Impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability of older adult residents of long-term care facilities: A structural equation analysis.

AIM: Previous studies have focused on the relationship between multi-morbidity, frailty, and anemia or functional disability alone rather than in combination. This study aimed to explore the impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability simultaneously in older adult residents of long-term care facilities. METHODS: This was a cross-sectional study. Data were retrieved from the electronic health records of eight long-term care facilities. Data from a total of 352 subjects aged at least 60 years and residing in these facilities for at least 6 months were analysed. Analytic datasets included the Barthel Index of Activities of Daily Living, the Frailty Phenotype Criteria, the number of chronic diseases, hemoglobin levels, age, and gender. RESULTS: The final model demonstrated acceptable goodness-of-fit indices, namely goodness-of-fit index, comparative fit index, and incremental fit index ≧0.90, root mean square error of approximation <0.08, and insignificance of χ2 (P > 0.05). Frailty, multi-morbidity, and hemoglobin levels all had direct associations with functional disability (all P < 0.001). Hemoglobin levels had a direct association with frailty (ß = -0.11). Multi-morbidity had an indirect association (ß = 0.04) with functional disability through hemoglobin levels. Hemoglobin levels had an indirect association (ß = 0.05) with functional disability through frailty. CONCLUSIONS: The impacts of multi-morbidity, hemoglobin levels, and frailty on functional disability were explored. A high-quality disease management program, interventions for the prevention of frailty, and the provision of continued education for staff about reducing progressive frailty and functional disability for older adult residents are recommended. Geriatr Gerontol Int 2021; 21: 532-537.

Functional Capacity and Life Satisfaction in Older Adult Residents Living in Long-Term Care Facilities: The Mediator of Autonomy.

BACKGROUND: Although relationships among functional capacity, autonomy, and life satisfaction have been identified, little is known about how the mechanism of autonomy mediates functional capacity and life satisfaction in older adult residents of long-term care (LTC) facilities. PURPOSE: The objectives of the study were to examine the relationship between functional capacity and life satisfaction in older adult residents living in LTC facilities and to test the extent to which autonomy mediated that relationship. METHODS: A cross-sectional and correlational study was conducted with a convenience sample. Two hundred twenty-eight participants were recruited from 10 LTC facilities in Kaohsiung City. Four structured instruments were used to collect data: the life satisfaction questionnaire, the Chinese version of Perceived Enactment Autonomy Scale, the Barthel Activity Daily Living Index, and a personal profile datasheet. Descriptive statistics, t tests, analysis of variance, Pearson correlations, and both simple and hierarchical linear regression models were analyzed. RESULTS: Positive associations between life satisfaction and functional capacity (r = .183, p = .003) and autonomy (r = .469, p < .001) were identified. Autonomy and functional capacity were significantly correlated (r = .278, p < .001). After controlling for autonomy, the beta values reduced from .193 (p = .003) to .08 (p > .05), and the explained variance reduced from 3.7% to 0.1% between functional capacity and life satisfaction. The results indicate that autonomy is significant as a mediator. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: To improve the life satisfaction of older adult residents of LTC facilities, facility managers and staff should develop a self-support program that encourages older adult residents to participate in physical activities and maintain autonomy.