Long-term care facilities' response to the COVID-19 pandemic: An international, cross-sectional survey.

AIMS: To (i) assess the adherence of long-term care (LTC) facilities to the COVID-19 prevention and control recommendations, (ii) identify predictors of this adherence and (iii) examine the association between the adherence level and the impact of the pandemic on selected unfavourable conditions. DESIGN: Cross-sectional survey. METHODS: Managers (n = 212) and staff (n = 2143) of LTC facilities (n = 223) in 13 countries/regions (Brazil, Egypt, England, Hong Kong, Indonesia, Japan, Norway, Portugal, Saudi Arabia, South Korea, Spain, Thailand and Turkey) evaluated the adherence of LTC facilities to COVID-19 prevention and control recommendations and the impact of the pandemic on unfavourable conditions related to staff, residents and residents' families. The characteristics of participants and LTC facilities were also gathered. Data were collected from April to October 2021. The study was reported following the STROBE guidelines. RESULTS: The adherence was significantly higher among facilities with more pre-pandemic in-service education on infection control and easier access to information early in the pandemic. Residents' feelings of loneliness and feeling down were the most affected conditions by the pandemic. More psychological support to residents was associated with fewer residents' aggressive behaviours, and more psychological support to staff was associated with less work-life imbalance. CONCLUSIONS: Pre-pandemic preparedness significantly shaped LTC facilities' response to the pandemic. Adequate psychological support to residents and staff might help mitigate the negative impacts of infection outbreaks. IMPACT: This is the first study to comprehensively examine the adherence of LTC facilities to COVID-19 prevention and control recommendations. The results demonstrated that the adherence level was significantly related to pre-pandemic preparedness and that adequate psychological support to staff and residents was significantly associated with less negative impacts of the pandemic on LTC facilities' staff and residents. The results would help LTC facilities prepare for and respond to future infection outbreaks. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Promoting workplace retention during global crises: An international survey of the preventive role of psychological support among victims of social discrimination in long-term care facilities.

This international cross-sectional survey examined the potential role of organizational psychological support in mitigating the association between experiencing social discrimination against long-term care (LTC) facilities' healthcare professionals (HCPs) and their intention to stay in the current workplace during the COVID-19 pandemic. Participants included a convenience sample of 2,143 HCPs (nurses [21.5 %], nurse aids or residential care workers [40.1 %], social workers [12.1 %], and others [26.4 %]) working at 223 LTC facilities in 13 countries/regions. About 37.5 % of the participants reported experiencing social discrimination, and the percentage ranged from 15.3 % to 77.9 % across countries/regions. Controlling for socio-demographic and work-related variables, experiencing social discrimination was significantly associated with a lower intention to stay, whereas receiving psychological support showed a statistically significant positive association (p-value=0.015 and <0.001, respectively). The interaction term between social discrimination and psychological support showed a statistically significant positive association with the intention to stay, indicating a moderating role of the psychological support.

The relationship between depression and risk of violence in portuguese community-dwelling older people.

BACKGROUND: Mental disorders are highly prevalent in older people, being depression a predominant disorder. Evidence points to a possible relationship between depression and violence against older people. Nonetheless, the role of the depressive symptomology severity in the risk of violence against older people remains unclear. Thus, this study's main objective was to analyze the relationship between geriatric depressive symptomatology and the risk of violence against older people. METHODS: This exploratory study involved 502 community-dwelling older persons aged 65 to 96 years (73.3 ± 6.5). Measures were performed using the Geriatric Depression Scale and the Risk Assessment of Violence against the Non-Institutionalized Elderly scale. RESULTS: One hundred nineteen older people (23.7%) had mild/moderate depressive symptomology, and twenty-six (5.2%) had severe depressive symptomology. There were significant relationships between the severity of depressive symptomatology and the risk of violence (p < 0.05). The presence of depressive symptomatology increased the likelihood of being victims of violence, particularly among women (odds ratio: 2-8, p < 0.05). CONCLUSIONS: The severity of depressive symptomatology plays an essential role in the risk of violence against community-dwelling older people. Moreover, it was found that older persons with depression symptomatology were at higher risk of being victims of violence. Our study findings support the need for protective measures within mental health national or regional policies to prevent depression and violence against community-dwelling older people.

Aging safely in Alentejo - understanding for action - preventing falls and violence against older people: study rationale, aims, design, and preliminary results.

BACKGROUND: Falls and violence against older people might represent a joint public health problem, as both may result in injury, fear, social isolation, sedentary behavior and dependence or even death. The ESACA project "Aging safely in Alentejo - Understanding for action" was designed to promote the healthy aging of older people in Alentejo by preventing the occurrence of falls and violence. This study aimed to report the ESACA protocol and the preliminary outcomes. METHODS: The ESACA study has a twofold design as a cross-sectional study that included retrospective and prospective surveys. The participants were 508 community-dwelling older people. Assessments included falls, the risk of violence against older people, sociodemographic characteristics, health-related measurements, fear of falling, anthropometric measures and body composition, functional physical fitness, physical activity, and environmental hazards. RESULTS: Among the participants, 43% were fallers, 21% were recurrent fallers, and 22% were victims of one or more kinds of violence (psychological: 17.1%, physical: 5.6%, and patrimonial: 3.0%). Moreover, the cumulative results suggested high risk on several risk factors for falling (7 factors: 0.6% to 2 factors: 17.4%) and of  violence (26.7%). CONCLUSIONS: In the ESACA project, a wide range of potential influencing factors on falls and violence risk factors were measured, and comprehensive quality control measures were applied. Overall, the results suggest that for falls and violence prevention strategies to be effective, it is essential to evaluate, diagnose, and inform all stakeholders in a directed and useful way. Moreover, we believe that our project outcomes may help change mindsets and behaviors by involving people in active aging and well-being programs that promote exercise and avoid isolation.

Key factor cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults: the role of physical fitness, body composition, physical activity, health condition, and environmental hazards.

BACKGROUND: Fall risk assessment and determination of older adults' individual risk profiles are crucial elements in fall prevention. As such, it is essential to establish cutoffs and reference values for high and low risk according to key risk factor outcomes. This study main objective was to determine the key physical fitness, body composition, physical activity, health condition and environmental hazard risk outcome cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults. METHODS: Five-hundred community-dwelling Portuguese older adults (72.2 ± 5.4 years) were assessed for falls, physical fitness, body composition, physical (in) activity, number of health conditions and environmental hazards, and sociodemographic characteristics. RESULTS: The established key outcomes and respective cutoffs and reference values used for fall risk stratification were multidimensional balance (low risk: score > 33, moderate risk: score 32-33, high risk: score 30-31, and very high: score < 30); lean body mass (low risk: > 44 kg, moderate risk: 42-44 kg, high risk: 39-41 kg, and very high: < 39 kg); fat body mass (low risk: < 37%, moderate risk: 37-38%, high risk: 39-42%, and very high: > 42%); total physical activity (low risk: > 2800 Met-min/wk., moderate risk: 2300-2800 Met-min/wk., high risk: 1900-2300 Met-min/wk., and very high: < 1900 Met-min/wk); rest period weekdays (low risk: < 4 h/day, moderate risk: 4-4.4 h/day, high risk: 4.5-5 h/day, and very high: > 5 h/day); health conditions (low risk: n < 3, moderate risk: n = 3, high risk: n = 4-5, and very high: n > 5); and environmental hazards (low risk: n < 5, moderate risk: n = 5, high risk: n = 6-8, and very high: n > 8). CONCLUSIONS: Assessment of community-dwelling older adults' fall risk should focus on the above outcomes to establish individual older adults' fall risk profiles. Moreover, the design of fall prevention interventions should manage a person's identified risks and take into account the determined cutoffs and respective interval values for fall risk stratification.

Scale for supported care in primary care: a methodological study. / Escala para o cuidado apoiado na atenção primária: um estudo metodológico.

OBJECTIVE: To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care. METHOD: Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis. RESULTS: The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care. CONCLUSION: The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.

Lifestyles: social representations construed by patients with myocardial infarction and family members. / Estilos de vida: representações sociais construídas por doentes com infarto do miocárdio e familiares.

OBJECTIVE: The social representations of lifestyles construed by family members and patients diagnosed with myocardial infarction. METHOD: Exploratory qualitative study supported by the theory of social representations, with 70 patients and 70 family members of two Portuguese hospitals, one on the coast and one inland from January to June 2015. Structural analysis was performed using two questionnaires relying on the technique called Free Association of Words. RESULTS: The evocations of patients and family members indicated weak convergence between the two groups in representing Lifestyle, yet showed the existence of knowledge that enhances a healthy lifestyle. CONCLUSIONS: The categories Eat and Change were a consensus among the groups. For patients and family members, it was consensual that a poor diet is a harmful lifestyle for health. It was also clear that change is fundamental. Such an assumption makes room for the intervention of health professionals.

Representation of illness in Familial Amyloidotic Polyneuropathy Portuguese Association newspaper: A documental study.

This study explores illness representations within Familial Amyloidotic Polyneuropathy Portuguese Association newspaper . A content analysis was performed of the issue data using provisional coding related to the conceptual framework of the study. All dimensions of illness representation in Leventhal's Common Sense Model of illness cognitions and behaviors are present in the data and reflect the experience of living with this disease. Understanding how a person living with an hereditary, rare, neurodegenerative illness is important for developing community nursing interventions. In conclusion, we suggest an integration of common sense knowledge with other approaches for designing an intervention program centered on people living with an hereditary neurodegenerative illness, such as familial amyloidotic polyneuropathy.

Fear of COVID-19 among professional caregivers of the elderly in Central Alentejo, Portugal.

The coronavirus disease 2019 (COVID-19) has infected many institutionalised elderly people. In Portugal, the level of pandemic fear among professional caregivers of the elderly is unknown, as are its predictive factors. This study aimed to investigate predictors of fear of COVID-19 among workers caring for institutionalised elderly people in nursing homes. This is a cross-sectional study using multiple linear regression applied to a population of 652 caregivers located in 14 municipalities in Central Alentejo, Portugal, at March 2021. The criterion variable was the fear of COVID-19. Standardised regression coefficients showed that the higher the level of education, the lower the level of fear (ß = - 0.158; t = - 4.134; p < .001). Other predictors of the level of fear were gender, with women having higher levels (ß = 0.123; t = t = 3.203; p < 0.001), higher scores on COVID-19-like suspicious symptoms (ß = 0.123; t = 3.219; p < 0.001) and having received a flu vaccine (ß = 0.086; t = 2.252; p = 0.025). The model explains 6.7% of the variation in fear of COVID-19 (R2Adj = 0.067). Health literacy can minimise the impact on the physical and mental health of these workers. In Central Alentejo, caregivers of the elderly play a fundamental role in social balance. Further studies are needed to better understand the factors that can improve their personal and professional well-being.

Difficulties in Caring for the Older Adults: Perspective of Brazilian and Portuguese Caregivers.

This study aims to understand the difficulties in caring for the older adults with functional dependence from the perspective of Brazilian and Portuguese caregivers. This is a study based on the Theory of Social Representations, based on the Thematic Content Analysis proposed by Bardin, carried out with 21 informal caregivers of older adults in Brazil and 11 informal caregivers of older adults in Portugal. The instrument consisted of a questionnaire with sociodemographic data and data on health conditions along with an open interview with guiding questions on the theme of care. Data were analyzed using the Content Analysis technique proposed by Bardin, with the help of the QRS NVivo® Version 11 software (QSR International, Burlington, MA, USA). Three categories emerged from the speeches: "Caregiver burden", "Caregiver support network" and "Older adults resistance". The main difficulties mentioned by caregivers were associated with family articulation in meeting the needs of their older adults, whether due to the excessive demand of tasks, which results in overloading the caregiver, or the behaviors of the older adults themselves, or even the availability of a truly supportive and effective network.

Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal.

Our aim was to analyze the association between socioeconomic status and quality of life (QoL) among older people with depressive symptoms treated through the Primary Health Care (PHC) system in Brazil and Portugal. This was a comparative cross-sectional study with a nonprobability sample of older people in the PHC in Brazil and Portugal conducted between 2017 and 2018. To evaluate the variables of interest, the socioeconomic data questionnaire, the Geriatric Depression Scale and the Medical Outcomes Short-Form Health Survey were used. Descriptive and multivariate analyses were performed to test the study hypothesis. The sample consisted of n = 150 participants (Brazil n = 100 and Portugal n = 50). There was a predominance of woman (76.0%, p = 0.224) and individuals between 65 and 80 years (88.0%, p = 0.594). The multivariate association analysis showed that in the presence of depressive symptoms, the QoL mental health domain was most associated with the socioeconomic variables. Among the prominent variables, woman group (p = 0.027), age group 65-80 years (p = 0.042), marital status "without a partner" (p = 0.029), education up to 5 years (p = 0.011) and earning up to 1 minimum wage (p = 0.037) exhibited higher scores among brazilian participants. The portuguese participants showed an association between the general health status domain and woman group (p = 0.042) and education up to 5 years (p = 0.045). The physical functioning domain was associated with income of up to 1 minimum wage (p = 0.037). In these domains, the portuguese participants exhibited higher scores than the brazilian participants. We verified the association between socioeconomic profile and QoL in the presence of depressive symptoms, which occurred mainly among woman, participants with low levels of education and low income, with QoL aspects related to mental, physical and social health and self-perceived health. The group from Brazil had higher QoL scores than the group from Portugal.

Quality of Life in the Face of Depression Among Older People: A Cross-Sectional Study in Brazil and Portugal.

Background: This study aimed to analyze and compare the association of depression levels with quality of life among older people in primary health care in Brazil and Portugal. Methods: This was a cross-sectional study conducted with older people in primary health care. The Medical Outcomes Short-Form Health Quality of Life (SF-36) instrument was used to measure the quality of life, and the Beck Depression Inventory was used to evaluate depression. We grouped the depression level variables into "absent/mild" and "moderate/severe" and tested their association with the categorical variables of quality of life ("better quality of life" and "worse quality of life"). Results: The total sample was 150 participants (Brazil n = 100 and Portugal n = 50). Each group results in the subcategory of absent/mild depression (n = 129) indicated better quality of life in Portugal in physical role functioning (P = .027/odds ratio = 2.768), physical functioning (P < .001/odds ratio = 5.864), and the physical health dimension (P = .002/odds ratio = 3.752). The binary logistic regression analysis highlighted the domains physical role functioning (odds ratio = 1.01/CI for 95% = 1.00-1.03), physical functioning (odds ratio = 1.02/CI for 95% = 1.01-1.03), and the physical health dimension (odds ratio = 1.09/CI for 95% = 1.04-1.13). Conclusion: There was an association between better assessments of the physical and functional aspects of quality of life and lower levels of depression, in which we could highlight those aspects related to physical health and functionality. Among the groups studied, Portugal had better quality of life evaluations than Brazil. However, none of the groups overlapped the other in levels of depression.

Therapeutic Futility in Nursing: A Focus Group.

Introduction: The implementation of futile nursing interventions seems to be a persistent problem in adult intensive care units. Understanding this phenomenon can contribute to its prevention and all deleterious effects associated with it. Objective: To identify the perceptions of expert nurses from adult intensive care units about therapeutic futility in nursing. Methods: This study consists of a conventional content analysis. Data was collected through a focus group interview that included five expert nurses in adult intensive care, with a minimum of fifteen years of professional experience in intensive care. To analyze the information, the technique of thematic categorical analysis was used, according to Bardin. Results: Four central categories were identified for the topic under study, for which several subcategories were identified that allow a better understanding of this phenomenon. Conclusion: Adult intensive care expert nurses advocate that therapeutic futility in nursing is a reality perceived by teams and families, which should be avoided due to the risk of potentiating the implementation of ethically reprehensible care.

Quality of Life in Community-Dwelling Older People with Functional and Nutritional Impairment and Depressive Symptoms: A Comparative Cross-Sectional Study in Brazil and Portugal.

BACKGROUND: The interaction of quality of life (QoL) with functionality, nutrition and depression has been studied, but few studies have compared different realities. Our objective was to compare the associations of QoL with impaired functionality, nutritional status and depressive symptoms among older people patients treated in primary health care (PHC) in Brazil and Portugal. METHODS: Cross-sectional, comparative study was conducted with primary data from PHC services in Brazil and Portugal with users over 65 years old. Participants' scores were classified as "impaired" and "preserved" for QoL, functional decline, nutrition and depression. We used Pearson's chi-square test, Fisher's exact test and the Mann-Whitney U test. RESULTS: Our sample had a total of 150 PHC users. We found lower QoL scores in Brazil, which were associated with the risk of functional decline for the domains Physical Functioning, General Health Perceptions, Mental Health dimensions and Physical Health. Nutritional impairment in the group from Portugal included the domains of Vitality and Social Role Functioning. For depressive impairment, Portugal showed an association with the domains Mental Health, Vitality and Social Role Functioning. CONCLUSIONS: QoL was associated with functional and nutritional impairment and depressive symptoms, highlighting physical, mental and social characteristics related to the perception of well-being.

[User's representations of chronic diseases and educational practice]. / As representações dos usuários sobre a doença crônica e a prática educativa.

This is a qualitative research study held between October, 2008, and March, 2009, with 45 users over 60 years of age from a Health Unit, which aimed to identify their representations of chronic disease. Inerviews were carried out to collect chronic disease's representation. Three team meetings were also carried out, with an average of 8 users. Twenty-four (24) users participated in this step. The themes brought out of their discourses were: "The arrival of the disease: explanatory factors"; "The mystery of the bodyly changes: an obligation to change", and "The importance of learning and sharing the experience". Participants recognized the factors related to the disease onset and their commitments, the changes necessary to keep living and put off complications, and they also valued the exchange of experiences through dialogue in educational activities.

Conceptual Models of Nursing in Critical Care.

INTRODUCTION: Intensive care units are systems organized for the provision of care to patients in critical situations. In general, it is suggested that intensive care consists of a multidisciplinary and interprofessional specialty. Nevertheless, the predominance, relative to the professions that incorporate these units, falls on nurses. A conceptual model of nursing provides a framework for reflection, observation, and interpretation of phenomena and, specifically, it provides guidelines and guidance for aspects of clinical practice. OBJECTIVE: To understand the applicability of conceptual models of nursing in intensive care units. METHOD: Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The research was performed in CINAHL, Cochrane, Pubmed, Scopus, and Web of Science to identify studies published prior to 2021. Fourteen studies were selected. RESULTS: There is no conceptual model of nursing universally accepted as ideal for intensive care units. However, there is unanimity in the identification of several benefits associated with the application of a conceptual model of nursing in the care of critically ill patients. CONCLUSION: For the selection of a conceptual model of nursing for these contexts, the focus should be on the person and the choice should fall on the model that is most appropriate to the patient, and not on the philosophy that supports the model. Considering the nature of care, the nursing team can select a model or a combination of models.

Factors influencing physical activity: A cross-sectional study of the community-dwelling older adults in a Portuguese rural area.

BACKGROUND: There are a variety of intrinsic determinants which are key to understand the reasons for older people to stay (or not) active. OBJECTIVES: To identify and analyse the factors underlying the physical activity engagement in older Portuguese living in a rural area. METHODS: A total of 504 community-dwelling older adults (aged ≥65 years) were enrolled in this cross-sectional study. Sociodemographic data, physical activity levels, physical fitness and body composition were analysed. RESULTS: Gender, age, income level, lower body strength, overweight, muscle mass and sedentarism (sitting time) were significantly associated with different physical activity levels. The multinomial logistic regression pointed out that dynamic balance, BMI and sitting time for moderate levels, as well as muscle mass for high levels, were the main independent factors that seem to influence the engagement in these levels compared to low physical activity levels. Additionally, classification tree analysis confirmed sitting time, dynamic balance and gender as discriminating factors for physical activity levels. CONCLUSION: Physical fitness-related variables seem to mainly determine the levels of physical activity in the studied population. Thus, nursing care must promote the integration of physical activity into daily life routines of community-dwelling older adults, especially in rural areas. IMPLICATIONS FOR PRACTICE: The diverse nature of factors influencing physical activity must be taken into account in primary health care, particularly in rural areas. Nursing care for older people must promote the integration of physical activity into daily life routines of community-dwelling older adults.

Depression and quality of life in Brazilian and Portuguese older people communities: Analysis of association.

ABSTRACT: We aimed to compare the association of depression with aspects of quality of life (QoL) among older people users of primary health care (PHC) living in Brazil and Portugal.We carried out an observational, cross-sectional and comparative study with a quantitative approach in the PHC scope in Brazil and Portugal, where we obtained a nonrandom sample of 150 participants aged 65 years or older (100 Brazilians and 50 Portuguese). We used the socioeconomic and health data questionnaire, the Medical Outcomes Short-Form Health Survey QoL (SF-36) questionnaire and the Beck Inventory.Among the socioeconomic profiles, most were females aged between 65 and 80 years in both countries. There was a significant difference between groups in the income variable, with 100.0% of Portuguese people earning up to 1 minimum wage (P value <.001), and the presence of chronic diseases in 92.0% of respondents in Portugal (P value = .033). In the association analysis, most aspects of QoL had a higher median score (>50.0) within the categorical variables of "absent" and "mild" depression. The Emotional role functioning, Physical role functioning, Physical functioning, Mental health, Total score domains and the Mental health and Physical health summary measures stood out with this behavior in Brazil and in Portugal, where these latter 2 presented moderate to strong correlation values (ρ > 0.400) in Portugal. Greater associations of depression on QoL were revealed in Portugal than in Brazil. Among their most expressive associations, the Physical role functioning (odds ratio [OR] = 4.776; 95.0% confidence interval [CI]: 2.41-9.43), Physical functioning (OR = 3.037; 95.0% CI: 3.037), Vitality (OR = 6.000; 95.0% CI: 1.56-23.07) and Total score (OR = 3.727; 95.0% CI: 2.24-6.17) domains and the Mental health summary measure (OR = 3.870; 95.0% CI: 2.13-7.02) stood out.Aspects related to the emotional, physical, functional and mental health components stood out. The association and correlation with depression were more expressive in Portugal compared to Brazil. However, similar results were obtained in Brazil but with less relevance.

[Current dynamics of nursing in Portugal: nurses' representations]. / Dinâmicas atuais da enfermagem em Portugal: a representação dos enfermeiros.

This research study, with a qualitative approach was carried out aiming to identify nurses' representation on current professional dynamics, evolutionary landmarks and the future outlook for Portuguese nursing with twenty nurses from Evora, Portugal, in April / May of 2009, through narrative testimony. Qualification obtained along the years as well as the Nurses' Association were mentioned as the central representative pillars in order to build up professional identity. Autonomy is part of daily caring routine, however hegemonic power issues in the health team still ground nurses' action and underpin their self and peer professional and social recognition. Future outlook addresses issues such as employment, career uncovering hope for some and uncertainty for others.

Risk for physical dependence in community-dwelling older adults: The role of fear of falling, falls and fall-related injuries.

BACKGROUND: Falls and fall-related injuries along with fear of falling (FoF) seem to restrict activities of daily living (ADL), resulting in physical dependence. However, it is still unclear how falls and related injuries or FoF by themselves explain general and specific ADL dependence. OBJECTIVES: To investigate the relationships between falls and related injuries, FoF and physical dependence on ADL in community-dwelling older adults, controlling for age, gender, physical activity and physical fitness as confounders. METHODS: This cross-sectional descriptive study assessed 588 community-dwelling older adults. Falls and fall-related injuries, ADL dependence on basic, instrumental and advanced activities, FoF, demographic characteristics and health conditions were assessed through a questionnaire. Physical activity was measured through the International Physical Activity Questionnaire. Physical fitness was assessed by the Senior Fitness Test and the Fullerton Advanced Balance Scale. Body composition was measured through bioimpedance. RESULTS: Severe injuries occurrence increased the likelihood of moderate and high physical dependence by 3 and 6 times, while FoF increased this likelihood by 3 and 7 times, respectively. Also, the occurrence of previous falls, resulting in severe injuries, increased the likelihood of dependence in two instrumental ADL (3 and 4 times), while FoF increased this likelihood in numerous basic, instrumental and advanced ADL (2-3 times). The FoF was shown to explain overall physical functioning dependence, by itself, representing a constraint on the performance of most basic, instrumental and advanced ADL. CONCLUSION: The FoF showed to be a greater threat to ADL dependence than falls and related injuries. Assessment guidelines for older adults living in the community should include the FoF in clinical evaluation. IMPLICATIONS FOR PRACTICE: Understand the isolated interplay of FoF and previous falls and injuries on ADL dependence among older adults allows healthcare professionals to perform more accurate clinical evaluations and develop more successful interventions to prevent further dependence.