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Terms modified by ADL Selected AbstractsA national stroke quality register: 12 years experience from a participating hospitalEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007P. Appelros Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994,2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias. [source] Comprehensive geriatric assessment of elderly highlanders in Qinghai, China I: Activities of daily living, quality of life and metabolic syndromeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2009Kozo Matsubayashi Aim: To reveal the comparison of comprehensive geriatric functions of elderly highlanders in Qinghai Plateau in China among three different ethnic groups. Methods: Activities of daily living (ADL), screening-based depression, quality of life (QOL) and checking-up of metabolic syndrome including community-based oral glucose tolerance test were assessed in 393 community-dwelling elderly subjects aged 60 years or more (247 Han elderly subjects, 49 Mongolian ones and 97 Tibetan ones). Results: Tibetan elderly highlanders were more disabled in ADL, but had higher QOL than Han elderly ones in Qinghai Plateau. Blood pressure measurements, rate of hypertension and hemoglobin concentrations in Tibetan elderly highlanders were lower than Han ones. Rates of diabetes and impaired glucose tolerance in elderly highlanders were relatively lower than other Asian elderly lowlanders. Conclusion: Prevalence of metabolic syndrome in elderly highlanders in Qinghai was still not high, however, we should pay attention to its tendency related with socialglobalism in the near future. Further investigation on physiological adaptability to hypoxic environment and human ageing phenomena in a global context may open a new research frontier for ageing science. [source] Difference in subjective well-being between ethnic Korean and Japanese elderly residents in an urban community in JapanGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2007Jong-Seong Moon Background: The ethnic Korean community in Japan has witnessed the increasing aging of their population structure. The purpose of our study was to clarify the differences in standards of living between elderly ethnic Korean and elderly Japanese populations living in Japan, and to examine whether there is any difference in subjective well-being between the two populations. Methods: We conducted a cross-sectional questionnaire-based survey that consisted of items addressing ethnicity, age, gender, literacy, living conditions, mental health, "sense of purpose in life", activities of daily living (ADL), medical history, quality of life (QOL), and receipt of pension benefits and public assistance; the participants were 425 elderly people (ethnic Korean residents in Japan, n = 204; Japanese, n = 221) aged 65 and older living in a community in Osaka City. Findings from the two groups were compared using the Student's t -test and the ,2 test. We also employed multiple linear regression analysis. Results: We found that the ethnic Korean group had less formal education (P < 0.001), lower ADL (P < 0.05) and QOL (P < 0.001), higher illiteracy (P < 0.05) and depression rates (P < 0.001), and a higher prevalence of hypertension, myocardial infarction and diabetes mellitus than the Japanese group. Ethnicity was a significant variable for subjective well-being in simple linear regression analysis. After adjusting for literacy, absence of sense of purpose in life and mental health in multiple regression analysis, ethnicity remained a significant variable. Conclusions: The present findings indicate that ethnic Korean elderly have poor health and social situations compared with the Japanese group, and that there was a difference in subjective well-being between the two ethnic groups. [source] Usefulness of measuring serum markers in addition to comprehensive geriatric assessment for cognitive impairment and depressive mood in the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2006Hidenori Arai Background: To determine the utility of various serum markers for assessment of cognitive and mental functions in the elderly, we performed a Comprehensive Geriatric Assessment (CGA) in the out-patient clinic in Kyoto University Hospital. Methods: We measured serum levels of dehydroepiandrosterone (DHEA), DHEA-S, malondialdehyde low-density lipoproteins (MDA-LDL), and high-sensitivity C-reactive protein (hs-CRP) in 145 patients to find the association of these markers with activities of daily living (ADL), cognitive impairment and depressive symptoms. Results: We found that the levels of hs-CRP were significantly higher in patients with lower scores in Mini-Mental State Examination (MMSE) and Kohs block design test, and higher scores in the button test, indicating that hs-CRP may be associated with the cognitive function in elderly patients. We also found that the levels of DHEA-S were lower in patients with higher scores (9 or over) on the Geriatric Depression Scale-15 (GDS), indicating that DHEA-S may be associated with depressive mode in elderly patients. Total cholesterol, high-density cholesterol (HDL-C), or albumin were not statistically different in each group studied. Conclusions: Thus, our data indicate that measuring hs-CRP and DHEA-S would be helpful to assess the cognitive function and depressive symptoms in elderly patients. [source] Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: VI.GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2005Maubin in Myanmar Background: The objective of the present study is to compare the findings of comprehensive geriatric assessments of community-dwelling elderly in Maubin township, Myanmar with those in Japan. Methods: A cross-sectional, study was undertaken of community-dwelling people aged 60 years and over who were living in downtown Maubin and two rural villages near Maubin city, and 411 people aged 65 years and over who were living in Sonobe, Kyoto, Japan. They were examined using a common comprehensive geriatric assessment tool, which included interviews regarding activities of daily living (ADL), medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale. Anthropometric, neurobehavioral and blood chemical examinations were also conducted. Using anova and Post Hoc Scheffe's F -test, findings from the three groups were compared. Results: Scores of basic ADL, instrumental self-maintenance, intellectual activities, social roles, QOL, Tokyo Metropolitan Institute of Gerontology Index of Competence, body mass index, total cholesterol levels, blood hemoglobin levels and HDL levels were lower in Myanmar's elderly subjects than in Japanese ones. There was no significant difference in prevalence of depression. Mean blood pressure measurements and rates of subjects with systolic pressure > 140 mmHg or diastolic pressure > 90 mmHg and prevalence of stroke were higher in downtown Maubin than in Japan. The atherogenic index was higher in Myanmar's elderly than in Japanese. Conclusion: In Myanmar subjects had lower ADL and QOL scores than Japanese elderly. Of particular note is the higher prevalence of anemia and subjects with history of stroke in Myanmar than in Japan. Further study is needed to detect the cause of high prevalence of stroke in Myanmar. [source] Depression, age and ADL in community-dwelling elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2003Masayuki Ishine No abstract is available for this article. [source] Changes in TMIG-Index of Competence by subscale in Japanese urban and rural community older populations: Six years prospective studyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2003Yoshinori Fujiwara Objective: To examine the longitudinal changes in higher-level functional capacity in Japanese urban and rural community older populations. Design: Population-based cross-sectional, and prospective cohort studies. Setting: Koganei city in a suburb of Tokyo, and Nangai village, Akita Prefecture, Japan. Participants: One thousand, five hundred and six older persons (793 in Koganei and 713 in Nangai) aged 65,83 years living at home. Main outcome measures: Disability in Instrumental Self-Maintenance (IADL), Intellectual Activity or Social Role, measured by the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results: At baseline, older men and women in the rural area, Nangai, had higher prevalence of disability in Intellectual Activity compared with respective counterparts in the urban area, Koganei. By contrast, disability in Social Role was more prevalent among elderly people in Koganei than in Nangai. In both areas older men and women had lowest prevalence of disability in IADL among three subscales. The six-year longitudinal survey on older persons who had initially no disability in all three subscales demonstrated that in urban Koganei older persons were most likely to be disabled in Social Role with advancing age, followed in turn by Intellectual Activity and IADL. By contrast, elderly people in rural Nangai were most likely to be disabled in Intellectual Activity, followed by Social Role and instrumental ADL. The Cox-proportional hazard model analysis for those who had no IADL disability at baseline revealed that the baseline level of Intellectual Activity or Social Role predicted significantly future onset of IADL disability in both areas even after controlling for sex, age, and chronic medical conditions. Conclusions: In both urban and rural community older populations, disability in Social Role and Intellectual Activity preceded IADL disability, and predicted significantly the future onset of IADL disability. [source] Functional capacity in elderly Japanese living in the communityGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1-2 2001Hiroshi Shibata The present addresses concepts, definitions, and measurements of functional capacity. Further, distributions of functional capacity are assessed by such various indices as activities of daily living (ADL), instrumental ADL (IADL), the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, and active life expectancy in the Japanese elderly. Further, predictors of functional status are demonstrated, and the impact of functional decline on quality of life is investigated in elderly Japanese living in the community. [source] The utility of the Dutch Arthritis Impact Measurement Scales 2 for assessing health status in individuals with haemophilia: a pilot studyHAEMOPHILIA, Issue 6 2000N. L. U. Van Meeteren The aim of this pilot study was to examine the usefulness of the Dutch version of the Arthritis Impact Measurement Scales 2 (D-AIMS2)in assessing the health status of Dutch individuals with haemophilia. Sixty-eight individuals with mild, moderate, and severe haemophilia attending our clinic for their annual check-up participated. They first completed the Canadian Occupational Performance Measure (COPM). The D-AIMS2 was filled in afterwards at home. With the COPM, individuals rated their specific problematic activities of daily life (ADL), as well as the severity and importance of each problem. The D-AIMS2 is a comprehensive, self-administered questionnaire that evaluates functional health status. Fifty-seven individuals completed and returned the D-AIMS2. Reliability analysis demonstrated good internal consistency for the scales (Cronbach's ,=0.76,1.00), as well as for the components (,=0.80,0.88), except for the component ,social interaction' (,=0.44). Criterion validity of the D-AIMS2 was assessed by comparison with COPM outcomes; 80% of the problematic ADLs were included in the questionnaire, 20% were missing. Correlations between the D-AIMS2 components ,physical health' and ,symptoms' with predicted scores of those individuals by a highly experienced physiotherapist (r=0.63 and 0.53, respectively) substantiated its concurrent validity. Based on these results we concluded that the D-AIMS2, with minor adjustments, can be an appropriate tool for assessing the health status of Dutch haemophilia patients. [source] Costs and determinants of privately financed home-based health care in Ontario, CanadaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2008Denise N. Guerriere PhD Abstract The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (< 90 days of service utilisation) and 256 continuing care clients (> 90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed. [source] Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?HEALTH ECONOMICS, Issue 4 2003Dahlia K. Remler Abstract This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for ,healthy' groups by 36.4%, while the increase for the ,sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2,7%. Copyright © 2002 John Wiley & Sons, Ltd. [source] Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?HEALTH SERVICES RESEARCH, Issue 1p2 2008Peter Kemper Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source] Stress affects carers before patient's first visit to a memory clinicINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009Tor Atle Rosness Abstract Objective To measure and compare the burden on spousal carers of patients with and without dementia who were consulting a memory clinic for the first time. Methods We included 413 dyads of patients and their spousal carers consulting a memory clinic for the first time. Of them 276 had a diagnosis of Cognitive Impairment No Dementia (CIND) and 137 had a dementia diagnosis. The burden of care was measured with the Relative Stress Scale (RSS). The gender of patients and their spouses was recorded and measures of cognition, depression and functional capacity of the patients were included in the analysis. Results Of all carers, 27.6% had a score on the RSS of above 23, indicating a moderate to severe burden. The corresponding score for carers of patients with CIND was 20.3%, compared to 42.2% for those with dementia. However, in a linear regression analysis with RSS as the dependent variable, the dementia diagnosis variable was not significant. Three variables were significant (p,<,0.05) and has explained 34% of the variance of the score on the RSS, impaired function in activities of daily living (ADL) was the most important variable (, 0.56), followed by female gender of carers (, 0.19) and the extent of the symptoms of depression observed in the patients (, 0.10). Conclusion Carers of both CIND and dementia patients when attending a memory clinic for initial diagnostic assessment experience high levels of stress. Impaired function in ADL in patients is the strongest predictor of this stress. Copyright © 2009 John Wiley & Sons, Ltd. [source] Special acute care unit for older adults with Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Maria E. Soto Abstract Objective To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). Methods One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Results Four-hundred and ninety-two patients were assessed. Their mean age was 81.1,±,7.7, the mean length of stay was 10.7,±,6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5,±,7.4; a mean total ADL score of 3.7,±,1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. Conclusion AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Quality of life in dementia: a 2-year follow-up studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2007Pierre Missotten Abstract Objectives To examine the evolution of quality of life (QOL) in demented subjects at base-line, one and 2 years later and to determine clinical variables associated with QOL. Method Longitudinal study of a cohort of 127 subjects living at home or in a long-term care institution. A QOL measure (Alzheimer Disease Related Quality of Life; ADRQL) was administered three times. In addition, several clinical instruments (MMSE, IADL, ADL and CDR/M) were also administered. Results ADRQL data analysis did not reveal significant modifications of QOL over the 2-year period, whereas results from clinical instruments showed a significant deterioration. On the group, the variations of ADRQL scores were limited, with some improvement after the first year followed by some deterioration after the second year. On the other hand, ADRQL scores fluctuated every year by at least 10 points for more than 50% of subjects. With dementia evolution, it was observed that the clinical variables were more strongly correlated with ADRQL scores and were more significant predictors. This varied from 5.9% (MMSE) in 2002 to 40.01% in 2004 (MMSE and CDR/M). Conclusions QOL did not develop in a strictly linear manner following the deterioration of clinical state. This suggests that the evolution of QOL is also determined by other variables relating to the physical and social environment of the patients. Their role seems particularly important for the mild to moderate stages of dementia. Copyright © 2007 John Wiley & Sons, Ltd. [source] The impact of depression and anxiety on well being, disability and use of health care services in nursing home patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2006Martin Smalbrugge Abstract Objective To determine the impact of depression and anxiety on well being, disability and use of health care services among nursing patients. Methods The study-population consisted of 350 elderly nursing home patients from 14 nursing homes in the Netherlands. Well being, disability, use of health care services (i.e. assistance in ADL, paramedical care, number of medications) and depression and anxiety and other relevant characteristics (gender, age, education, marital status, urbanization, cognition, morbidity, social support) were measured cross-sectionally. Associations of well being, disability and use of health care services with independent baseline characteristics were assessed with bivariate and with multivariate analyses. Results Presence of depression and/or anxiety was associated with significantly less well being, but not with more disability. Presence of depression and/or anxiety was also significantly associated with four of the seven indicators of health care service use measured in this study: less assistance in ADL, more consultation of medical specialists, a higher mean number of medications and more use of antidepressants. Conclusion Presence of depression and/or anxiety has a statistically and clinically significant negative impact on well being, but not on disability. Future studies should focus on interventions for improving the detection, diagnosis and treatment of depression and/or anxiety in the nursing home. Copyright © 2006 John Wiley & Sons, Ltd. [source] Cost of Alzheimer's disease in a developing country settingINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005M. Zencir Abstract Purpose To evaluate the economic impact of AD in Denizli, Turkey. Design and Methods This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons. Results The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300,2.231] and $4,930 (95% CI; 3.3714,6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition. Conclusions These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult. Copyright © 2005 John Wiley & Sons, Ltd. [source] Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2003L. Lechowski Abstract Background Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. Material and methods 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). Results The number of men with available data for IADL total score was too small to make any analysis. ,Group A' gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. ,Group B', pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. Conclusion The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients. Copyright © 2003 John Wiley & Sons, Ltd. [source] A new approach to the qualitative evaluation of functional disability in dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2003X. Kurz Abstract Background Dementia patients suffer from the progressive deterioration of cognitive and functional abilities. Instrumental disabilities usually appear in the earlier stages of the disease while basic disabilities appear in the more advanced stages. In order to differentiate between mild, moderate and severe patients both instrumental and basic functional disabilities should be taken into account simultaneously. Objectives The objective of this study was to find a new method for classifying dementia patients based on their disabilities by using a basic and an instrumental Activities of Daily Living (ADL) scale. Methods Functional disability was assessed in a Belgian cohort of dementia patients using the Katz and Lawton Instrumental Activities of Daily Living (IADL) scales. A k -means derived clustering method allocated patients to disability clusters according to their Katz and Lawton scores. In order to validate the classification, we compared socio-demographic, clinical and costs parameters between the groups. Results The clustering method allocated patients between three clusters: dependent, non-dependent with instrumental functional disability (ND-IFD) and non-dependent. Dependence, as defined by these clusters, significantly correlates with age, residential setting, MMSE, patient's quality of life and costs. Conclusion This new classification of patients suffering from dementia will provide better understanding of functional disabilities and will complement the evaluation of disease severity based on cognitive function. Copyright © 2003 John Wiley & Sons, Ltd. [source] Use of constraints and surveillance in Norwegian wards for the elderlyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2003Øyvind Kirkevold Abstract Objective To describe the use of constraints and surveillance and their correlates in a nationwide sample of wards in institutions for the elderly in Norway. Methods Questionnaires were sent to 975 institutions and returned by 623 (64%) with 1398 wards. The wards' head nurses were asked whether any patient was currently subjected to physical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The reporting of constraints was found reliable. Results In all, 79% of the head nurses reported daily or occasional use of constraints in their wards. Most frequently reported were force or pressure in the performing of activities of daily living (reported by 61%, 95% Confidence Intervals (CI) 59,64), use of force or pressure in medical treatment or examination (49%, 95% CI 47,53) and use of physical restraints (38%, 95% CI 36,41). Electronic surveillance was used less frequently (14%, 95% CI 13,16). All classes of constraints, except physical constraints, were used significantly more frequently in special care units for persons with dementia than in ordinary nursing home units. The methodology does not allow conclusions to be drawn regarding the role of ward size and person characteristics. The staffing was unrelated to the use of constraints which varied significantly across the counties. Conclusion Constraints are widely used in Norwegian institutions for the elderly. A different pattern in use of constraints was found between special care units for demented patients and ordinary units in nursing homes. Copyright © 2003 John Wiley & Sons, Ltd. [source] Predicting needs for nursing home admission , does sense of coherence delay nursing home admission in care dependent older people?INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2009A longitudinal study Objectives., This study examined predisposing, enabling and need variables (Andersen's Behavioral Model) influencing the need for nursing home admission (NHA) in older people receiving home nursing care. In particular, the potential role of coping ability, measured as ,sense of coherence' (SOC), was studied. Design, sample, and measurements., A survey with baseline- and follow-up data after a 2-year period was undertaken with 208 patients aged 75+. The measures used were: gender, education, age, social visits, SOC, social provision scale (SPS), self-rated health (SRH), general health questionnaire (GHQ), clinical dementia rating (CDR), Barthel activities of daily living (ADL) index, and registered illnesses (RI). A Cox proportional model was used to examine factors that could explain risk of NHA. Results., Measures with predictive properties were Barthel ADL index, SPS, SRH, and gender. SOC, along with subjective health complaints, general health questionnaire, RI and social visits did not predict NHA. Conclusions., It is concluded that the patients' subjective evaluations of both their health and perceived social support were important predictors of future NHA needs, and should be seriously taken into consideration, along with the more commonly used objective measures of ADL and CDR. [source] Factors associated with quality of life of Brazilian older adultsINTERNATIONAL NURSING REVIEW, Issue 1 2009L. Paskulin rn Objective:, The objective of the study was to explore factors associated with quality of life (QoL) of Brazilian community-dwelling older adults. Methods:, This was a descriptive exploratory cross-sectional study. Data were collected through a household survey. A random sample of 288 older adults from Porto Alegre, Brazil participated in the study. A demographic and health data sheet, the OARS activities of daily living (ADL) scale and the WHOQOL-BREF were administered. Results and Discussion:, The mean age of participants was 71.2 years (SD = 7.5) and 67.4% were female. Using multiple linear regression analysis, with overall QoL as the dependent variable, perceived health status, education level, engagement in physical activity, medical conditions, age group and use of primary health care were significant associated factors. With physical QoL as the dependent variable, significant factors included: perceived health status, medical conditions, education, physical activities and dependence in ADL; with social QoL as the dependent variable, only age group and paid work were significant. In relation to environmental QoL, education and perceived health were significant factors. Conclusions:, The results illustrate the complexity of factors influencing QoL. With a better understanding of these factors, it is possible to plan appropriate health interventions. [source] Depressive Symptoms in Middle Age and the Development of Later-Life Functional Limitations: The Long-Term Effect of Depressive SymptomsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Kenneth E. Covinsky MD OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61. PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS. MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves. RESULTS: Eight hundred eighty-seven (12%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06,2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25,1.66). CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age. [source] Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical IllnessJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008Cynthia M. Boyd MD OBJECTIVES: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. DESIGN: Observational. SETTING: Tertiary care hospital, community teaching hospital. PARTICIPANTS: Older (aged ,70) patients nonelectively admitted to general medical services (1993,1998). MEASUREMENTS: Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. RESULTS: By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. CONCLUSION: For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated. [source] Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12-Year Cohort Study of Elderly JapaneseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2008Tomonori Okamura MD OBJECTIVES: To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people. DESIGN: Population-based cohort study. SETTING: National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980. PARTICIPANTS: One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years. MEASUREMENTS: Decline in ADLs and mortality. RESULTS: After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (,40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94,2.57) for men and 3.06 (95% CI=1.89,4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79,0.97) and 0.79 for women (95% CI=0.72,0.87)), which was not significantly associated in the group with TC at or above the median. CONCLUSION: In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women. [source] Early Markers of Prolonged Hospital Stays in Older People: A Prospective, Multicenter Study of 908 Inpatients in French Acute HospitalsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006Pierre-Olivier Lang MD OBJECTIVES: To identify early markers of prolonged hospital stays in older people in acute hospitals. DESIGN: A prospective, multicenter study. SETTING: Nine hospitals in France. PARTICIPANTS: One thousand three hundred six patients aged 75 and older were hospitalized through an emergency department (Sujet Âgé Fragile: Évaluation et suivi (SAFEs) ,Frail Elderly Subjects: Evaluation and follow-up). MEASUREMENTS: Data used in a logistic regression were obtained through a gerontological evaluation of inpatients, conducted in the first week of hospitalization. The center effect was considered in two models as a random and fixed effect. Two limits were used to define a prolonged hospital stay. The first was fixed at 30 days. The second was adjusted for Diagnosis Related Groups according to the French classification (f-DRG). RESULTS: Nine hundred eight of the 1,306 hospital stays that made up the cohort were analyzed. Two centers (n=298) were excluded because of a large volume of missing f-DRGs. Two-thirds of subjects in the cohort analyzed were women (64%), with a mean age of 84. One hundred thirty-eight stays (15%) lasted more than 30 days; 46 (5%) were prolonged beyond the f-DRG-adjusted limit. No sociodemographic variables seemed to influence the length of stay, regardless of the limit used. For the 30-day limit, only cognitive impairment (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.2,4.0) was identified as a marker for prolongation. f-DRG adjustment revealed other clinical markers. Walking difficulties (OR=2.6, 95% CI=1.2,16.7), fall risk (OR=2.5, 95% CI=1.7,5.3), cognitive impairment (OR=7.1, 95% CI=2.3,49.9), and malnutrition risk (OR=2.5, 95% CI=1.7,19.6) were found to be early markers for prolonged stays, although dependence level and its evolution, estimated using the Katz activity of daily living (ADL) index, were not identified as risk factors. CONCLUSION: When the generally recognized parameters of frailty are taken into account, a set of simple items (walking difficulties, risk of fall, risk of malnutrition, and cognitive impairment) enables a predictive approach to the length of stay of elderly patients hospitalized under emergency circumstances. Katz ADLs were not among the early markers identified. [source] Memory Complaint Is Not Necessary for Diagnosis of Mild Cognitive Impairment and Does Not Predict 10-Year Trajectories of Functional Disability, Word Recall, or Short Portable Mental Status Questionnaire LimitationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006Jama L. Purser PhD OBJECTIVES: To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10-year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20-item word recall. DESIGN: Prospective cohort study. SETTING: Washington and Iowa counties, Iowa. PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (N=3,673; aged ,65; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, SPMSQ score, 20-item word recall, ADL or instrumental ADL disability, and chronic medical conditions. RESULTS: The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10-year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment. CONCLUSION: Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006. [source] Rates of Acute Care Admissions for Frail Older People Living with Met Versus Unmet Activity of Daily Living NeedsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006Laura P. Sands PhD OBJECTIVES: To determine whether older people who do not have help for their activity of daily living (ADL) disabilities are at higher risk for acute care admissions and whether entry into a program that provides for these needs decreases this risk. DESIGN: A longitudinal cohort study. SETTING: Thirteen nationwide sites for the Program of All-inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and long-term care to community-living older adults. PARTICIPANTS: Two thousand nine hundred forty-three PACE enrollees with one or more ADL dependencies. MEASUREMENTS: Unmet needs were defined as the absence of paid or unpaid assistance for ADL disabilities before PACE enrollment. Hospital admissions in the 6 months before PACE enrollment and acute admissions in the first 6 weeks and the 7th through 12th weeks after enrollment were determined. RESULTS: Those who lived with unmet ADL needs before enrollment were more likely to have a hospital admission before PACE enrollment (odds ratio (OR)=1.28, 95% confidence interval (CI)=1.01,1.63) and an acute admission in the first 6 weeks after enrollment (OR=1.45, 95% CI=1.00,2.09) but not after 6 weeks of receiving PACE services (OR=0.86, 95% CI=0.53,1.40). CONCLUSION: Frail older people who live without needed help for their ADL disabilities have higher rates of admissions while they are living with unmet ADL needs but not after their needs are met. With state governments under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, it is important that they be aware of the potential health consequences of older adults living without needed ADL assistance. [source] Setting Eligibility Criteria for a Care-Coordination BenefitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2005Christine T. Cigolle MD Objectives: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served. Design: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older. Setting: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey. Participants: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries). Measurements: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency. Results: A small portion of Medicare beneficiaries (1.3,5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population. Conclusion: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults. [source] Weight Change and Lower Body Disability in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2005Soham Al Snih MD Objectives: To examine the association between 2-year weight change and onset of lower body disability over time in older Mexican Americans. Design: Data were from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993,2001). Weight change was examined by comparing baseline weight to weight at 2-year follow-up. Incidence of lower body disability was studied from the end of this period through an additional 5 years. Setting: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants: One thousand seven hundred thirty-seven noninstitutionalized Mexican-American men and women aged 65 and older who reported no limitation in activities of daily living (ADLs) and were able to perform the walk test at 2-year follow-up. Measurements: In-home interviews assessed sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), self-reported ADLs, depressive symptoms, and number of hospitalizations. Cognitive function, handgrip muscle strength, and body mass index (BMI) were obtained. The outcomes were any limitation of lower body ADL (walking across a small room, bathing, transferring from a bed to a chair, and using the toilet) and limitation on the walk test over subsequent 5-year follow-up period. General Estimation Equation (GEE) was used to estimate lower body disability over time. Results: Weight change of 5% or more occurred in 42.3% of the participants; 21.7% lost weight, 20.6% gained weight, and 57.7% had stable weight. Using GEE analysis, with stable weight as the reference, weight loss of 5% or more was associated with greater risk of any lower body ADL limitation (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.06,1.95) and walking limitation (OR=1.35, 95% CI=1.03,1.76) after controlling for sociodemographic variables and BMI at baseline. Weight gain of 5% or more was associated with greater risk of any lower body ADL limitation (OR=1.39, 95% CI=1.02,1.89), after controlling for sociodemographic variables and BMI at baseline. When medical conditions, handgrip muscle strength, high depressive symptomatology, cognitive function, and hospitalization were added to the equation, the relationship between 2-year weight change (>5% loss or >5% gain) and lower body disability decreased. Conclusion: Health conditions and muscle strength partially mediate the association between weight loss or gain and future loss of ability to walk and independently perform ADLs. [source] | ||||||||||||||||||||||||||||||||||||||||