This study examines hierarchical patterns of progression in activities of daily living (ADL) disabilities among older adults in low- and middle-income countries.
Data from WHO’s SAGE survey (2007-2010) on adults aged 60 and above in China, India, Russia, Ghana, Mexico, and South Africa, were analyzed. We used factor analysis and Rasch modelling to develop ADL hierarchies for cross-national comparisons.
Data fitted the Rasch model well and Cronbach’s α were 0.80-0.87 across countries. Based on scaled logit scores, ‘walking’ was the most difficult item for older adults in five of the six countries. Older persons in developing countries also found ‘transferring’ to/from beds challenging. ‘Eating’ and ‘dressing’ ranked lower in the hierarchies, thus perceived as easier than other activities. Sequences were most compact for China, Mexico, and India, implying that older adults in these countries who have difficulty ‘walking’ are at high risk of developing the rest of the disabilities.
This is the first study that used Rasch analysis to demonstrate that functional loss sequences in various developing countries share certain broad similarities. Interventions targeted at improving walking and transferring activities can help offset certain deficits in independent functioning for community-dwelling elderly in these countries.

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