Factors associated with ADL dependence: A comparative study of residential care home and community-dwelling elderly in Japan


Han Kwee Ho, Department of Geriatric Medicine, Kyoto University Hospital. 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606–0507, Japan. Email: hkpk1311@iname.com


Background:  Since the start of Long Term Nursing Insurance in Japan in April 2000, there has been much discussion about and emphasis on leading healthy and active twilight years, without ever being bedridden if possible. In an attempt to address some of these concerns, this comparative study examines the factors associated with dependence in the activities of daily living (ADL) in two samples of elderly people living in two different environments.

Methods:  In this cross-sectional, self-reported study, 262 and 968 elderly people from a residential care home and Yogo town completed a 65-item questionnaire. Questions pertaining to ADL, medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale were included in the questionnaire. Using logistic regression model, factors associated with ADL dependence were determined.

Results:  In the residential care home group, age, female gender, instrumental ADL, communication-related ability, history of falls, stroke, and osteoarthropathy, depressive tendency and low satisfaction with life emerged as the factors associated with ADL dependence, after multivariate logistic regression. The corresponding factors in the community-dwelling elderly group were age, depressive tendency, history of osteoarthropathy, and low sense of health.

Conclusion:  Age and female gender were the two non-modifiable risk factors associated with ADL dependence. Stroke, followed by osteoarthropathy and falls were the main medical conditions predisposing to functional dependence. Dependence in instrumental ADL, independence in communication-related ADL, depressive tendency and components of QOL were factors associated with ADL dependence. Awareness of these factors not only helps to identify at-risk patients, to initiate preventive measures and to promote disability-delaying activities, but also helps in the holistic management of geriatric patients.