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Functional Independence in Community-Dwelling Older Adults: Associations with Nutritional Status, Depressive Symptoms, and Fall Risk

This cross-sectional study of 245 community-dwelling older adults in Türkiye found that nutritional status is the strongest predictor of functional independence, while depressive symptoms, fall risk, and older age are significant negative factors, underscoring the need for comprehensive geriatric assessments that integrate nutritional, psychological, and functional evaluations.

Original authors: Funda Tuncer Sahin

Published 2026-10-23

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Funda Tuncer Sahin

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

As people live longer, the question of how to age well has moved from a personal worry to a global priority. A key part of aging successfully is maintaining the ability to care for oneself, a state experts call functional independence. This is not just about having enough energy to get out of bed; it encompasses the full range of daily tasks, from the basic physical acts of eating and bathing to the more complex chores of managing money, taking medication, and shopping. While getting older naturally brings changes to the body, research suggests that losing the ability to live independently is rarely caused by age alone. Instead, it is often the result of a web of interacting factors, including what a person eats, how they feel emotionally, and the safety of their physical environment. Understanding how these pieces fit together is essential for helping older adults remain active and self-reliant in their own homes.

In a recent study conducted in Turkey, researchers set out to untangle these connections among 245 community-dwelling older adults. The team focused on three specific areas that often go unexamined together: nutritional status, which refers to how well a person is nourished; depressive symptoms, covering feelings of sadness or loss of interest; and fall risk, which measures the likelihood of a person falling due to balance issues, medication, or other health conditions. The researchers wanted to see how these factors influenced the two main types of daily living: basic activities like dressing and eating, and instrumental activities like using the telephone or handling finances. By interviewing participants at a local family health center and using established questionnaires to measure each factor, the study aimed to identify which elements were the strongest drivers of independence.

The results painted a clear picture of what keeps an older adult independent and what threatens that independence. The most significant finding was that nutritional status emerged as the single strongest predictor of a person's ability to perform daily tasks. Those with better nutrition were significantly more likely to remain independent in both basic and complex activities. In contrast, higher levels of depressive symptoms, a greater risk of falling, and advancing age were all linked to a decline in the ability to care for oneself. The study also found that while age and depression affected both basic and complex tasks, a person's sex played a role only in the more complex instrumental activities, though the specific direction of this association was not detailed in the findings.

When the researchers looked at the data more closely, they found that these factors did not operate in isolation. Poor nutrition was linked to higher levels of depression and a greater risk of falling, suggesting a cycle where one problem can worsen the others. For instance, the data showed that individuals with higher fall risk scores also tended to have more depressive symptoms and poorer nutritional status. The statistical models used in the study were able to explain a substantial portion of the differences in independence among the participants, with nutrition, mood, fall risk, and age collectively accounting for nearly 40 percent of the variation in basic daily tasks and over 50 percent of the variation in complex daily tasks. This indicates that while age is a factor, the modifiable conditions of diet, mental health, and safety are powerful determinants of how well an older person can function.

The study concludes that preserving independence requires a holistic approach that looks at the whole person rather than just a single medical issue. Because nutritional status proved to be the most powerful predictor, the findings suggest that ensuring older adults receive adequate nutrition is fundamental to maintaining their ability to live on their own. However, because depression and fall risk also showed strong, independent links to functional decline, these areas cannot be ignored. The researchers emphasize that healthcare providers, particularly nurses, should assess these factors together. By checking a person's diet, mood, and safety risks simultaneously, caregivers can identify early warning signs and provide support that addresses the complex, interconnected needs of aging, helping to keep older adults safe and independent for longer.

Technical Summary: Functional Independence in Community-Dwelling Older Adults

Problem Statement
With the global demographic shift toward an aging population, preserving functional independence—the ability to perform daily activities without assistance—has become a critical public health priority. While functional independence is a key indicator of successful aging, it is not solely determined by biological aging but is influenced by a complex interplay of physical, psychological, and environmental factors. Previous research has often investigated nutritional status, depressive symptoms, and fall risk in isolation, failing to address their combined, multidimensional impact on functional independence within a comprehensive framework. This study addresses the gap in understanding how these specific factors interact to influence the ability of community-dwelling older adults to perform Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).

Methodology
The study employed an analytical cross-sectional design guided by the Ecological Systems Perspective, focusing on individual-level (microsystem) factors.

Participants: The sample consisted of 245 community-dwelling adults aged 65 and older registered at a Family Health Center in Aksaray, Türkiye. Participants were excluded if they had advanced cognitive impairment, severe communication barriers, or declined consent.
Data Collection: Data were collected via face-to-face interviews between February and May 2026.
Instruments:
- Functional Independence: Assessed using the Barthel Activities of Daily Living Index (ADL) and the Lawton and Brody Instrumental Activities of Daily Living Scale (IADL).
- Nutritional Status: Evaluated via the Mini Nutritional Assessment–Short Form (MNA-SF).
- Depressive Symptoms: Measured using the 30-item Geriatric Depression Scale (GDS-30).
- Fall Risk: Assessed using a 20-item Fall Risk Assessment Form.
- Demographics: A researcher-developed form captured sociodemographic and clinical data.
Statistical Analysis: Data were analyzed using IBM SPSS Statistics 26.0. Descriptive statistics, Pearson correlation analysis, and multiple linear regression analyses were performed. ADL and IADL scores served as dependent variables, with nutritional status, depressive symptoms, fall risk, age, and sex as independent variables.

Key Results

Descriptive Findings: The mean ADL score was 71.53 ± 21.62, and the mean IADL score was 18.94 ± 5.70. The mean nutritional score (MNA-SF) was 8.81 ± 3.29, indicating a general risk of malnutrition. Depressive symptoms were mild (mean GDS-30: 15.77 ± 6.63), and fall risk scores averaged 6.87 ± 3.70.
Correlations: ADL and IADL were strongly positively correlated ( $r = 0.806$ ). Both functional measures showed moderate positive correlations with nutritional status and moderate negative correlations with depressive symptoms and fall risk. A significant negative correlation was also found between nutritional status and both depressive symptoms and fall risk.
Regression Analysis (ADL): The regression model explained 38.6% of the variance in ADL scores ( $p < 0.001$ ). Nutritional status was the strongest positive predictor ( $\beta = 0.360$ ). Depressive symptoms, fall risk, and older age were significant negative predictors. Sex was not a significant predictor for ADL.
Regression Analysis (IADL): The model explained 50.6% of the variance in IADL scores ( $p < 0.001$ ). Nutritional status remained the strongest positive predictor ( $\beta = 0.353$ ). Age, fall risk, sex, and depressive symptoms were all significant negative predictors. Notably, sex was significantly associated with IADL but not ADL.

Key Contributions

Multidimensional Assessment: The study provides empirical evidence that functional independence is best understood through the simultaneous evaluation of nutritional, psychological, and safety-related factors rather than in isolation.
Predictive Hierarchy: It identifies nutritional status as the single strongest predictor for both basic and instrumental functional independence in this population, surpassing age, depression, and fall risk in predictive power.
Differentiation of ADL and IADL: The findings highlight that while basic self-care (ADL) is less sensitive to gender differences, instrumental tasks (IADL) are significantly influenced by sex, likely due to lifelong role differences and the complex coordination of physical and cognitive capacities required for IADL.
Theoretical Application: The research successfully applies the Ecological Systems Perspective to geriatric nursing, demonstrating how microsystem factors (nutrition, mood, fall risk) interact to shape functional outcomes.

Significance and Claims
The author claims that these findings underscore the necessity of a holistic approach in geriatric nursing care. Specifically, the study argues that:

Nutritional Status is Central: Preserving adequate nutritional status is fundamental to maintaining functional independence, as it directly impacts muscle mass, strength, and endurance.
Interconnected Determinants: Nutritional status, depressive symptoms, and fall risk are interrelated determinants; for instance, poor nutrition may exacerbate depressive symptoms, which in turn may reduce physical activity and increase fall risk, creating a cycle of functional decline.
Clinical Implication: Comprehensive geriatric assessments should integrate nutritional, psychological, and functional evaluations. The author suggests that nurses are well-positioned to coordinate multidisciplinary, person-centered care that addresses these interconnected needs to support independence in later life.

The study acknowledges limitations, including its cross-sectional design (preventing causal inference), the single-site sample (limiting generalizability), and the reliance on self-reported data. Furthermore, while guided by the Ecological Systems Perspective, the analysis focused primarily on microsystem factors, leaving mesosystem and macrosystem influences (e.g., family support, environmental characteristics) unmeasured.

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