 1.1-2.5) and functional dependency (OR 1.5 95% CI 1.0-2.2), showed an association with this syndrome. The risk profile showed that subjects with a greater number of comorbidities were more likely to suffer a fall (0.163). Conclusions: The prevalence of the falls syndrome is similar to that reported in previous studies. Comorbidities associated with old age showed a relationship with a higher risk of falls. A directly proportional relationship was observed between the number of comorbidities and the increased risk of falls.

Objetivo: Determinar os fatores associados à síndrome de queda em um grupo de idosos indígenas. Material e Métodos: Estudo descritivo transversal, realizado com 518 indígenas com mais de 60 anos de idade, que estimou a prevalência da síndrome de quedas durante o ano de 2019. Os instrumentos utilizados incluíram entrevista demográfica e histórico médico, Mini Avaliação Nutricional (MNA sigla em inglês) para avaliar o estado nutricional, Mini Exame do Estado Mental (MMSE sigla em inglês) e RUDAS para determinar o nível cognitivo; a sintomatologia depressiva foi avaliada com a escala de Depressão Geriátrica de Yesavage; o nível funcional foi avaliado com a escala Atividades Instrumentais de Vida Diária (AIVD). Modelos de regressão logística multivariada foram usados para examinar a associação entre variáveis sociodemográficas e a presença de morbidades. Perfis de risco entre indivíduos foram construídos para estimar a probabilidade de queda, por meio de análise de classe latente. Resultados: 35,9% dos participantes sofreram pelo menos uma queda. Homens (OR 0,55 IC 95% 0,38-0,80), pessoas com hipertensão arterial (OR 3,4 IC 95% 1,4-8,2), doença coronariana (OR 2,5 IC 95% 1,3-5,0), artrite ou osteoartrite (OR 1,5 IC 95% 1,0-2,0), pessoas com queixas de memória (OR 1,6 IC 95% 1,1-2,5) e dependência funcional (OR 1,5 IC 95% 1,0-2,2) apresentaram associação com essa síndrome. O perfil de risco mostrou que indivíduos com um número maior de comorbidades tinham maior probabilidade de cair (0,163). Conclusões: A prevalência da síndrome de quedas é semelhante à descrita em estudos anteriores. As comorbidades características da idade avançada mostraram uma relação com o aumento do risco de quedas. Observa-se uma relação diretamente proporcional entre o número de comorbidades e o aumento do risco de quedas.

Deterioro cognitivo y factores asociados en adultos mayores rurales / Cognitive deterioration and associated factors in rural elderly adults

Resumen El deterioro cognitivo es una condición clínica entre el envejecimiento normal y un probable proceso demencial, manifestado por pérdida de memoria mayor a la esperada para la edad, sin cumplir con criterios diagnósticos establecidos para la enfermedad de Alzheimer. Esta condición se presenta en personas con edad avanzada y con características demográficas, médicas y funcionales generalmente precarias, sobre todo en contextos rurales. El objetivo del presente estudio fue identificar los factores asociados con el deterioro cognitivo en un grupo de adultos mayores de contexto rural; a través de un estudio cuantitativo, transversal analítico, con fuente de información primaria, en 266 adultos mayores residentes en la zona rural del municipio de La Unión, Nariño, Colombia, empleando muestreo por conveniencia. Los factores sociodemográficos y el estado de salud se determinaron a través de una encuesta, la condición cognitiva se evaluó con el Minimental, el nivel emocional se valoró con la escala Yesavage y para la medición funcional se aplicó el cuestionario VIDA. Los resultados mostraron que el 51 % de los adultos mayores evaluados presentaron deterioro cognitivo. Respecto a las características sociodemográficas, el realizar oficios varios evidenció casi tres veces más riesgo (OR; 3.6; IC95 % 1.36 - 10.33) de tener implicación cognitiva. Asimismo, a nivel funcional se observó relación en actividades como preparación y toma de medicamentos con respecto a la incidencia de esta implicación mental. En conclusión, para el análisis del rendimiento cognitivo global en adultos mayores son relevantes los factores sociodemográficos y el estado funcional, más aún cuando se abordan en contexto rural.

Abstract Cognitive Impairment is a clinical condition between normal aging and a probable dementia process, generally manifested by memory loss greater than expected for the age, without meeting the established diagnostic criteria for Alzheimer's disease. This disease usually occurs in elderly people whose demographic, medical and functional characteristics are generally poor, the foregoing attributed mostly in rural contexts. The objective of the present study was to identify the factors associated with cognitive impairment in a group of senior citizens from a rural context through a quantitative, cross-sectional and descriptive methodological design, with a primary source of information, in 266 older adults living in the rural area of the municipality of La Unión, Nariño, using convenience sampling. For the inclusion criteria, the following aspects were taken into account: being an adult aged 60 years or more, belonging to the Elderly Program of this municipality, which is a social assistant program for elderly people created by the Colombian Government, and also voluntarily accepting participation in the study and signing the informed consent. The exclusion criteria were the presence of some medical, cognitive and functional implication that prevented the application of the protocol. In this way, variables such as sociodemographic factors, medical history specifically related to perception of health, present illness and current medications treatment were considered. Each component was addressed and evaluated through an interdisciplinary team. For the cognitive evaluation, the Mini-Mental State Examination (MMSE) was applied, in this case the cut-off point used was ≥24. Similarly, depressive symptoms were established with the Yesavage geriatric depression scale, taking into account three categories according to the total score obtained from the sum of the 15 items: from 0 to 5 normal, 6 to 10 moderate depression and from 11 to 15 severe depression. For the functional measurement, the VIDA (Daily Life of the Elderly) questionnaire was applied, the score is from 10 to 38 points, assesses the independent performance of 10 activities, rated by Likert scale with 3 to 4 responses. The results showed from a total sample made up of 266 participants, of which 51.5 % had cognitive impairment. The findings do not show a direct relationship with the demographic characteristics, however, the subjects evaluated 81 years or older, have twice the risk of cognitive impairment compared to those aged 60 to 65 years, likewise older adults in living in civil partnership, compared to singles ones. No dose response effect was seen in relation to schooling. The presence of a caregiver and that he is younger, in particular a grandson or nephew, could be related to having cognitive impairment. Older adults who perform various trades compared to farmers, had almost three times the risk (OR; 3.6; 95 % CI 1.36 - 10.33) of having cognitive impairment. There was no evidence of a relationship between the general health perception variables and cognitive impairment. Finally, the allusive results with the Life questionnaire. Only in questions 1 (Preparation and taking of medicines) and 2 (Use of the telephone) in the category of greater independence (value of 4) compared to those with more dependence (Value of 1 on the scale) did they indicate a relationship with the condition of cognitive involvement. A dose response effect is apparently seen with the preparation and taking of medications, use of the telephone, performance of household chores and maintenance. These findings could guide the design of strategies, intervention programs and the structuring of public policies. The main limitation of the research was its cross-sectional nature, which did not allow answering questions of a causal nature. In conclusion, for the analysis of global cognitive performance in the elderly, sociodemographic factors and functional status are relevant even more when they are approached in a rural context.

Apoyo social y uso de espacios de vida en la persona mayor en el contexto rural / Social Support and the Use of Life Spaces by Older Adults in the Rural Context

Introducción: El uso de espacios de vida cobra interés investigativo sobre el envejecimiento, por ser una medida de movilidad y participación social, pues refleja factores físicos, psicosociales y ambientales necesarios para el funcionamiento independiente. Objetivo: Identificar los factores asociados con el apoyo social y uso de los espacios de vida en el contexto rural. Métodos: Estudio descriptivo, con 193 adultos mayores de 60 años, del municipio de Samaniego, departamento de Nariño. Se describió el comportamiento del uso del espacio de vida y su relación con variables demográficas, cognitivas, emocionales y psicosociales mediante modelos de regresión lineal y logística. Resultados: La escala LSA presentó una media de 21,68 (DE = 18,6), se observó correlación con la variable edad (Rho = -0,15, p = 0,042) y género (d = -0,05; IC 95 por ciento -0,35 a 0,23). Hubo relación directamente proporcional pero baja con el Test Minimental (Rho = 0,04, p = 0,580) y Yesavage (Rho = -0,13, p = 0,064). Con la escala apoyo social, hubo correlaciones bajas en apoyo emocional (Rho = 0,19, p = 0,009), instrumental (Rho = 0,13, p = 0,062), interacción social positiva (Rho = 0,23, p = 0,001) y apoyo afectivo (Rho = 0,16, p = 0,027). Conclusión: Las características psicosociales y demográficas influyeron en la utilización que el adulto mayor rural hace de su espacio vital(AU)

Introduction: The use of life spaces is gaining research interest regarding aging, as it is a measure of mobility and social participation, insofar it reflects physical, psychosocial and environmental factors necessary for independent functioning. Objective: To identify the factors associated with social support and the use of life spaces in the rural context. Methods: Descriptive study carried out with 193 adults aged over 60 years, from the Samaniego Municipality, Nariño Department. The behavior of the use of life spaces and its relationship with demographic, cognitive, emotional and psychosocial variables were described using linear and logistic regression models. Results: The LSA scale presented a mean of 21.68 (SD=18.6). A correlation was observed with the variable age (Rho=-0.15, P=0.042) and gender (d=-0.05; CI 95 percent: -0.35 to 0.23). There was a directly proportional but low relationship with the Minimental test (Rho=0.04, P=0.580) and Yesavage (Rho=-0.13, P=0.064). With the social support scale, there were low correlations in emotional support (Rho=0.19, P=0.009), instrumental support (Rho=0.13, P=0.062), positive social interaction (Rho=0.23, P=0.001), and affective support (Rho=0.16, P=0.027). Conclusion: The psychosocial and demographic characteristics influenced on how rural older adults make use of their life spaces(AU)

Funcionalidad y factores asociados en el adulto mayor de la ciudad San Juan de Pasto, Colombia / Functionality and Associated Factors in the Older Adult of the City of San Juan de Pasto, Colombia / Funcionalidade e fatores associados em idosos de San Juan de Pasto, na Colômbia

Resumen Introducción: la capacidad funcional es uno de los determinantes del estado de salud del adulto mayor. En esta población se presenta una mayor dependencia que conlleva a cambios significativos en los estilos de vida, y en la interacción social y familiar. El presente estudio analiza la relación de factores sociodemográficos y condiciones de salud con el estado funcional en una muestra de adultos mayores de la ciudad de Pasto, Colombia. Materiales y métodos: estudio de corte transversal en una muestra de 391 adultos mayores a quienes se les evaluó su estado funcional con la escala de actividades instrumentales de la vida diaria de Lawton y Brody. Se estudiaron las características demográficas, los antecedentes médicos, el nivel cognitivo global y la sintomatología depresiva. Se calculó como medida de asociación la razón de disparidad (RD) cruda y ajustada con sus respectivos intervalos de confianza del 95%, mediante modelos de regresión logística binaria. Resultados: un 26,3% de los adultos mayores se encontró en un nivel de dependencia funcional, asociado al género masculino (RD = 2,72; IC95% 1,51-4,93), dependencia económica (OR = 1,41; IC95% 1,26-4,40), antecedentes de enfermedad cerebrovascular (or = 3,41; IC95% 1,21-9,61), artritis (OR = 2,24; IC95% 1,27-3,98), síntomas depresivos (OR = 3,07; IC95% 1,54-6,123) y deterioro cognitivo (OR = 2,04; IC95% 1,15-3,64). Conclusión: los resultados del presente estudio determinaron que, con el proceso de envejecimiento, la capacidad funcional se ve condicionada a múltiples factores, lo cual lleva a que el adulto mayor pierda paulatinamente su nivel de independencia, lo que puede impactar en su calidad de vida y, por ende, en el contexto donde interactúa.

Abstract Introduction: Functional dependence is one of the determinants of health status in older adults. Increasing dependence lead to significant changes in lifestyles, social and family interaction. This study analyzes the relationship of socio-demographic and health conditions with functional dependency in a sample of elderly from Pasto city-Colombia. Materials and methods: A cross-sectional study in a sample of 391 older adults were done. Functional status was assessed with instrumental activities of daily living (Lawton and Brody scale). Demographic characteristics, medical history, overall cognitive level, and depressive symptoms were evaluated. As a measure of association, the odds ratio (OR) crude and adjusted with confidence intervals were calculated using binary logistic regression. Results: 26,3% of older adults were found with functional dependence. Male gender (RD = 2.72, 95% CI 1.51 to 4.93), economic dependence (OR = 1, 41, 95% CI 1.26 to 4.40), history of cerebrovascular disease (or = 3.41, 95% CI 1.21 to 9.61), arthritis (OR = 2.24; 95% CI 1,27- 3,98), depressive symptoms (OR = 3.07, 95% CI 1.54 to 6.123), and cognitive impairment (OR = 2.04, 95% CI 1.15 to 3.64) were related with functional dependence. Conclussion: With the aging process, functional capacity in elderly is a multifactorial problem. The results support the evidence that elderly gradually lose their level of independence, which can impact their quality of life and therefore in the context in which it interacts.

Resumo Introdução: a capacidade funcional é um dos determinantes do estado de saúde dos idosos. Nesta população crescente dependência levando a mudanças significativas no estilo de vida, interação social e familiar é apresentada. Este estudo analisa a relação dos fatores sociodemográficos e condições de saúde, com estado funcional em uma amostra de adultos sobre a cidade de Pasto Colômbia. Materiais e métodos: estudo transversal em uma amostra de 391 adultos, sobre os quais o seu estado funcional foi avaliada com a escala de atividades instrumentais de vida diária Lawton e Brody. características demográficas, história médica, nível cognitivo global, e os sintomas depressivos foram avaliados. Foi calculada como uma medida de associação a razão de chances (RD) bruta e ajustada com intervalos de confiança respetivos 95% em modelos de regressão logística binária. Resultados: 26,3% dos adultos mais velhos foram encontrados em um nível de dependência funcional, está associado ao sexo masculino (RD = 2,72, 95% CI 1,51-4,93), dependência económica (OR = 1, 41; 95% CI 1,26-4,40), história de doença cerebrovascular (OR = 3,41, 95% CI 1,21-9,61), artrite (OR = 2,24, 95% CI 1,27-3, 98), sintomas depressivos (OR = 3,07, 95% CI 1,54-6,123) e cognitivo impairment (OR = 2,04, 95% CI 1,15-3,64). Conclussão: Os resultados deste estudo constatou que, com o processo de envelhecimento, a capacidade funcional é sujeita a muitos fatores, as ligações acima para os idosos perdem gradualmente o seu nível de independência, o que pode afetar sua qualidade de vida e, por conseguinte, no contexto no qual ele interage.

Desempeño funcional en un grupo de adultos mayores / Functional performance in a group of elderlies

Introduccion: La capacidad funcional es uno de los determinantes del estado de salud del adulto mayor. En esta población se presenta una mayor dependencia que conlleva a cambios significativos en los estilos de vida, la interacción social y familiar. Objetivo: Establecer el nivel de desempeño funcional en un grupo de adultos mayores de 60 años de la ciudad de Pasto. Métodos: Estudio de carácter cuantitativo, con un nivel descriptivo y transversal. En 426 adultos mayores, se evaluaron características sociodemográficas y desempeño de actividades de la vida diaria básica e instrumental, a través de la aplicación del Índice de Barthel y la Escala de Lawton y Brody. Para el análisis estadístico se utilizó el paquete SPSS versión 2.0. Resultados: Se observó un nivel mayor de funcionalidad respecto a actividades básicas de la vida diaria, con una asociación significativa en edad. Mientras que en actividades instrumentales se determinan relaciones significativas en edad y sexo. Conclusiones: Con el proceso de envejecimiento, la capacidad funcional se ve condicionada, fundamentalmente a nivel de las actividades instrumentales de la vida diaria. De igual manera las variables edad y género se relacionan significatvamente respecto al componente funcional(AU)

Introduction: Functional capacity is one of the determinants of the health status of the elderly. This population is characterized by greater dependence, which leads to significant changes in lifestyles, as well as in social and family interaction. Objective: To establish the level of functional performance in a group of elderlies aged more than 60 years from the city of Pasto. Methods: Quantitative study, with a descriptive and cross-sectional level. We evaluated 426 elderlies with a focused on their sociodemographic characteristics and performance of basic and instrumental daily life activities, through the application of the Barthel Index and the Lawton and Brody Scale. For the statistical analysis, we used the SPSS package version 2.0. Results: A greater level of functionality was observed for basic activities of daily life, with a significant association in age. While instrumental activities determined significant relationships in age and sex. Conclusions: With the aging process, functional capacity is conditioned, mainly at the level of instrumental activities of daily life. In the same way, the variables age and gender are significantly associated with the functional component(AU)