Samenvatting

Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent
from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable
well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity,
empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare
professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized
manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify
clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe
them according to individual characteristics.
Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis
identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed
and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically
strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically
somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically
limited people with insufficient coping styles who receive professional help. These subgroups showed significant
differences in demographic characteristics and clinical FI outcomes.
Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups
based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for
each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of
FI in the community-dwelling older population.