Health and functional capacity as predictors of community dwelling among elderly people

The aim of this study was to identify factors that predict community dwelli ng (i.e., nonuse of institutional bed-days) among elderly people. This was a longitudinal study of institution use including both short-term and long- term use of hospitals and nursing homes. The impact of health, functional p erformance, and carrying out the activities of daily living on community dw elling was studied using the method of path analysis. The participants were all the 75-year-old (N = 388) and 80-year-old (N = 291) men and women resi dent in the City of Jyvaskyla, Finland. Predictor variables included diseas e severity, symptoms of illness, cognitive capacity, walking speed, muscle strength, hearing, and ability to carry out the activities of daily living. The outcome variable was community dwelling. Over 70% of the elderly peopl e had received institutional care during the 5-year follow-up. The path ana lysis models showed that disease severity and symptoms of illness had an ef fect on community dwelling: those with a more severe disease or more sympto ms needed more institutional care. The effect was also mediated through lim itations in physical performance and cognitive capacity and need for assist ance in activities of daily living. The explanatory power of these models v aried from 23% to 36%. The results of this study suggest that prevention, t reatment, and rehabilitation programs aimed at the promotion of community d welling in elderly people should focus on the severity of diseases, functio nal performance. and the ability to carry out the activities of daily livin g. (C) 2000 Elsevier Science Inc. All rights reserved.