{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:05:03Z","timestamp":1789193103631,"version":"build-2803163510"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007047","name":"Norway Grants","doi-asserted-by":"publisher","award":["4300-367\/2014"],"award-info":[{"award-number":["4300-367\/2014"]}],"id":[{"id":"10.13039\/501100007047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004329","name":"Javna Agencija za Raziskovalno Dejavnost RS","doi-asserted-by":"publisher","award":["P3-0154"],"award-info":[{"award-number":["P3-0154"]}],"id":[{"id":"10.13039\/501100004329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004329","name":"Javna Agencija za Raziskovalno Dejavnost RS","doi-asserted-by":"publisher","award":["P3-0339"],"award-info":[{"award-number":["P3-0339"]}],"id":[{"id":"10.13039\/501100004329","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Independence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objective<\/jats:title><jats:p>We focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Design<\/jats:title><jats:p>Cross-sectional observational study.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Settings and participants<\/jats:title><jats:p>Data was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants\u2019 homes. The outcome measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Results<\/jats:title><jats:p>The final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model.<\/jats:p><\/jats:sec><jats:sec id=\"sec006\"><jats:title>Conclusions<\/jats:title><jats:p>A considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0245465","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T22:16:29Z","timestamp":1611353789000},"page":"e0245465","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors that determine dependence in daily activities: A cross-sectional study of family practice non-attenders from Slovenia"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4328-3333","authenticated-orcid":true,"given":"Antonija","family":"Poplas Susi\u010d","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-1754","authenticated-orcid":true,"given":"Zalika","family":"Klemenc-Keti\u0161","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rok","family":"Blagus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8505-1437","authenticated-orcid":true,"given":"Nina","family":"Ru\u017ei\u0107 Gorenjec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"pone.0245465.ref001","unstructured":"Anon. Active Ageing. A Policy Framework. Geneva: WHO; 2002 [cited 2019 October 21]. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/67215\/WHO_NMH_NPH_02.8.pdf;jsessionid=A94EBA5222EF544190D53BAD9FF5D139?sequence=1."},{"key":"pone.0245465.ref002","first-page":"3","volume-title":"Current Diagnosis & Treatment: Geriatrics","author":"W Brie","year":"2014","edition":"2"},{"issue":"38","key":"pone.0245465.ref003","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.15585\/mmwr.mm6538a1","article-title":"Adults with One or More Functional Disabilities\u2014United States, 2011\u20132014","volume":"65","author":"AC Stevens","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"32","key":"pone.0245465.ref004","doi-asserted-by":"crossref","first-page":"882","DOI":"10.15585\/mmwr.mm6732a3","article-title":"Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults\u2014United States, 2016","volume":"67","author":"CA Okoro","year":"2018","journal-title":"MMWR Morb Mortal Wkly 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Ramadass","year":"2018","journal-title":"Journal of family medicine and primary care"},{"issue":"4","key":"pone.0245465.ref008","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S0277-9536(98)00370-0","article-title":"Risk factors for functional status decline in community-living elderly people: a systematic literature review","volume":"48","author":"AE Stuck","year":"1999","journal-title":"Social Science & Medicine"},{"key":"pone.0245465.ref009","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/1471-2318-10-77","article-title":"Loneliness and the rate of motor decline in old age: the Rush Memory and Aging Project, a community-based cohort study","volume":"10","author":"AS Buchman","year":"2010","journal-title":"BMC Geriatr"},{"issue":"6","key":"pone.0245465.ref010","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1093\/arclin\/acw049","article-title":"Assessment of Activities of Daily Living, Self-Care, and Independence","volume":"31","author":"ME Mlinac","year":"2016","journal-title":"Arch Clin Neuropsychol"},{"issue":"3","key":"pone.0245465.ref011","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/jgs.14547","article-title":"Family Caregiver Factors Associated with Unmet Needs for Care of Older Adults","volume":"65","author":"SR Beach","year":"2017","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0245465.ref012","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1089\/pop.2017.0026","article-title":"Integrating Social Services and Home-Based Primary Care for High-Risk Patients","volume":"21","author":"J Feinglass","year":"2018","journal-title":"Popul Health Manag"},{"issue":"1","key":"pone.0245465.ref013","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1089\/pop.2017.0015","article-title":"Designing a Community-Based Population Health Model","volume":"21","author":"CJ Durovich","year":"2018","journal-title":"Popul Health Manag"},{"issue":"3","key":"pone.0245465.ref014","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/gerona\/59.3.M255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care","volume":"59","author":"LP Fried","year":"2004","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"pone.0245465.ref015","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s10433-010-0141-9","article-title":"Interventions to prevent disability in frail community-dwelling older persons: an overview","volume":"7","author":"R Daniels","year":"2010","journal-title":"Eur J Ageing"},{"issue":"3","key":"pone.0245465.ref016","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10433-009-0126-8","article-title":"Forgone health care due to cost among older adults in European countries and in Israel","volume":"6","author":"H Litwin","year":"2009","journal-title":"Eur J Ageing"},{"key":"pone.0245465.ref017","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1186\/1471-2458-12-723","article-title":"What do we know about who does and does not attend general health checks? Findings from a narrative scoping review","volume":"12","author":"R Dryden","year":"2012","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0245465.ref018","doi-asserted-by":"crossref","first-page":"e019901","DOI":"10.1136\/bmjopen-2017-019901","article-title":"Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey","volume":"8","author":"X Li","year":"2018","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0245465.ref019","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/07370016.2019.1630996","article-title":"A Slovenian Model of Comprehensive Care for Patients with Difficulties Accessing Healthcare: A Step Towards Health Equity","volume":"36","author":"Z Klemenc-Ketis","year":"2019","journal-title":"J Community Health Nurs"},{"key":"pone.0245465.ref020","doi-asserted-by":"crossref","first-page":"110657","DOI":"10.1016\/j.nut.2019.110657","article-title":"Risk for malnutrition in family practice non-attenders living in the community: A cross-sectional study from Slovenia","volume":"72","author":"Z Klemenc-Ketis","year":"2019","journal-title":"Nutrition"},{"issue":"5","key":"pone.0245465.ref021","first-page":"315","article-title":"The Lawton Instrumental Activities of Daily Living (IADL) Scale","volume":"18","author":"C Graf","year":"2009","journal-title":"Medsurg Nurs"},{"key":"pone.0245465.ref022","first-page":"1","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","author":"Anon","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"issue":"3","key":"pone.0245465.ref023","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1093\/ajcn\/81.3.555","article-title":"Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men","volume":"81","author":"Y Wang","year":"2005","journal-title":"Am J Clin Nutr"},{"issue":"2","key":"pone.0245465.ref024","first-page":"303","article-title":"Validity and reliability of the family APGAR as a test of family function","volume":"15","author":"G Smilkstein","year":"1982","journal-title":"J Fam Pract"},{"issue":"5","key":"pone.0245465.ref025","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1079\/BJN20041258","article-title":"Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the \u2019malnutrition universal screening tool\u2019 (\u2019MUST\u2019) for adults","volume":"92","author":"RJ Stratton","year":"2004","journal-title":"Br J Nutr"},{"key":"pone.0245465.ref026","volume-title":"Preventing patient falls","author":"J Morse","year":"1997"},{"key":"pone.0245465.ref027","doi-asserted-by":"crossref","first-page":"514589","DOI":"10.1155\/2014\/514589","article-title":"Correlation between Body Mass Index and Waist Circumference in Patients with Metabolic Syndrome","volume":"2014","author":"M Gierach","year":"2014","journal-title":"ISRN Endocrinol"},{"issue":"1","key":"pone.0245465.ref028","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.archger.2013.08.001","article-title":"Total daily activity declines more rapidly with increasing age in older adults","volume":"58","author":"AS Buchman","year":"2014","journal-title":"Arch Gerontol Geriatr"},{"key":"pone.0245465.ref029","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2017"},{"key":"pone.0245465.ref030","unstructured":"Holst KK. gof-package: Model-diagnostics based on cumulative residuals 2014 [cited 2019 April 9]. https:\/\/rdrr.io\/cran\/gof\/man\/gof-package.html."},{"key":"pone.0245465.ref031","unstructured":"Harrell FEJ. rms: Regression Modeling Strategies. R package version 5.1\u20133.12019 2019, September 15 [cited 2019 September 15]. https:\/\/CRAN.R-project.org\/package=rms."},{"issue":"10","key":"pone.0245465.ref032","doi-asserted-by":"crossref","first-page":"e0165127","DOI":"10.1371\/journal.pone.0165127","article-title":"Limitations in Activities of Daily Living in Community-Dwelling People Aged 75 and Over: A Systematic Literature Review of Risk and Protective Factors","volume":"11","author":"A van der Vorst","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0245465.ref033","first-page":"45","article-title":"Correlation of coronary heart disease patient assessment of chronic illness care and quality of care procedures","volume":"11","author":"K Tu\u0161ek-Bunc","year":"2018","journal-title":"Acta Medico-Biotechnica"},{"issue":"3","key":"pone.0245465.ref034","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.maturitas.2013.04.005","article-title":"Factors associated with increasing functional decline in multimorbid independently living older people","volume":"75","author":"W Laan","year":"2013","journal-title":"Maturitas"},{"issue":"18","key":"pone.0245465.ref035","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.3109\/09638288.2011.647233","article-title":"An empirical exploration of the relations between the health components of the International Classification of Functioning, Disability and Health (ICF)","volume":"34","author":"RJ Perenboom","year":"2012","journal-title":"Disabil Rehabil"},{"key":"pone.0245465.ref036","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1186\/1471-2458-14-381","article-title":"Impacts of mobility disability and high and increasing body mass index on health-related quality of life and participation in society: a population-based cohort study from Sweden","volume":"14","author":"M Holmgren","year":"2014","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0245465.ref037","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/NNR.0000000000000227","article-title":"Fear and Risk of Falling, Activities of Daily Living, and Quality of Life: Assessment When Older Adults Receive Emergency Department Care","volume":"66","author":"T Cinarli","year":"2017","journal-title":"Nurs Res"},{"issue":"1","key":"pone.0245465.ref038","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/jgs.12071","article-title":"Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study","volume":"61","author":"NK Sekaran","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"pone.0245465.ref039","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1471-2318-9-26","article-title":"Social participation and independence in activities of daily living: a cross sectional study","volume":"9","author":"E Rubio","year":"2009","journal-title":"BMC Geriatr"},{"issue":"6","key":"pone.0245465.ref040","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5539\/gjhs.v4n6p99","article-title":"Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study","volume":"4","author":"JR Pharr","year":"2012","journal-title":"Glob J Health Sci"},{"key":"pone.0245465.ref041","doi-asserted-by":"crossref","first-page":"84","DOI":"10.11606\/s1518-8787.2017051006959","article-title":"Validity of questions about activities of daily living to screen for dependency in older adults","volume":"51","author":"M Reboucas","year":"2017","journal-title":"Rev Saude Publica"},{"issue":"3","key":"pone.0245465.ref042","first-page":"506","article-title":"Screening for dependence in activities of daily living in the elderly: minimum set of questions","volume":"47","author":"LR Ramos","year":"2013","journal-title":"Rev Saude 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