I
nte
rna
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l J
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urna
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(
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J
P
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Vo
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Factors
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l,
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n
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On
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In
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A
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f
d
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g
Fu
n
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ab
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Me
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s
ta
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P
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p
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P
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ab
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T
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C
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:
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Scien
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ail:
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541@
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5
1
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s
tr
o
k
e
(
4
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.
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d
en
tal
an
d
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r
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p
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o
b
lem
s
(
1
9
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ch
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(
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6
%)
an
d
d
iab
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ellit
u
s
(
4
.
8
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[
1
]
.
Ag
i
n
g
r
ef
er
s
to
th
e
p
r
o
ce
s
s
o
f
g
ettin
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ld
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w
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d
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r
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as
p
h
y
s
ical,
m
e
n
tal
a
n
d
s
o
cial
ch
an
g
es
[
2
]
.
A
s
s
h
o
w
n
i
n
m
an
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s
t
u
d
ies,
ag
in
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s
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f
p
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s
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w
it
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h
e
m
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h
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g
h
er
m
o
r
b
id
it
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a
n
d
m
o
r
talit
y
[
3
]
.
Old
ag
e
is
a
s
s
o
ciate
d
w
it
h
a
g
r
ad
u
al
d
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lin
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n
p
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in
cr
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r
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al
d
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li
n
e
in
i
n
d
i
v
id
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ca
p
ac
ities
[
4
]
.
W
h
en
a
p
er
s
o
n
ex
p
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ce
s
a
n
in
cr
ea
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in
a
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m
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lik
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p
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to
ex
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p
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s
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m
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tal
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s
p
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ec
o
n
o
m
ic
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n
d
s
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ci
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Fo
r
th
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eld
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l
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n
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o
f
th
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m
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t
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ati
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s
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t
h
i
s
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icate
d
b
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t
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d
ata
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n
d
is
ea
s
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p
atter
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s
in
t
h
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ly
.
Ost
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ar
t
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r
itis
(
O
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)
i
s
a
lead
in
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ca
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s
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p
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an
d
lead
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to
a
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ce
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q
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f
e
[
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
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6
I
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P
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Sci
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Vo
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11
,
No
.
1
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M
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20
22
:
1
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2
Mo
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Acc
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[
2
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.
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h
ea
s
t
A
s
ia
n
r
eg
io
n
.
Ost
eo
ar
th
r
iti
s
(
O
A
)
is
t
h
e
m
o
s
t
co
m
m
o
n
m
u
s
cu
lo
s
k
eleta
l
d
is
o
r
d
er
th
at
af
f
ec
t
s
p
atien
t
s
'
q
u
alit
y
o
f
li
f
e.
A
p
p
r
o
x
i
m
atel
y
3
5
-
4
0
m
ill
io
n
E
u
r
o
p
ea
n
s
an
d
~3
5
5
m
illi
o
n
p
eo
p
le
h
av
e
OA
w
o
r
ld
w
id
e
[
6
]
,
[
7
]
.
A
cc
o
r
d
in
g
to
th
e
Am
er
ica
n
A
ca
d
e
m
y
o
f
Or
th
o
p
ed
ic
Su
r
g
eo
n
(
AA
O
S),
o
s
teo
ar
th
r
itis
i
s
o
n
e
o
f
t
h
e
f
i
v
e
ca
u
s
e
s
o
f
d
i
s
ab
ilit
y
d
u
e
to
b
o
n
e
d
is
ea
s
e
[
8
]
.
Ost
eo
ar
th
r
iti
s
(
O
A
)
,
a
d
eg
en
er
ativ
e
d
is
ea
s
e
o
f
th
e
d
iar
t
h
r
o
d
ial
j
o
in
t,
is
in
f
lu
e
n
ce
d
b
y
m
ec
h
an
ical
an
d
in
f
la
m
m
a
to
r
y
f
ac
to
r
s
w
it
h
a
g
i
n
g
,
o
b
esi
t
y
,
c
h
r
o
n
ic
in
j
u
r
y
,
a
n
d
s
ec
o
n
d
ar
y
d
is
ea
s
e
co
n
s
id
er
ed
to
b
e
th
e
m
ai
n
f
ac
to
r
s
d
r
iv
i
n
g
t
h
e
d
eg
e
n
er
ati
o
n
o
f
ar
tic
u
lar
ca
r
tila
g
e
[
9
]
OA
i
s
al
s
o
a
m
u
lt
if
ac
eted
d
is
ea
s
e
b
ased
o
n
r
ec
en
t
f
i
n
d
in
g
s
th
at,
ap
ar
t
f
r
o
m
ce
llu
lar
a
n
d
m
o
lec
u
lar
m
ec
h
a
n
is
m
s
,
in
f
la
m
m
atio
n
,
m
e
tab
o
lic
p
r
o
ce
s
s
es,
an
d
ep
ig
en
etic
m
o
d
if
ica
tio
n
s
[
1
0
]
ar
e
in
v
o
l
v
ed
in
d
is
ea
s
e
p
at
h
o
g
en
esi
s
an
d
p
r
o
g
r
ess
io
n
[
1
1
]
–
[
1
3
]
.
Ost
eo
ar
th
r
iti
s
i
s
a
ch
r
o
n
ic
d
is
ea
s
e
w
h
o
s
e
e
x
ac
t
ca
u
s
e
i
s
n
o
t
y
et
k
n
o
w
n
,
b
u
t
it
is
ch
ar
ac
te
r
ized
b
y
a
g
r
ad
u
al
lo
s
s
o
f
j
o
in
t
ca
r
tilag
e.
B
ased
o
n
th
e
Natio
n
al
C
e
n
ter
s
f
o
r
Hea
lth
S
tatis
t
ics,
an
es
ti
m
ated
1
5
.
8
m
illi
o
n
(
1
2
%)
ad
u
lts
b
et
w
ee
n
t
h
e
a
g
es
o
f
2
5
-
7
4
y
ea
r
s
h
a
v
e
co
m
p
lain
ts
o
f
o
s
teo
ar
th
r
it
is
.
T
h
e
p
r
ev
alen
ce
o
f
j
o
in
t
d
is
ea
s
e
i
n
I
n
d
o
n
e
s
ia
i
s
also
q
u
ite
h
i
g
h
,
u
p
to
2
4
.
7
%
an
d
it
in
cr
ea
s
es
w
it
h
a
g
e.
T
h
e
p
r
ev
ale
n
ce
is
3
7
.
2
%
at
th
e
ag
e
o
f
4
5
-
5
4
,
4
5
%
at
th
e
a
g
e
o
f
5
5
-
6
4
,
5
1
.
9
%
at
ag
e
o
f
6
5
-
7
4
,
an
d
5
4
.
8
%
at
th
e
ag
e
o
f
7
5
an
d
m
o
r
e.
I
n
th
e
Sp
ec
ial
R
e
g
io
n
o
f
Yo
g
y
a
k
ar
t
a,
h
ea
lt
h
w
o
r
k
er
s
h
a
v
e
f
o
u
n
d
5
.
6
%
d
iag
n
o
s
ed
f
o
r
j
o
in
t
d
is
e
ase,
2
2
,
7
%
h
av
in
g
s
y
m
p
to
m
s
an
d
th
at
o
s
teo
ar
th
r
i
tis
is
h
i
g
h
er
in
w
o
m
e
n
(
1
3
.
4
%)
th
an
m
en
(
1
0
.
3
%)
as
w
ell
as
th
e
s
y
m
p
to
m
s
o
f
o
s
teo
ar
th
r
itis
i
n
w
o
m
e
n
(
2
7
.
5
%)
h
i
g
h
er
t
h
an
m
e
n
(
2
1
.
8
%)
[
1
4
]
.
B
ased
o
n
th
e
Stat
is
tic
s
o
f
B
an
tu
l
R
e
g
e
n
c
y
,
o
n
e
o
f
t
h
e
Dis
tr
ict
s
i
n
th
e
Sp
ec
ial
P
r
o
v
in
ce
o
f
Yo
g
y
a
k
ar
ta,
I
n
d
o
n
e
s
ia
(
2
0
1
2
)
th
e
n
u
m
b
er
o
f
eld
er
l
y
r
esi
d
en
ts
i
n
B
an
t
u
l
R
eg
e
n
c
y
w
a
s
1
1
1
,
7
5
0
p
e
o
p
le
co
n
s
is
tin
g
o
f
4
9
,
8
9
2
m
e
n
a
n
d
6
1
,
8
5
8
w
o
m
e
n
.
L
i
f
e
e
x
p
ec
tan
c
y
in
B
an
t
u
l
R
eg
e
n
c
y
h
a
s
i
n
cr
ea
s
ed
,
f
r
o
m
7
1
.
3
1
y
ea
r
s
i
n
2
0
1
0
in
cr
ea
s
ed
to
7
1
.
6
2
y
ea
r
s
i
n
2
0
1
4
.
T
h
e
p
r
o
b
le
m
o
f
t
h
e
e
ld
er
l
y
w
i
th
o
s
teo
ar
t
h
r
itis
w
as
t
h
e
lac
k
o
f
in
d
ep
en
d
en
ce
i
n
ca
r
r
y
i
n
g
o
u
t
ac
tiv
itie
s
o
f
d
ail
y
li
v
in
g
.
T
h
e
Ob
s
er
v
atio
n
r
es
u
lt
s
s
h
o
w
th
a
t
th
e
eld
er
l
y
w
h
o
liv
e
w
it
h
c
h
ild
r
en
w
er
e
n
o
t
i
n
d
ep
en
d
en
t
i
n
ca
r
r
y
i
n
g
o
u
t
ac
t
iv
i
t
ies
o
f
d
ail
y
li
f
e.
L
ik
e
w
is
e,
t
h
e
eld
er
l
y
w
h
o
d
o
g
y
m
n
ast
ics
d
o
n
o
t
g
u
ar
an
tee
th
eir
i
n
d
ep
en
d
en
ce
in
ca
r
r
y
i
n
g
o
u
t
ac
ti
v
itie
s
o
f
d
ail
y
li
f
e.
A
cti
v
it
ies
o
f
d
ail
y
liv
i
n
g
(
A
D
L
)
r
ef
er
t
o
ac
tiv
iti
es
o
r
ien
ted
to
w
ar
d
s
s
el
f
-
ca
r
e.
T
h
ese
ac
tiv
ities
ar
e
f
u
n
d
a
m
e
n
tal
to
liv
i
n
g
i
n
th
e
s
o
cial
w
o
r
ld
;
th
e
y
e
n
ab
le
b
asi
c
s
u
r
v
i
v
al
an
d
w
ell
-
b
ein
g
,
s
u
c
h
as
b
ath
i
n
g
,
to
ileti
n
g
,
d
r
ess
i
n
g
an
d
ea
tin
g
[
1
5
]
.
P
h
y
s
ical
ac
ti
v
it
y
a
m
o
n
g
th
e
eld
er
ly
h
as
b
ee
n
a
s
s
o
ciate
d
w
it
h
r
ed
u
ce
d
r
is
k
f
r
o
m
all
c
au
s
e
s
o
f
d
ea
th
an
d
i
m
p
r
o
v
e
p
h
y
s
ical,
m
e
n
tal
an
d
s
o
cial
w
ell
-
b
ein
g
[
1
6
]
.
T
h
e
b
en
ef
it
s
o
f
th
i
s
r
esear
ch
ar
e
in
p
u
t
f
o
r
th
e
B
an
t
u
l
P
ler
et
Hea
lth
C
e
n
ter
r
elate
d
to
th
e
p
r
o
g
r
a
m
f
o
r
t
h
e
eld
er
ly
,
an
d
f
o
r
o
th
er
h
ea
lth
ce
n
te
r
s
in
I
n
d
o
n
esia
i
n
in
cr
ea
s
i
n
g
t
h
e
i
n
d
ep
en
d
en
ce
o
f
o
s
teo
ar
th
r
iti
s
s
u
f
f
er
er
s
i
n
a
s
u
s
tai
n
ab
le
m
an
n
er
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
e
ty
p
e
o
f
th
i
s
r
esear
ch
w
as
d
escr
ip
tiv
e
co
r
r
elatio
n
w
it
h
cr
o
s
s
s
ec
tio
n
al
ap
p
r
o
ac
h
.
R
esp
o
n
d
en
ts
i
n
th
is
s
t
u
d
y
w
er
e
eld
er
l
y
i
n
B
a
n
tu
l
R
eg
e
n
c
y
,
I
n
d
o
n
e
s
ia.
T
o
tal
s
a
m
p
lin
g
a
n
d
c
h
i
s
q
u
ar
e
was
o
b
tain
ed
w
i
th
9
5
s
a
m
p
les.
T
h
e
n
u
m
b
er
o
f
s
a
m
p
les
w
as
d
eter
m
i
n
ed
b
ased
o
n
t
h
e
n
u
m
b
er
o
f
p
o
p
u
latio
n
,
as
u
m
i
n
g
th
a
t
t
h
e
o
s
teo
ar
th
r
itis
eld
er
l
y
w
er
e
1
2
0
in
n
u
m
b
er
.
T
h
er
ef
o
r
e,
th
is
r
esear
ch
u
s
ed
th
e
Slo
v
in
f
o
r
m
u
la
to
g
et
ά
=
0
.
0
5
.
T
h
e
s
am
p
li
n
g
tech
n
iq
u
e
u
s
ed
w
as
r
an
d
o
m
s
a
m
p
li
n
g
tech
n
i
q
u
e.
T
h
e
in
clu
s
io
n
cr
iter
ia
f
o
r
th
e
eld
er
ly
i
n
th
i
s
s
tu
d
y
ar
e
eld
er
l
y
p
eo
p
le
w
it
h
o
s
teo
ar
th
r
itis
,
at
least
6
0
y
ea
r
s
o
ld
,
th
e
eld
er
ly
ar
e
r
esid
en
t
s
w
h
o
liv
e
i
n
P
ler
et
Dis
tr
ict,
B
an
t
u
l
R
e
g
e
n
c
y
,
Yo
g
y
ak
ar
ta,
I
n
d
o
n
e
s
ia
t
h
e
eld
er
l
y
ar
e
ab
le
to
u
n
d
er
s
tan
d
w
h
at
t
h
e
au
th
o
r
s
s
a
y
,
an
d
th
e
eld
er
l
y
ar
e
w
illi
n
g
to
b
e
r
esp
o
n
d
en
ts
.
T
h
e
in
s
tr
u
m
e
n
t
u
s
e
d
to
m
ea
s
u
r
e
i
n
d
ep
en
d
en
ce
i
n
th
e
eld
er
l
y
is
T
h
e
Katz
I
n
d
ex
o
f
I
n
d
ep
en
d
en
ce
i
n
ac
ti
v
itie
s
o
f
d
ail
y
li
v
i
n
g
(
ADL
)
,
W
ester
n
O
n
tar
io
a
n
d
Mc
Ma
s
ter
U
n
iv
er
s
itie
s
Ost
eo
ar
th
r
iti
s
I
n
d
ex
(
W
OM
AC
)
s
co
r
e
f
o
r
f
u
n
ctio
n
al
ab
i
lit
y
an
d
s
h
o
r
t
p
o
r
tab
le
m
en
tal
s
tatu
s
q
u
est
io
n
n
air
e
SP
MSQ
f
o
r
m
en
tal
s
tatu
s
.
T
h
e
W
ester
n
O
n
tar
io
a
n
d
Mc
Ma
s
ter
Un
iv
er
s
ities
Ost
eo
ar
t
h
r
iti
s
I
n
d
ex
(
W
OM
A
C
s
co
r
e)
w
h
ic
h
co
n
tai
n
s
2
4
q
u
es
tio
n
s
:
f
i
v
e
q
u
esti
o
n
s
ab
o
u
t
p
ain
,
t
w
o
q
u
e
s
tio
n
s
ab
o
u
t
s
ti
f
f
n
e
s
s
an
d
1
7
q
u
est
io
n
s
ab
o
u
t
p
ain
ac
tiv
it
y
.
T
h
is
W
O
MA
C
s
co
r
e
q
u
est
io
n
n
air
e
u
s
e
s
a
s
co
r
e
o
f
1
-
5
.
T
h
e
o
r
ig
in
al
m
ea
s
u
r
e
m
e
n
t
s
ca
le
o
n
th
i
s
q
u
esti
o
n
n
air
e
u
s
e
s
an
o
r
d
in
al
d
ata
s
ca
le,
b
u
t it
w
as c
h
an
g
ed
to
a
n
o
m
in
al
s
ca
le.
A
cti
v
it
ies
o
f
d
ail
y
li
v
in
g
ar
e
a
s
elf
-
ca
r
e
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iate
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ed
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s
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is
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is
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h
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ip
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ical
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les.
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w
o
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ar
iab
le
s
s
h
o
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ld
co
n
s
is
t
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J
P
u
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8806
F
a
cto
r
s
o
f in
d
ep
en
d
en
t o
f
a
ctivities o
f d
a
ily
livin
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o
s
teo
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erly
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r
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d
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a
n
i
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3
t
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m
o
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e
ca
teg
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ical,
i
n
d
e
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en
d
en
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g
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p
s
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x
a
m
p
le
in
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ep
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en
t
v
ar
iab
les
t
h
at
m
ee
t
t
h
is
cr
iter
io
n
i
n
cl
u
d
e
Fu
n
ctio
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ab
ilit
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el
(
to
tal
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e
W
OM
AC
0
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2
4
=
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2
4
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48=
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er
ate
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n
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v
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,
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=v
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y
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,
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io
lo
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y
(
g
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-
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y
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n
ast
ics),
m
en
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tat
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l
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0
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er
r
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r
s
=
w
h
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le,
3
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er
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o
r
s
=m
ild
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m
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a
ir
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5
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er
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o
r
s
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m
o
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er
ate
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m
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air
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e
n
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n
d
eig
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o
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m
o
r
e
er
r
o
r
s
:
s
ev
er
e
i
m
p
air
m
e
n
t
)
[
1
7
]
an
d
Katz
in
d
e
x
o
f
i
n
d
ep
en
d
en
ce
in
A
c
tiv
ities
o
f
Dail
y
L
i
v
i
n
g
(
s
co
r
i
n
g
1
=i
n
d
ep
en
d
en
t,
2
-
7=
d
ep
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d
en
t)
.
Giv
i
n
g
co
d
in
g
i
n
t
h
e
ADL
(
Activ
it
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f
Dail
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iv
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g
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r
esea
r
ch
o
f
th
e
eld
e
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l
y
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n
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es:
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n
d
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en
t
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tal=
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d
in
g
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n
li
g
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t=2
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d
in
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l
ig
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3
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ep
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in
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=4
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ep
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t=
5
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ep
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d
in
g
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v
ie
s
t=
6
an
d
d
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d
in
g
o
n
th
e
to
tal=
7
.
T
h
e
o
d
d
s
r
atio
(
OR
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is
p
ar
ticu
lar
l
y
u
s
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f
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l
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au
s
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n
ef
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ize
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it
g
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an
d
d
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in
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o
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m
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h
e
m
o
s
t
in
f
lu
e
n
tia
l
r
is
k
f
ac
to
r
w
as
ca
lc
u
lated
b
y
th
e
o
d
d
s
r
atio
(
OR
)
.
T
h
e
eth
ical
co
n
s
id
er
atio
n
s
o
f
th
i
s
s
t
u
d
y
h
a
v
e
r
ec
eiv
ed
ap
p
r
o
v
al
f
r
o
m
t
h
e
E
th
ic
s
C
o
m
m
ittee
at
t
h
e
I
n
s
tit
u
te
o
f
Hea
lth
Scie
n
ce
s
o
f
Su
r
y
a
Glo
b
al
w
i
th
n
u
m
b
er
3
.
1
9
/KE
P
K/SS
G/I
X/
2
0
2
0
.
T
h
is
ap
p
r
o
v
al
i
s
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j
u
s
ted
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th
e
o
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j
ec
tiv
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a
n
d
r
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d
en
t
s
i
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t
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i
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tu
d
y
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n
a
m
el
y
o
s
teo
ar
t
h
r
itis
in
t
h
e
eld
e
r
l
y
.
T
h
e
p
r
ep
ar
atio
n
o
f
in
f
o
r
m
ed
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n
s
en
t
w
as
ca
r
r
ied
o
u
t
to
f
u
l
f
il
l
th
e
co
n
s
i
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er
atio
n
s
,
w
it
h
th
e
a
i
m
o
f
p
r
o
v
id
in
g
ac
c
u
r
ate
in
f
o
r
m
atio
n
to
th
e
o
s
teo
ar
th
r
it
is
eld
er
l
y
.
F
u
r
t
h
er
m
o
r
e,
th
is
c
o
n
s
id
er
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n
h
as
t
h
e
p
r
iv
ileg
e
o
f
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ein
g
i
n
v
o
l
v
ed
in
r
esear
ch
v
o
lu
n
tar
il
y
o
r
n
o
t.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
T
he
cha
ra
ct
er
is
t
ic
elderly
T
h
e
A
D
L
d
is
tr
ib
u
tio
n
in
eld
e
r
l
y
w
it
h
o
s
teo
ar
th
r
itis
b
ased
o
n
in
d
iv
id
u
al
c
h
ar
ac
ter
is
tics
i
n
T
ab
le
1
s
h
o
w
s
t
h
at
in
g
en
er
al,
th
e
el
d
er
ly
at
th
e
a
g
ed
6
0
-
7
4
y
ea
r
s
(
7
5
.
8
%),
f
em
a
le
g
en
d
er
(
7
7
.
9
%),
an
d
lev
el
of
ed
u
ca
tio
n
p
r
i
m
ar
y
s
c
h
o
o
l
(
5
0
.
5
%),
em
p
lo
y
m
en
t
s
ta
tu
s
w
as
tr
ad
er
s
(
1
8
.
9
%)
an
d
em
p
lo
y
m
e
n
t
s
tat
u
s
w
a
s
h
o
u
s
e
w
i
f
e
(
6
4
.
2
)
.
T
h
e
r
esu
lts
o
f
o
th
er
s
t
u
d
ies
in
d
icate
t
h
at
t
h
e
m
ai
n
f
ac
to
r
s
a
s
s
o
ciate
d
w
it
h
t
h
e
o
n
s
et
o
f
k
n
ee
p
ain
in
cl
u
d
e
b
ein
g
f
e
m
ale
[
1
8
]
.
T
h
e
p
r
ev
alen
ce
in
w
o
m
e
n
is
g
r
ea
ter
th
a
n
m
e
n
;
O
A
s
ev
er
it
y
also
g
r
ea
ter
i
n
w
o
m
en
.
S
tu
d
y
s
h
o
w
s
th
a
t h
o
r
m
o
n
e
s
p
la
y
a
r
o
le
in
t
h
e
m
ec
h
an
is
m
o
f
O
A
[
1
9
]
.
T
h
e
r
esu
lt o
f
th
i
s
s
t
u
d
y
w
a
s
th
e
m
aj
o
r
ity
o
f
s
t
u
d
y
eld
er
l
y
lo
w
ed
u
ca
tio
n
(
p
r
i
m
ar
y
s
c
h
o
o
l)
.
T
h
e
r
esu
lt
s
o
f
a
n
o
th
er
s
tu
d
y
s
h
o
w
ed
t
h
at
lo
w
ed
u
ca
tio
n
w
a
s
p
r
ed
icto
r
f
ac
t
o
r
s
a
m
o
n
g
d
e
m
e
n
tia
a
m
o
n
g
eld
er
l
y
i
n
n
u
r
s
i
n
g
h
o
m
es
[
1
4
]
.
Ov
er
v
ie
w
o
f
r
esp
o
n
d
en
ts
b
y
i
n
d
iv
id
u
al
ca
n
b
e
s
ee
n
in
t
h
e
T
ab
le
1
.
T
ab
le
1
.
T
h
e
ch
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
T
h
e
c
h
a
r
a
c
t
e
r
i
st
i
c
s
n
%
A
g
e
(
y
e
a
r
s)
60
-
74
72
7
5
.
8
≥
7
5
23
2
4
.
2
L
e
v
e
l
o
f
e
d
u
c
a
t
i
o
n
P
r
i
mary
sch
o
o
l
48
5
0
.
5
Ju
n
i
o
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h
i
g
h
sc
h
o
o
l
42
4
4
.
2
S
e
n
i
o
r
h
i
g
h
S
c
h
o
o
l
3
3
.
2
C
o
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e
g
e
2
2
.
1
Gend
e
r
M
a
l
e
21
2
2
.
1
F
e
mal
e
74
7
7
.
9
E
m
p
l
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m
e
n
t
s
t
a
t
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s
F
a
r
mer
10
1
0
.
5
T
r
a
d
e
r
s
18
1
8
.
9
Emp
l
o
y
e
e
s
3
3
.
2
N
o
n
e
m
p
l
o
y
m
e
n
t
st
a
t
u
s
R
e
t
i
r
e
e
s
3
3
.
2
H
o
me
mak
e
r
61
6
4
.
2
3
.
2
.
B
iv
a
ria
t
e
a
na
ly
s
is
T
h
e
A
D
L
d
i
s
tr
ib
u
tio
n
i
n
eld
er
l
y
w
i
th
o
s
teo
ar
th
r
iti
s
b
ased
o
n
v
ar
iab
le
r
esear
ch
in
T
ab
le
2
s
h
o
w
s
t
h
at
in
g
en
er
al,
t
h
e
eld
er
l
y
w
er
e
6
0
-
7
4
y
ea
r
s
(
7
5
.
8
%),
liv
e
w
it
h
ch
ild
an
d
o
t
h
er
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eo
p
le
(
f
a
m
il
y
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th
er
s
)
ea
c
h
3
4
.
7
,
an
d
h
a
v
e
m
o
d
er
ate
f
u
n
ctio
n
a
l
ab
ilit
y
(
8
7
.
4
)
,
n
o
n
-
g
y
m
n
a
s
t
ic
p
h
y
s
io
lo
g
ical
ab
ili
t
y
(
5
2
.
6
)
,
w
h
o
le
co
g
n
iti
v
e
ab
ilit
y
(
4
7
.
4
)
.
T
h
e
r
esu
lts
o
f
t
h
e
b
iv
ar
iate
an
al
y
s
is
t
h
at
s
h
o
w
ed
th
e
r
elatio
n
a
m
o
n
g
v
ar
iab
les
a
f
f
ec
tin
g
th
e
in
d
ep
en
d
en
ce
o
f
t
h
e
A
D
L
o
f
th
e
eld
er
l
y
ar
e
s
h
o
w
n
in
T
ab
le
2
.
T
h
e
r
esu
lts
s
h
o
w
t
h
at
t
h
e
r
e
w
as
co
r
r
elatio
n
b
et
w
ee
n
ag
e
i
n
t
h
e
eld
er
l
y
a
n
d
A
D
L
i
n
d
ep
en
d
en
ce
.
I
t
w
a
s
s
e
en
f
r
o
m
th
e
v
al
u
e
o
f
P
ea
r
s
o
n
C
h
i
s
q
u
ar
e
(
λ
2
)
an
d
as
y
m
p
s
ig
n
i
f
ica
n
t
(
p
-
v
al
u
e)
.
T
h
er
e
w
as
co
r
r
elatio
n
b
et
w
ee
n
p
h
y
s
io
lo
g
ical
ab
il
it
y
an
d
t
h
e
i
n
d
ep
en
d
en
ce
o
f
t
h
e
eld
er
ly
in
f
u
l
f
illi
n
g
A
D
L
.
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h
y
s
io
l
o
g
ical
ab
ilit
y
h
ad
a
r
is
k
o
f
OR
=
7
.
0
7
(
9
5
%
C
I
=
2
.
8
6
-
1
7
.
4
7
)
in
cr
ea
s
in
g
t
h
e
in
d
ep
en
d
en
ce
o
f
th
e
eld
er
l
y
i
n
f
u
lf
illi
n
g
A
D
L
.
I
n
ad
d
itio
n
,
th
er
e
w
as
co
r
r
elatio
n
b
et
w
ee
n
f
u
n
ct
io
n
al
ab
ilit
y
an
d
th
e
i
n
d
ep
en
d
en
ce
o
f
th
e
eld
er
ly
i
n
f
u
lf
illi
n
g
AD
L
f
u
n
ctio
n
al
ab
il
it
y
w
h
o
s
e
r
i
s
k
was
OR
=
2
.
3
4
(
9
5
%
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2252
-
8
8
0
6
I
n
t J
P
u
b
lic
Hea
lth
Sci
,
Vo
l.
11
,
No
.
1
,
M
ar
ch
20
22
:
1
-
7
4
CI
=1
.
8
2
-
3
.
0
1
)
in
cr
ea
s
es
t
h
e
i
n
d
ep
en
d
en
ce
o
f
th
e
eld
er
l
y
i
n
f
u
l
f
illi
n
g
A
D
L
.
I
t
w
a
s
al
s
o
f
o
u
n
d
t
h
at
a
g
e
w
as
th
e
p
r
o
tectiv
e
f
ac
to
r
f
o
r
t
h
e
i
n
d
ep
en
d
en
ce
o
f
t
h
e
eld
er
l
y
in
f
u
l
f
illi
n
g
A
D
L
w
i
th
O
R
=
.
3
4
7
(
9
5
%
C
I
=.
2
5
3
-
.
4
7
7
)
.
B
esid
es,
th
er
e
w
a
s
n
o
co
r
r
elatio
n
b
et
w
ee
n
p
lace
a
n
d
ADL
a
n
d
al
s
o
b
et
w
ee
n
co
g
n
it
iv
e
ab
ilit
y
a
n
d
t
h
e
in
d
ep
en
d
en
ce
o
f
t
h
e
eld
er
l
y
i
n
f
u
l
f
il
lin
g
A
D
L
.
T
ab
el
2
.
T
h
e
d
is
tr
ib
u
tio
n
o
f
r
elatio
n
s
h
ip
s
b
et
w
ee
n
v
ar
iab
les
in
f
lu
e
n
ci
n
g
th
e
i
n
d
ep
en
d
en
ce
o
f
th
e
eld
er
l
y
’
s
ac
tiv
itie
s
o
f
d
ail
y
liv
in
g
(
A
D
L
)
o
f
th
e
eld
er
l
y
A
D
L
n
=
9
5
λ
2
OR
9
5
%
C
I
p
i
n
d
e
p
e
n
d
e
n
t
N
o
n
i
n
d
e
p
e
n
d
e
n
t
n
%
n
%
A
g
e
(
y
e
a
r
s)
60
-
74
47
4
9
.
5
25
2
6
.
3
7
2
(
7
5
.
8
)
2
9
.
7
.
3
4
7
.
2
5
3
-
.
4
7
7
.
0
0
0
≥
7
5
0
0
23
2
4
.
2
2
3
(
2
4
.
2
)
Pl
a
c
e
L
i
v
i
n
g
a
l
o
n
e
2
2
.
1
7
7
.
4
9
(
9
.
5
)
7
.
0
7
1
.
7
6
.
5
3
2
-
5
.
8
4
.
3
4
9
W
i
t
h
c
h
i
l
d
4
4
.
2
29
3
0
.
5
3
3
(
3
4
.
7
)
W
i
t
h
a
p
a
t
n
e
r
2
2
.
1
18
1
8
.
9
2
0
(
2
1
.
1
)
O
t
h
e
r
s
2
2
.
1
31
3
2
.
6
3
3
(
3
4
.
7
)
Fun
c
t
i
o
n
a
l
a
b
i
l
i
t
y
L
i
g
h
t
0
0
9
9
.
5
9
(
9
.
5
)
1
4
.
7
2
.
3
4
1
.
8
2
-
3
.
0
1
.
0
0
0
M
o
d
e
r
a
t
10
10
73
7
6
.
8
8
3
(
8
7
.
4
)
H
e
a
v
y
0
0
3
3
.
1
3
(
3
.
1
)
Phy
s
o
l
o
g
i
c
a
l
a
b
i
l
i
t
y
G
y
mn
a
st
i
c
s
33
7
0
.
5
12
1
2
.
6
4
5
(
4
7
.
4
)
1
9
.
5
7
.
0
7
2
.
8
6
-
1
7
.
4
7
.
0
0
0
N
o
n
g
y
mn
a
st
i
c
s
14
1
4
.
7
36
3
7
.
9
5
0
(
5
2
.
6
)
M
e
n
t
a
l
st
a
t
u
s
W
h
o
l
e
5
5
.
3
40
4
2
.
1
4
5
(
4
7
.
4
)
.
8
4
3
1
.
4
6
.
6
5
0
-
3
.
2
8
4
.
3
5
8
M
i
l
d
i
m
p
a
i
r
me
n
t
3
3
.
2
27
2
8
.
4
30
(
3
1
.
6
)
M
o
d
e
r
a
t
e
i
m
p
a
i
r
me
n
t
2
2
.
1
16
1
6
.
8
18
(
1
8
.
9
)
S
e
v
e
r
e
i
mp
a
i
r
me
n
t
0
0
2
2
.
1
2
(
2
.
1
)
T
h
e
r
esu
lts
o
f
t
h
is
s
tu
d
y
i
n
d
i
ca
te
th
at
th
e
m
aj
o
r
ity
o
f
eld
er
l
y
w
h
o
h
a
v
e
o
s
teo
ar
th
r
iti
s
wer
e
f
e
m
ale
an
d
ag
ed
6
0
-
7
4
y
ea
r
s
.
T
h
er
e
w
a
s
co
n
s
is
te
n
t e
v
id
en
ce
t
h
at
f
e
m
ales
w
er
e
at
h
i
g
h
er
r
is
k
o
f
k
n
ee
O
A
.
(
p
o
o
led
OR
1
.
6
8
,
9
5
%
C
I
1
.
3
7
-
2
.
0
7
)
[
2
0
]
.
T
h
e
r
esu
lt
s
o
f
a
n
o
th
er
s
t
u
d
y
s
h
o
w
ed
t
h
at
K
n
ee
a
n
d
h
ip
OA
r
ates
in
cr
ea
s
ed
co
n
tin
u
o
u
s
l
y
w
i
th
ag
e
a
n
d
f
e
m
ale
-
to
-
m
ale
r
ate
r
atio
s
(
R
R
s
)
w
er
e
h
i
g
h
e
s
t
at
ag
e
7
0
–
7
5
y
ea
r
s
[
2
1
]
.
T
h
is
is
s
u
p
p
o
r
ted
b
y
r
esear
ch
,
s
h
o
w
i
n
g
t
h
at
m
o
r
e
eld
er
l
y
p
eo
p
le
ag
ed
≥
6
0
ar
e
at
r
is
k
f
o
r
o
s
teo
ar
th
r
itis
.
I
n
cr
ea
s
in
g
ag
e
i
n
a
p
er
s
o
n
w
i
ll
ca
u
s
e
a
r
ed
u
ctio
n
i
n
v
o
lu
m
e/co
n
te
n
t
s
o
f
ca
r
tilag
e,
p
r
o
teo
g
l
y
ca
n
s
,
c
ar
tilag
e
v
asc
u
lar
it
y
an
d
p
er
f
u
s
io
n
,
d
ec
r
ea
s
ed
m
u
s
cle
s
tr
en
g
t
h
,
lo
s
s
o
f
p
r
o
p
r
io
ce
p
tio
n
,
d
eg
en
er
ati
v
e
ch
a
n
g
es
i
n
th
e
m
e
n
is
c
u
s
an
d
lig
a
m
en
t j
o
in
ts
,
a
n
d
ca
lcif
icati
o
n
o
f
j
o
in
t
ti
s
s
u
e
[
2
2
]
.
T
h
is
ch
an
g
e
ca
n
ca
u
s
e
th
e
j
o
in
t
s
p
ac
e
to
n
ar
r
o
w
,
ca
u
s
i
n
g
f
r
ictio
n
b
et
w
ee
n
t
h
e
en
d
s
o
f
t
h
e
b
o
n
es in
t
h
e
k
n
ee
,
th
is
is
w
h
at
ca
u
s
e
s
p
ain
[
2
3
]
.
I
n
co
n
tr
ast,
th
e
r
is
k
o
f
f
e
m
al
e
h
an
d
O
A
p
ea
k
s
at
ag
e
6
0
-
6
4
y
ea
r
s
,
an
d
th
e
co
r
r
esp
o
n
d
in
g
f
e
m
ale
-
to
-
m
ale
r
ate
r
atio
s
(
R
R
s
)
w
er
e
h
i
g
h
e
s
t
at
50
-
5
5
y
ea
r
s
[
2
1
]
.
Ag
e
i
s
t
h
e
b
ig
g
e
s
t
r
is
k
f
ac
to
r
f
o
r
asteo
ar
t
h
r
itis
s
tr
o
n
g
.
Me
c
h
a
n
is
m
is
s
t
ill
u
n
clea
r
,
b
u
t
it
is
clo
s
el
y
r
elate
d
to
t
h
e
p
r
o
ce
s
s
b
io
lo
g
y
o
f
th
e
j
o
in
ts
.
T
h
e
ag
i
n
g
p
r
o
ce
s
s
w
ill
d
ec
r
ea
s
e
t
h
e
n
u
m
b
er
o
f
ch
o
n
d
r
o
c
y
tes i
n
ca
r
tila
g
e
s
e
n
d
an
d
w
il
l c
o
r
r
elate
d
ir
ec
tly
w
i
t
h
th
e
d
eg
r
ee
o
f
ca
r
ti
lag
e
d
a
m
a
g
e
[
1
9
]
.
T
h
e
r
esu
lt
o
f
th
is
s
t
u
d
y
w
as
t
h
at
th
e
m
aj
o
r
ity
o
f
t
h
e
eld
er
l
y
h
av
e
th
e
r
o
le
o
f
f
a
m
il
y
m
e
m
b
er
s
an
d
s
till
liv
e
w
it
h
t
h
eir
f
a
m
ilie
s
,
b
o
th
w
it
h
t
h
eir
s
p
o
u
s
e
s
,
ch
ild
r
e
n
,
an
d
ch
ild
-
in
-
la
w
s
[
2
4
]
.
T
h
er
e
is
n
o
r
elatio
n
s
h
ip
b
et
w
ee
n
p
lace
s
w
it
h
A
D
L
.
T
h
is
is
i
n
li
n
e
w
it
h
t
h
e
r
esu
lts
o
f
o
th
er
s
tu
d
ie
s
w
h
ich
s
tate
f
a
m
il
y
s
u
p
p
o
r
t,
m
en
ta
l
s
tatu
s
an
d
A
D
L
as d
eter
m
in
a
n
ts
o
f
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es i
n
th
e
eld
er
l
y
[
2
5
]
.
T
h
e
r
esu
lt
o
f
s
tat
is
tica
l
test
s
o
f
f
u
n
ctio
n
al
ab
ilit
y
an
d
AD
L
i
n
d
ep
en
d
en
ce
lev
el
s
h
o
w
ed
th
at
th
er
e
w
a
s
a
s
ig
n
i
f
ica
n
t
r
elatio
n
s
h
ip
b
et
w
ee
n
f
u
n
ctio
n
al
ab
ilit
y
a
n
d
A
D
L
lev
e
l
o
f
th
e
eld
er
l
y
with
o
s
teo
ar
th
r
iti
s
i
n
B
an
tu
l,
I
n
d
o
n
e
s
ia.
I
f
th
e
f
u
n
c
tio
n
al
ab
ilit
y
o
f
t
h
e
eld
er
l
y
is
g
ettin
g
b
etter
,
th
e
lev
el
o
f
i
n
d
ep
en
d
en
ce
o
f
th
e
eld
er
ly
AD
L
w
ill
also
b
e
b
etter
o
r
in
d
ep
en
d
en
t.
R
e
s
ea
r
ch
co
n
d
u
cted
,
s
h
o
w
ed
t
h
at
t
h
e
m
aj
o
r
ity
o
f
eld
er
l
y
p
eo
p
le
s
u
f
f
er
i
n
g
f
r
o
m
ch
r
o
n
ic
d
is
ea
s
es
o
n
e
o
f
w
h
ich
i
s
o
s
teo
ar
th
r
itis
;
it
ca
u
s
es
a
d
ec
r
ea
s
e
in
f
u
n
c
tio
n
al
s
tat
u
s
,
as
w
ell
as
e
x
p
o
s
u
r
e
to
v
ar
io
u
s
r
is
k
f
ac
to
r
s
a
n
d
lif
e
e
x
p
er
ien
ce
s
t
h
at
g
r
ea
tl
y
a
f
f
ec
t
t
h
e
m
en
tal
s
ta
tu
s
o
f
t
h
e
eld
er
ly
s
o
as
to
m
ak
e
th
e
eld
er
l
y
m
o
r
e
p
r
o
n
e
to
d
ep
r
ess
io
n
[
2
6
]
.
B
ased
o
n
s
ev
er
al
t
h
eo
r
ies,
th
er
e
ar
e
s
ev
er
a
l
clin
ical
m
a
n
i
f
estatio
n
s
o
f
o
s
t
eo
ar
th
r
itis
,
n
a
m
el
y
p
ain
,
s
t
if
f
n
e
s
s
,
s
w
elli
n
g
,
li
m
i
ted
m
o
b
ilit
y
,
cr
ep
itu
s
,
an
d
d
ef
o
r
m
itie
s
,
an
d
s
o
m
e
o
f
t
h
ese
ca
n
lead
to
d
ec
r
ea
s
ed
f
u
n
c
tio
n
al
ab
ilit
ie
s
an
d
d
ep
r
ess
io
n
.
D
ec
r
ea
s
ed
f
u
n
ctio
n
a
l
ab
ilit
y
ca
n
b
e
ca
u
s
ed
b
y
j
o
in
t
s
ti
f
f
n
es
s
,
j
o
in
t
s
w
elli
n
g
,
an
d
li
m
ited
j
o
in
t
m
o
tio
n
,
wh
ile
t
h
e
d
e
g
r
ee
o
f
in
d
ep
en
d
en
ce
o
f
A
D
L
i
n
t
h
e
eld
er
ly
ca
n
o
cc
u
r
b
ec
a
u
s
e
s
o
m
eo
n
e
w
h
o
e
x
p
er
ien
ce
s
ch
r
o
n
ic
p
ain
w
ill
ex
p
er
ien
ce
f
ee
lin
g
s
o
f
h
o
p
eles
s
n
e
s
s
an
d
d
ep
r
ess
io
n
a
s
s
o
ciate
d
w
it
h
ch
a
n
g
e
s
i
n
d
ail
y
ac
ti
v
it
ies
[
2
7
]
,
[
2
8
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N:
2252
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8806
F
a
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s
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ctivities o
f d
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th
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(
Ha
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5
T
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ical
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it
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d
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lev
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an
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esia.
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h
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r
is
k
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f
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ev
elo
p
in
g
k
n
ee
O
A
[
2
9
]
.
E
x
er
cise
an
d
p
h
y
s
ica
l
ac
tiv
it
y
ar
e
h
ig
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o
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ed
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p
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t f
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Stre
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ad
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icep
s
a
n
d
h
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m
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tr
i
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cle
s
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it c
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it c
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f
in
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k
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j
o
in
t
[
3
0
]
,
[
3
1
]
.
T
h
er
e
is
n
o
r
elatio
n
s
h
ip
b
et
w
ee
n
m
en
tal
s
ta
tu
s
es
w
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th
AD
L
.
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h
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li
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th
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ies
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tate
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-
co
m
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icab
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d
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t
ADL
.
4.
CO
NCLU
SI
O
N
T
h
e
d
eg
r
ee
o
f
A
D
L
in
eld
er
l
y
w
it
h
o
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ar
th
r
iti
s
i
s
i
n
f
lu
e
n
ce
d
b
y
a
g
e,
p
h
y
s
io
lo
g
ical
a
b
ilit
y
a
n
d
f
u
n
ctio
n
al
ab
ilit
y
.
I
n
ad
d
itio
n
,
th
e
d
o
m
in
a
n
t
r
is
k
f
ac
to
r
is
p
h
y
s
io
lo
g
ical
ab
ilit
y
.
T
h
e
d
eg
r
ee
o
f
A
D
L
i
n
eld
er
l
y
p
eo
p
le
w
ith
o
s
teo
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th
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itis
is
i
n
f
l
u
en
ce
d
b
y
a
g
e,
p
h
y
s
io
lo
g
ical
ab
ilit
ies
a
n
d
f
u
n
c
tio
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al
ab
ilit
i
es.
I
n
ad
d
itio
n
,
t
h
e
d
o
m
i
n
a
n
t
r
is
k
f
ac
to
r
is
p
h
y
s
io
lo
g
ical
ab
ilit
y
.
Hea
lt
h
s
er
v
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s
ca
n
u
s
e
th
e
r
esu
lts
o
f
t
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t
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y
a
s
a
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o
f
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ata
o
n
p
r
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b
lem
s
w
it
h
f
u
n
ctio
n
al
ab
ilit
ie
s
,
p
h
y
s
io
lo
g
ica
l
ab
il
ities
a
n
d
lev
el
s
o
f
AD
L
in
d
ep
en
d
en
ce
t
h
at
o
cc
u
r
in
t
h
e
eld
er
l
y
.
T
h
is
ca
n
b
e
an
in
p
u
t
i
n
i
n
cr
ea
s
i
n
g
s
p
ec
ial
p
r
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a
m
s
to
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ce
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h
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le
v
el
o
f
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ce
o
f
th
e
eld
er
ly
(
in
d
ep
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d
e
n
t
eld
er
l
y
)
an
d
i
n
cr
ea
s
e
f
u
n
ctio
n
al
ab
i
liti
es.
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l
th
s
er
v
ice
s
s
h
o
u
l
d
m
ax
i
m
ize
h
e
a
lth
ed
u
ca
tio
n
s
o
t
h
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u
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lic
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n
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w
led
g
e
o
f
d
eter
m
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n
e
t
h
e
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s
k
f
ac
to
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s
o
f
ac
tiv
ities
o
f
d
ail
y
liv
in
g
(
A
D
L
)
in
d
ep
en
d
en
t i
n
o
s
teo
ar
th
r
iti
s
e
ld
er
ly
ca
n
b
e
in
cr
ea
s
ed
.
ACK
NO
WL
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th
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itu
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lt
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Scie
n
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s
o
f
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r
y
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Glo
b
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g
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k
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ta
(
ST
I
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Su
r
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lo
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g
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k
ar
ta)
an
d
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ar
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i
C
o
lleg
e
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f
N
u
r
s
i
n
g
K
h
o
n
Kae
n
(
B
C
NKK)
f
o
r
s
u
p
p
o
r
tin
g
t
h
i
s
r
esear
ch
.
RE
F
E
R
E
NC
E
S
[
1
]
J.
Y
u
n
i
t
a
,
N
.
N
u
r
l
i
s
i
s,
a
n
d
W
.
S
a
r
i
,
“
D
e
t
e
r
mi
n
a
n
t
s
o
f
t
h
e
q
u
a
l
i
t
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a
mo
n
g
p
r
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-
e
l
d
e
r
l
y
a
n
d
e
l
d
e
r
l
y
p
o
p
u
l
a
t
i
o
n
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
Pu
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
(
I
J
P
H
S
)
,
v
o
l
.
8
,
n
o
.
3
,
p
p
.
3
4
1
-
3
4
5
,
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e
p
.
2
0
1
9
,
d
o
i
:
1
0
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1
1
5
9
1
/
i
j
p
h
s.v
8
i
3
.
2
0
2
4
6
.
[
2
]
K
.
Y
a
v
a
r
i
,
M
.
B
a
sa
k
h
a
,
H
.
S
a
d
e
g
h
i
,
a
n
d
A
.
N
a
se
r
i
,
“
Ec
o
n
o
mi
c
A
sp
e
c
t
s
o
f
A
g
e
i
n
g
,
”
I
ra
n
i
a
n
J
o
u
r
n
a
l
o
f
A
g
e
i
n
g
,
v
o
l
.
1
0
,
n
o
.
1
,
p
p
.
92
–
1
0
5
,
2
0
1
5
.
[
3
]
M
.
C
.
S
.
W
o
n
g
,
D
.
X
.
Z
h
a
n
g
,
a
n
d
H
.
H
.
X
.
W
a
n
g
,
“
R
a
p
i
d
e
me
r
g
e
n
c
e
o
f
a
t
h
e
r
o
scl
e
r
o
si
s
i
n
A
si
a
:
A
s
y
st
e
mat
i
c
r
e
v
i
e
w
o
f
c
o
r
o
n
a
r
y
a
t
h
e
r
o
scl
e
r
o
t
i
c
h
e
a
r
t
d
i
se
a
se
e
p
i
d
e
mi
o
l
o
g
y
a
n
d
i
m
p
l
i
c
a
t
i
o
n
s fo
r
p
r
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
st
r
a
t
e
g
i
e
s,”
C
u
rr
e
n
t
O
p
i
n
i
o
n
i
n
L
i
p
i
d
o
l
o
g
y
,
v
o
l
.
2
6
,
n
o
.
4
,
p
p
.
2
5
7
–
2
6
9
,
A
u
g
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
9
7
/
M
O
L
.
0
0
0
0
0
0
0
0
0
0
0
0
0
1
9
1
.
[
4
]
C
.
J.
S
t
e
v
e
s,
T
.
D
.
S
p
e
c
t
o
r
,
a
n
d
S
.
H
.
D
.
Jac
k
so
n
,
“
A
g
e
i
n
g
,
g
e
n
e
s,
e
n
v
i
r
o
n
me
n
t
a
n
d
e
p
i
g
e
n
e
t
i
c
s:
w
h
a
t
t
w
i
n
s
t
u
d
i
e
s t
e
l
l
u
s n
o
w
,
a
n
d
i
n
t
h
e
f
u
t
u
r
e
,
”
Ag
e
a
n
d
Ag
e
i
n
g
,
v
o
l
.
4
1
,
n
o
.
5
,
p
p
.
5
8
1
–
5
8
6
,
S
e
p
.
2
0
1
2
,
d
o
i
:
1
0
.
1
0
9
3
/
a
g
e
i
n
g
/
a
f
s0
9
7
.
[
5
]
V
.
S
i
l
v
e
r
w
o
o
d
,
M
.
B
l
a
g
o
j
e
v
i
c
-
B
u
c
k
n
a
l
l
,
C
.
Ji
n
k
s,
J
.
L
.
Jo
r
d
a
n
,
J
.
P
r
o
t
h
e
r
o
e
,
a
n
d
K
.
P
.
Jo
r
d
a
n
,
“
C
u
r
r
e
n
t
e
v
i
d
e
n
c
e
o
n
r
i
sk
f
a
c
t
o
r
s
f
o
r
k
n
e
e
o
st
e
o
a
r
t
h
r
i
t
i
s
i
n
o
l
d
e
r
a
d
u
l
t
s
:
a
s
y
st
e
mat
i
c
r
e
v
i
e
w
a
n
d
me
t
a
-
a
n
a
l
y
si
s,”
O
s
t
e
o
a
r
t
h
ri
t
i
s
a
n
d
C
a
r
t
i
l
a
g
e
,
v
o
l
.
2
3
,
n
o
.
4
,
p
p
.
5
0
7
–
5
1
5
,
A
p
r
.
2
0
1
5
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
o
c
a
.
2
0
1
4
.
1
1
.
0
1
9
.
[
6
]
F
.
B
a
r
r
y
a
n
d
M
.
M
u
r
p
h
y
,
“
M
e
se
n
c
h
y
mal
st
e
m
c
e
l
l
s
i
n
j
o
i
n
t
d
i
se
a
se
a
n
d
r
e
p
a
i
r
,
”
N
a
t
u
r
e
R
e
v
i
e
w
s
R
h
e
u
m
a
t
o
l
o
g
y
,
v
o
l
.
9
,
n
o
.
1
0
,
p
p
.
5
8
4
–
5
9
4
,
O
c
t
.
2
0
1
3
,
d
o
i
:
1
0
.
1
0
3
8
/
n
r
r
h
e
u
m.
2
0
1
3
.
1
0
9
.
[
7
]
A
.
M
o
b
a
s
h
e
r
i
,
“
T
h
e
f
u
t
u
r
e
o
f
o
st
e
o
a
r
t
h
r
i
t
i
s
t
h
e
r
a
p
e
u
t
i
c
s:
T
a
r
g
e
t
e
d
p
h
a
r
ma
c
o
l
o
g
i
c
a
l
t
h
e
r
a
p
y
t
o
p
i
c
a
l
c
o
l
l
e
c
t
i
o
n
o
n
o
st
e
o
a
r
t
h
r
i
t
i
s,
”
C
u
rr
e
n
t
R
h
e
u
m
a
t
o
l
o
g
y
Re
p
o
r
t
s
,
v
o
l
.
1
5
,
n
o
.
1
0
,
p
p
.
1
-
13
,
O
c
t
.
2
0
1
3
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
1
9
2
6
-
0
1
3
-
0
3
6
4
-
9.
[
8
]
D
.
S
.
Je
v
s
e
v
a
r
,
“
Tr
e
a
t
me
n
t
o
f
O
st
e
o
a
r
t
h
r
i
t
i
s
o
f
t
h
e
k
n
e
e
:
Ev
i
d
e
n
c
e
-
b
a
s
e
d
g
u
i
d
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2
]
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2
3
]
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4
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[
2
5
]
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.
P
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.
R
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[
2
6
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[
2
7
]
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.
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2
8
]
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.
T
.
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,
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.
[
2
9
]
A
.
H
.
A
l
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a
l
.
,
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[
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]
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6
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5
.
[
3
1
]
B
.
Q
.
Jo
n
e
s,
C
.
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o
v
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y
,
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n
d
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M
a
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v
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t
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,
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N
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M
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me
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,
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Am
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F
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si
c
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n
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.
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2
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p
p
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0
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5
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AUTH
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Adn
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Ep
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re
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2
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8
sh
e
h
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s
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n
p
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d
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n
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le
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ra
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.
In
2
0
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9
sh
e
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2
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