Prevalence and predictors of functional dependence in Instrumental Activities of Daily Living (IADL) among older adults in Southern Saudi Arabia

Impaired functional ability threatens the autonomy of older adults, affecting their families and healthcare systems. As Saudi Arabia’s older population continues to grow, identifying the burden and drivers of functional disability is critical for guiding health policy, especially in rural areas that lack adequate data. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its predictive factors among older adults in Bisha Province, southern Saudi Arabia. An institution-based cross-sectional study was conducted in 16 randomly selected Primary Health Care Centers (PHCCs) from December 2023 to February 2024. Participants were selected using two-stage cluster sampling followed by systematic random sampling. Data were collected from 396 Saudi adults aged ≥ 60 years using a pre-tested, interviewer-administered Arabic questionnaire that included the validated Lawton IADL Scale. Functional disability was defined using gender-specific scoring. Univariate and multivariate logistic regressions were applied to determine the factors associated with IADL disability. The overall prevalence of IADL disability was 67.7% (56.6% among men, 83.9% among women). Severe dependence was observed in 31.1% and complete dependence in 5.3% of participants. In the final multivariable model, six independent predictors were identified: being female (adjusted Odds Ratio [aOR] 3.77; 95% confidence interval [CI] 2.16–6.59, p < .001), physical inactivity (aOR 3.49; CI 2.12–5.77, p < .001), history of falls (aOR 2.73; CI 1.11–6.73, p = .029), illiteracy (aOR 1.92; CI 1.15–3.19, p = .012), having a caregiver (aOR 1.88; CI 1.13–3.13, p = .015) and age ≥ 80 years (aOR 1.61; CI 1.11–2.35, p = .013). The prevalence of IADL disability among older adults in this rural Saudi setting is alarmingly high, exceeding rates reported in many national and international studies. This striking burden of IADL disability among older people emphasizes the urgent need for comprehensive healthcare services and public health interventions. The findings of this study contribute to the existing knowledge gap in this area and provide valuable insights for health policy programs.