Creation of a model of independence for community-dwelling elders in the United States.

摘要

BACKGROUND: A goal of many public policies in support of older Americans is independence, but the meaning of independence in the context of community-dwelling elders is not clear. OBJECTIVE: To create a preliminary conceptual model of independence for older, community-dwelling Americans. METHODS: Exploratory factor analysis was used during secondary analysis of a federal dataset, the Second Supplement on Aging (N = 9,447). After preparation of the dataset, 51 variables were selected for possible submission to factor analysis. Initial item reduction resulted in 21 variables for factor structure development. RESULTS: Three factors for a preliminary conceptual model of independence were identified: physical function, social ability, and physical health. Physical function, explaining 29.5% of the variance, included variables related to elders' ability to function in everyday life, such as how well they function in their homes. Social ability variables included items related to social activities, education, driving, and leaving the house, and accounted for 8.6% of the variance. Physical health explained 6.1% of the variance and included variables related to visits to the doctor, prescription drug use, and number of days spent in bed during the past year. DISCUSSION: Findings suggest the importance of physical function for independence and the importance of a physical environment that supports various levels of physical function. Social ability plays a role in independence and may require adequate physical function, financial and material resources, and social support. Physical health may be a component of physical function or reflect access to healthcare. Future studies using primary data are indicated for further development of the concept of independence in the context of community-dwelling elders in the United States. A conceptual model of independence will guide nurses in their assessments of and interventions for older, community-dwelling adults and will help policymakers prioritize spending for programs that have independence as a goal.