A Two-Factor Model of Functional Independence Among Community-Dwelling Indonesian Older Adults: Evidence from Exploratory and Confirmatory Factor Analysis

Wahyu Tri Sudaryanto, Farid Rahman, Raditya Nugroho Wicaksono

Abstract


Background: Despite the widespread use of functional independence measures in geriatric assessment, evidence regarding their underlying factor structure among Indonesian older adults remains limited. Therefore, this study aimed to identify and validate the factor structure of functional independence among Indonesian older adults using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Methods: The measurement items were derived from the 2023 Indonesian Health Survey (SKI 2023) dataset. These items were adapted from domains of the Barthel Index and were intended to assess functional independence among 95,552 older adults. EFA was initially conducted using the principal-factor method with varimax rotation. Factors with eigenvalues greater than 1.0 were retained, and items with factor loadings of at least 0.40 were considered acceptable. Subsequently, CFA was performed to assess the construct validity of the identified factor structure.

Results: The EFA results identified a two-factor structure consisting of 10 indicators, explaining 74.55% of the total variance. Factor 1, Basic Activities of Daily Living (ADL), comprised eight indicators and accounted for 52.59% of the variance. Factor 2, Continence Control, comprised two indicators and accounted for 21.96% of the variance. CFA demonstrated an acceptable model fit (RMSEA= 0.070, CFI= 0.975, TLI= 0.967, SRMR= 0.019, and CD= 98.7%), with Cronbach's alpha values= 0.92.

Conclusion: The two-factor model supports the conceptualization of functional independence as a multidimensional construct comprising both basic activities of daily living and continence control. The validated instrument may be useful for geriatric assessment, public health surveillance, and community-based services aimed at identifying older adults at risk of functional decline

Keywords


Exploratory Factor Analysis; Functional Independence; Older People

Full Text:

PDF
rticle

References


  1. Statistics Indonesia (2025). Statistics of Aging Population 2025. Retrieved from https://www.bps.go.id/en/­publi­cation/2025/12/12/868d335b088dcddc3ddee052/statistics-of-aging-popula­tion-2025.html on June 20, 2026.
  2. Khan, H.T.A., Addo, K.M., Findlay, H. (2024). Public Health Challenges and Responses to the Growing Ageing Populations. Public Health Chall, 3(3), e213. https://doi.org/­10.1002/puh2.213.
  3. Gianfredi, V., Nucci, D., Pennisi, F., Maggi, S., Veronese, N., & Soysal, P. (2025). Aging, longevity, and healthy aging: the public health approach. Aging Clin Exp Res, 37(1), 125. https://doi.org/10.1007/­s40520-025-03021-8.
  4. Goodarzi, F., Khoshravesh, S., Ayubi, E., Bashirian, S., & Barati, M. (2024). Psychosocial determinants of func­tional independence among older adults: A systematic review and meta-analysis. Health Promot Perspect, 14(1), 32–43. https://doi.­org/10.3417­2/hpp.42354.
  5. Ribeiro, D.K.M.N., Lenardt, M.H., Lourenço, T.M., Betiolli, S.E., Seima, M.D., & Guimarães, C.A. (2017). The use of the functional independence measure in elderly. Rev Gaúcha Enferm, 38(4), e66496. http://dx.doi.­org/10.1590/1983-1447.2017.04.664­96.
  6. Jahan, A.M. (2024). Insight into functio­nal decline assessment in older adults: A physiotherapist's perspec­tive. Archives of Gerontology and Geriatrics Plus, 1(4), 100048. https://doi.org/10.1016/j.aggp.2024.100048.
  7. Gupta, S., Yadav, R., & Malhotra, A.K. (2016). Assessment of physical disability using Barthel index among elderly of rural areas of district Jhansi (U.P), India. J Family Med Prim Care, 5(4), 853–857. https://doi.org/­10.4103/2249-4863.201178.
  8. Sinoff, G., & Ore, L. (2015). The Barthel Activities of Daily Living Index: Self-Reporting Versus Actual Performance in the Old-Old (≥ 75 years). J Am Geriatr Soc, 45(7), 832-836. https://doi.org/10.1111/j.1532-5415.1997.tb01510.x.
  9. Hopman-Rock, M., van Hirtum, H., de Vreede, P., & Freiberger, E. (2018). Activities of daily living in older community-dwelling persons: a systematic review of psychometric properties of instruments. Aging Clin Exp Res, 31(7), 917–925. https://doi.­org/10.1007/s40520-018-1034-6.
  10. Idaiani, S., & Indrawati, L. (2021). Functional status in relation to depression among elderly individuals in Indonesia: a cross-sectional analy­sis of the Indonesian National Health Survey 2018 among elderly indivi­duals. BMC Public Health, 21, 2332. https://doi.org/10.1186/s12889-021-12260-z.
  11. Izquierdo, I., Olea, J., & Abad, F.J. (2014). Exploratory factor analysis in validation studies: uses and recommendations. Psicothema, 26(3), 395–400. https://doi.org/10.7­334/psi­cothema2013.349.
  12. Watkins, M.W. (2018). Exploratory factor analysis: a guide to best practice. J Black Psychol, 44(3), 219–246. https://doi.org/10.1177/009579­8418771807.
  13. Dabbagh, A., Seens, H., Fraser, J., & MacDermid, J.C. (2023). Construct validity and internal consistency of the Home and Family Work Roles Questionnaires: a cross-sectional study with exploratory factor analy­sis. BMC Womens Health, 23, 56. https://doi.org/10.1186/s12905-023-02199-1.
  14. Jiang, G., Tan, X., Wang, H., Xu, M., & Wu, X. (2023). Exploratory and confirmatory factor analyses identi­fy three structural dimensions for measuring physical function in community-dwelling older adults. PeerJ, 11, e15182. https://doi.org/­10.7717/peerj.15182.
  15. Valero-Chillerón, M.J., Llagostera-Reverter, I., Luna-Aleixós, D., Moreno-Casbas, M., Andreu-Pejó, L., & González-Chordá, V.M. (2023). Exploring the construct validity of the Barthel index in a sample of Spanish hospitalised patients. Enferm Clin (Engl Ed), 33(5), 370-374. https://­doi.org/10.­1016/j.enfcle.2023.06.005.
  16. Kaambwa, B., Bulamu, N.B., Mpundu-Kaambwa, C., & Oppong, R. (2021). Convergent and Discrimi­nant Validity of the Barthel Index and the EQ-5D-3L When Used on Older People in a Rehabilitation Setting. Int J Environ Res Public Health, 18(19), 10314. https://doi.­org/10.3390/ijerph­181910314.
  17. Watson, R., & Thompson, D.R. (2006). Use of factor analysis in Journal of Advanced Nursing: litera­ture review. J Adv Nurs, 55(3), 330-41. https://doi.org/10.1111/j.1365-26­48.2006.03915.x.
  18. Mundfrom, D. J., Shaw, D. G., & Ke, T. L. (2005). Minimum Sample Size Recommendations for Conducting Factor Analyses. Int J Test, 5(2), 159–168. https://doi.org/10.1207/s­15327574ijt0502_4.
  19. Sigudla, J., & Maritz, J.E. (2023). Explo­ratory factor analysis of constructs used for investigating research uptake for public healthcare practice and policy in a resource-limited setting, South Africa. BMC Health Serv Res, 23, 1423. https://doi.org­/10.1186/s12913-023-10165-8.
  20. Rahman, Z.A., Isa, B., Shahibi, M.S., & Mansor, M.I. (2023). Exploratory factor analysis of items for evalua­ting healthy lifestyles related to mental health among undergraduate students. Malays Fam Physician, 18, 62. https://doi.org/10.51866/oa.448.
  21. Gaskin, C.J., & Happell, B. (2014). On exploratory factor analysis: a review of recent evidence, an assessment of current practice, and recommenda­tions for future use. Int J Nurs Stud, 51(3), 511-21. https://­doi.org/10.10­16/j.ijnurstu.2013.10.­005.
  22. Costello, A.B., & Osborne, J.W. (2005). Best practices in exploratory factor analysis: Four recommenda­tions for getting the most from your analysis. Pract Assess Res Eval, 10(7). Retrieved from http://pare­online.net/getvn.asp?v=10&n=7 on June 20, 2026.
  23. Kaiser, H.F. (1974). An Index of Factorial Simplicity. Psychometrika, 39(1), 31-36. https://doi.org/10.1007/­BF02291575.
  24. Michie, S., Johnston, M., Rothman, A.J., et al. (2021). Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study. Southamp­ton (UK): NIHR Journals Library. (Health Services and Delivery Research, No. 9.1.) Appendix 7, Scree plot of eigenvalues from explo­ratory factor analysis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK567042/ on June 20, 2026.
  25. Roos, M., & Bauldry, S. (2024). Confir­matory Factor Analysis. Sage Research Methods. https://doi.org/­10.4135/9781071938959.
  26. Goretzko, D., Siemund, K., & Sterner, P. (2023). Evaluating model fit of measurement models in confir­ma­tory factor analysis. Educ Psychol Meas, 84(1), 123–144. https://doi.­org/10.1177/00131644231163813.
  27. Johnson, A. (2017). Reliability, Cronbach’s alpha. Sage Ency­cl Commun Res Methods, 4, 1415-1417. SAGE Publi­cations, Inc. https://doi.­org/10.4135/9781483381411.n492.
  28. Kim, J.H., & Lee, S.B. (2025). Evaluation of activities of daily living: Current insights and future horizons. Ann Geriatr Med Res, 29(2), 143–158. https://doi.org/10­.4235/agmr.24.0172.
  29. Hicks, G.E., Shardell, M., Alley, D.E., Miller, R.R., Bandinelli, S., Guralnik, J., Lauretani, F., et al. (2011). Absolute Strength and Loss of Strength as Predictors of Mobility Decline in Older Adults: The InCHIANTI Study. J Gerontol A Biol Sci Med Sci, 67A(1), 66–73. https://­doi.org/10.1093/gerona/glr055.
  30. Tibaek, S., & Dehlendorff, C. (2012). Is Barthel Index a relevant measure for measuring prevalence of urinary incontinence in stroke patients?. Neurourol Urodyn, 31(1), 44-9. https://doi.org/10.1002/nau.21203.
  31. Farrés-Godayol, P., Jerez-Roig, J., Minobes-Molina, E., Yildirim, M., Molas-Tuneu, M., Escribà-Salvans, A., et al. (2022). Urinary incontinence and its association with physical and psycho-cognitive factors: A cross-sectional study in older people living in nursing homes. Int J Environ Res Public Health, 19(3), 1500. https://­doi.org/10.3390/ijerph19031500.
  32. Hardy, C.C., & Korstanje, R. (2023). Aging and urinary control: Altera­tions in the brain–bladder axis. Aging Cell, 22(12), e13990. https://doi.org/­10.1111/acel.13990.
  33. Malmstrom, T.L., Andresen, E.M., Wolinsky, F.D., Schootman, M., Miller, J.P., & Miller, D.K. (2010). Urinary and fecal incontinence and quality of life in African Americans. J Am Geriatr Soc, 58(10), 1941–1945. https://doi.org/10.1111/j.1532-5415.­2010.03057.x.
  34. Yip, S.O., Dick, M.A., McPencow, A.M., Martin, D.K., Ciarleglio, M.M., & Erekson, E.A. (2012). The associa­tion between urinary and fecal incontinence and social isolation in older women. Am J Obstet Gynecol, 208(2), 146.e1–146.e7. https://doi.­org/10.1016/j.ajog.2012.11.010.




DOI: https://doi.org/10.20961/placentum.v14i2.121977

Refbacks

  • There are currently no refbacks.


Copyright (c) 2026 Placentum: Jurnal Ilmiah Kesehatan dan Aplikasinya

View My Stats

Lisensi Creative Commons
This work is licensed under a Creative Commons Attribution-ShareAlike International 4.0 (CC BY-SA 4.0).