SEVERITY OF DISABILITY IN NURSING HOME RESIDENTS: PHYSICAL AND COGNITIVE CORRELATES (DEMENTIA, COGNITION).
Contributors: University of North Carolina at Chapel Hill.
Published: 1995
Number of pages: 218
Subjects: Health Sciences, Nursing.; Gerontology.; Health Sciences, Public Health.
Description: Disability is endemic among nursing home residents. Little is known about factors affecting disability severity. Applying disability models from community-dwelling adults may help isolate manipulable factors to guide disability prevention. Study objectives were: (1) to describe measurement characteristics of constructs within a modified Nagi disablement model in nursing home residents; (2) to assess form and strength of relationships among model constructs; and (3) to estimate the direct and indirect effects of cognitive and physical performance on disability in self-care. Secondary analysis of a cross-sectional study of 65 nursing home residents was performed. Subjects were similar clinically to nursing home residents nationally, but had different sociodemographic characteristics, with nearly double the national average of African Americans and males. Physical abilities were indicated by isometric strength, cognitive abilities by the Neurobehavioral cognitive screening examination (NCSE), limitations in function by a 7-item timed physical performance test, and disability by scores on the physical subscale of the Functional Independence Measure.

Reliability for all model constructs was excellent, except for the test-retest reliability of the memory and constructions subscales of the NCSE. Measurement models for each construct showed good fit after correlated measurement error terms were included. Factor structures of all constructs except cognition were consistent with earlier measurement work reported. No curvilinear relationships were detected among construct indicators. The magnitude and direction of relationships among strength, functional limitation and disability were consistent with effects reported in community-dwelling adults. The direct effect of functional limitation on disability was.57 standard units. The total effect of physical ability on disability was.46; the indirect effect mediated by functional limitations was.23. Cognition was not related to disability in basic self-care, possibly due to inadequate measurement of cognition, sampling error, or a true lack of relationship. Although partial support was demonstrated for the Nagi disability model in nursing home residents, the structural model had a poor fit, suggesting the need to consider other explanatory variables and relationships. Future studies should examine these relationships in probability samples of nursing home residents, with stronger measures of cognition using longitudinal and experimental designs.
Notes: Source: Dissertation Abstracts International, Volume: 56-10, Section: B, page: 5420.

Thesis (PH.D.)--THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, 1995.

School code: 0153.