Adaptation to disability in chronic obstructive pulmonary disease: neglected relationships to older adults' perceptions of independence

strategies available to older adults with COPD enables them to feel highly independent despite disability. Purpose: This study extends understanding of the relationship between disability and independence in older adults with COPD. Methods: An interviewer-administered questionnaire was used to examine disability, adaptation, perceptions of independence, and self-efficacy in a sample of 50 community-dwelling older adults. Odds ratios were used to investigate relationships between variables. Results: Participants used a wide range of behavioural strategies to adapt to their disability including: limiting activities, optimizing performance (e.g. taking rests), compensating for lost function (e.g. using equipment), and obtaining help from others. The relative use of these adaptations varied across five domains of activity: personal care, in-home mobility, household activities, community mobility, and valued activities. Most participants felt very or extremely independent in all domains. In personal care, those who reported greater disability (O.R. = 0.26), more frequent attempts to optimize performance (O.R. = 0.57), or greater reliance on help from others (O.R. = 0.79) were significantly (p < 0.05) less likely to feel very or extremely independent. Conclusions: The relationship between disability and perceptions of independence depends on the nature of the activity and is influenced by factors that are amenable to study and intervention. In particular, the vast array of behavioural strategies available to older adults with COPD enables them to feel highly independent despite disability.