Functional Impairments Associated with Patient Activation among Community-Dwelling Older Adults

Objectives Activity of Daily Living (ADL) stages and Instrumental Activity of Daily Living (IADL) stages demonstrated ordered associations with mortality, risk of hospitalization, and receipt of recommended care. This paper explores the associations of stages with three dimensions of patient activation: self-care efficacy, patient-doctor communication and health-information seeking. We hypothesized that higher ADL and IADL stages (greater limitation) are associated with a lower level of patient activation. Methods Patient activation factors were derived from the 2004 and 2009 Medicare Current Beneficiary Survey. In this cross-sectional study (N=8981), the associations of activity limitation stages with patient activation factors were assessed in latent factor models. Results Greater activity limitation was in general inversely associated with self-efficacy, patient-doctor communication and health information-seeking, even after adjusting for sociodemographic and clinical characteristics. For instance, the mean of self-care efficacy across ADL stages I-IV (mild, moderate, severe and complete limitation) compared to stage 0 (no limitation) decreased significantly by 0.17, 0.29, 0.34, and 0.60, respectively. Covariates associated with suboptimal patient activation were also identified. Discussion Our study identified multiple opportunities to improve patient activation, including providing support for older adults with physical impairments, at socioeconomic disadvantages, or with psychological or cognitive impairment. Disclosures: The research for this manuscript was supported by the grant from the National Institutes of Health (R01AG040105 and R01HD074756). There are no personal conflicts of interest of any of the authors, and no authors reported disclosures beyond the funding source. The opinions and conclusions of the authors are not necessarily those of the sponsoring agency. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated. This material has not been previously presented at a meeting. Acknowledgement: We thank Sean Hennessy, PharmD, PhD, for his valuable input in this manuscript. Corresponding Author: Ling Na, PhD, Email: lingna2000@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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