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Kim, Jiwon, Jacqueline Angel, and Sunshine Rote. "Understanding Transitions in IADL and Their Consequences for Cognitive Impairment Among Older Mexican Americans." Innovation in Aging 4, Supplement_1 (2020): 333–34. http://dx.doi.org/10.1093/geroni/igaa057.1070.
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Abstract Mexican Americans tend to live longer lives than other ethnic groups, but it remains unclear how this trend influences the trajectory of disability and its consequences for cognitive frailty. Building on previous research, we assess transitions in IADL among the oldest old. We use data from three waves of the Hispanic Established Population of the Epidemiologic Study of the Elderly (H-EPESE) to investigate trajectories of IADL disability as individuals’ age into their 80s and 90s, a period of the life course with much higher rates of morbidity and decreasing socioeconomic resources. The H-EPESE is a benchmark longitudinal cohort study based on an original sample of 3,050 Mexican-Americans aged 65 and older in the Southwestern United States. Our modeling approach estimates transitions in patterns of IADL employing the Latent Transition Analysis (LTA). Results revealed three heterogeneous latent classes: high IADLs, difficulty in transportation and mobility, and low IADLs. Those with high IADLs tended to remain in the same class over time. Individuals having difficulty in transportation and mobility tended to stay in the same class or transfer to high IADLs, whereas those with overall low IADLs transferred to either the same class or to difficulty in transportation and mobility. Additional analysis revealed that cognitive impairment was a significant predictor of instrumental disability over time. Furthermore, females were more likely than males to belong to difficulty in transportation or mobility class than to the low IADL class. Our results highlight the long term consequences of cognitive decline on IADL limitations.
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Mueller-Schotte, Sigrid, Nicolaas P. A. Zuithoff, Yvonne T. Van der Schouw, Marieke J. Schuurmans, and Nienke Bleijenberg. "Trends in Risk of Limitations in Instrumental Activities of Daily Living Over Age in Older Persons With and Without Multiple Chronic Conditions." Journals of Gerontology: Series A 75, no. 1 (2019): 197–203. http://dx.doi.org/10.1093/gerona/glz049.
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Abstract Background To investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons. Methods A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1–2, ≥ 3 MCC), and corrected for confounders. Results At inclusion, the number of IADL limitations was highest for the “≥3 MCC” group (2.00 interquartile range [1.00–4.00]) and equal for “no MCC” or “1–2 MCC” (1.00 interquartile range [0.00–2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the “no MCC” group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the “no MCC” group for most IADLs; grooming and telephone use were almost unaltered by age and MCC. Conclusion We observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.
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Feger, Danielle L., George W. Rebok, Sherry Willis, and Alden L. Gross. "INCIDENT DIFFICULTY IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING: WHICH COMES FIRST?" Innovation in Aging 3, Supplement_1 (2019): S522. http://dx.doi.org/10.1093/geroni/igz038.1924.
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Abstract Background: Instrumental activities of daily living (IADLs) are necessary for successful independent living. Older adults may develop difficulty completing IADLs as they become physically and/or cognitively frail. The relative ordering in which IADLs deteriorate, and the importance of this ordering, is not well understood. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who reported no difficulty with IADLs at baseline were included. Individuals were followed up to 10 years for incidence of self-reported difficulty in 19 specific IADLs. The outcome of interest was time to any incident difficulty. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of incident IADL difficulty for each IADL. Results: Of N=1,273 participants who contributed 6,144 person-years to the analysis, 887 developed difficulty with at least 1 IADL during the study period. The tasks in which participants reported difficulty earliest included giving self-injections (HR=5.69, [4.77, 6.79]), balancing checkbooks (HR=5.56, [4.32-7.16]), remembering often called numbers without having to look them up (HR=5.47, [4.55-6.59]), and household chores (HR=4.18, [3.43-5.11]). The last tasks to become difficult included keeping household expenses balanced (HR=0.07, [0.04-0.14]) and hanging up at the end of a phone call (HR=0.23, [0.09-0.56]). Conclusion: Independent older adults reported earlier difficulty with balancing checkbooks, remembering often called phone numbers, and doing household cleaning. Recognizing these early difficult tasks may facilitate early planning for family members and adoption of compensatory strategies.
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Steward, Kayla A., Tyler P. Bull, Richard Kennedy, Michael Crowe, and Virginia G. Wadley. "Neuropsychological Correlates of Anosognosia for Objective Functional Difficulties in Older Adults on the Mild Cognitive Impairment Spectrum." Archives of Clinical Neuropsychology 35, no. 4 (2019): 365–76. http://dx.doi.org/10.1093/arclin/acz065.
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Abstract Objective To examine the neuropsychological correlates of anosognosia for instrumental activities of daily living (IADLs) in older adults with mild cognitive impairment (MCI) and mild dementia. Method Participants (n = 103; age range = 54–88, 52% female) with MCI and mild dementia were recruited from neurology and geriatrics clinics for cross-sectional analysis. They completed neuropsychological tests along with subjective and performance-based assessments of six IADLs: financial management, driving, grocery shopping, nutrition evaluation, telephone use, and medication management. For each IADL, participants were classified as having anosognosia when there was objective difficulty but no subjective complaints. Results Depending on functional domain, 13–39% of the sample had objective IADL difficulty, and of those, 65–93% lacked insight into these deficits. Binomial logistic regression models controlling for demographic variables revealed that measures of global cognition, executive function, visual attention, and verbal memory predicted classification of anosognosia, and these relationships varied across IADLs. In contrast, basic auditory attention, working memory, depressive symptoms, nor cognitive reserve were significantly related to anosognosia for any IADL. Conclusion Results support the Conscious Awareness Model, which theorizes that accurate metacognitive output is reliant on attentional, memory, and executive functioning systems. Findings from this study suggest that anosognosia for different IADLs may arise from breakdowns at varying points in this model, explaining both inter- and intra-patient variability in self-awareness of functional deficits.
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Sebastião, Emerson, Lara A. Pilutti, and Robert W. Motl. "Aerobic Fitness and Instrumental Activities of Daily Living in People with Multiple Sclerosis." International Journal of MS Care 21, no. 1 (2019): 23–28. http://dx.doi.org/10.7224/1537-2073.2017-078.
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Abstract Background: There is ample evidence that aerobic fitness is reduced in people with multiple sclerosis (MS), and this may yield a reduction in independence in instrumental activities of daily living (IADLs). This study examined the association between aerobic fitness and self-reported IADLs in persons with MS. Methods: Sixty-two adults with MS completed an incremental exercise test as a measure of aerobic fitness (peak oxygen consumption), a demographic questionnaire, and an IADL scale and underwent a neurologic examination for characterization of disability level (ie, Expanded Disability Status Scale) in a single session. Results: The analysis revealed a weak but significant association between aerobic fitness and total IADL score (r = 0.28 [95% CI, 0.03–0.49], P = .033). Those reporting dependence in different IADL categories (eg, shopping, food preparation, housekeeping, laundry, and responsibility for own medication) presented with lower aerobic fitness compared with those reporting independence, although the difference was not statistically significant. Conclusions: These findings extend previous studies on activities of daily living in people with MS and underscore the need for studies examining the potential effect of aerobic exercise interventions on independence regarding IADLs in this population.
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Jacob, Alexandra E., Michael Crowe, Pariya L. Fazeli, and David E. Vance. "A-61 Predictors of Subjective and Objective Everyday Functioning in Middle-Aged and Older Adults with HIV." Archives of Clinical Neuropsychology 36, no. 6 (2021): 1103. http://dx.doi.org/10.1093/arclin/acab062.79.
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Abstract Objective Older adults with HIV are at increased risk for difficulties with instrumental activities of daily living (IADLs). Awareness of their functional capacity has emerged as an important area for research, but it is not well studied in PWH. The purpose of this study is: (1) to identify factors associated with subjective and objective IADL difficulty in PWH and (2) to identify factors associated with under- or over-reporting of IADL difficulties. Methods This cross-sectional study included 261 adults with HIV. Participants completed a neuropsychological battery, self-report and performance-based measures of IADLs. Self-report measures included the Patient’s Assessment of Own Functioning Inventory (PAOFI) and the Lawton and Brody IADL Questionnaire. The Timed Instrumental Activities of Daily Living (TIADL) task was used as an objective measure. Hierarchical multiple regressions were performed to identify factors associated with subjective and objective assessment of everyday functioning as well as factors associated with discrepancy between self-report and actual performance of IADLS. Results On the PAOFI, higher depression (p = 0.001), lower conscientiousness (p > 0.001), and better processing speed (p = 0.017) predicted worse functioning. On the Lawton and Brody, higher depression (p = 0.049) predicted of worse functioning. On the TIADL, older age (p = 0.1), lower WRAT-4 score (p > 0.001), worse processing speed (p > 0.001), and worse motor function (p = 0.1) were associated with worse performance. Processing speed predicted discrepancy between subjective and objective performance of IADLs (p = 0.1). Conclusions Several demographic, cognitive, and personality variables are associated with worse subjective and objective everyday functioning, as well as an individual’s ability to accurately self-appraise their functional capacity.
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Ayotte, Brian, Andrew Revell, and Nicole Belanger. "The Examination of Instrumental Activities of Daily Living and Perceived Adulthood in Emerging Adults." International Journal of Aging and Human Development 91, no. 4 (2020): 467–75. http://dx.doi.org/10.1177/0091415020907312.
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Emerging adults differ in terms of the extent to which they perceive themselves as adults. We examined how the ability to perform activities related to independent living (i.e., instrumental activities of daily living [IADLs]) was associated with perceived adulthood. Data were collected from 236 emerging adults in college. Results suggested that IADL scores were positively related to perceived adulthood and achieved criteria of adulthood even after controlling for race, year in school, age, and sex. Results are discussed in terms of the development and importance of IADLs during emerging adulthood.
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Paryad, Ezzat, Alireza Balaafkandah, and Atefeh Ghanbari. "Factors Predicting Daily and Instrumental Living Activities in Obese and Overweight Patients After Coronary Artery Bypass Graft Surgery." Quarterly of the Horizon of Medical Sciences 26, no. 1 (2020): 2–13. http://dx.doi.org/10.32598/hms.26.1.2959.1.
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Aims Obese or overweight people are more likely to have complications after Coronary Artery Bypass Graft (CABG) surgery. It affects the patientschr('39') postoperative abilities to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The aim of this study was to determine the factors predicting ADLs and IADLs in overweight and obese patients after CABG. Methods & Materials This analytical study with cross-sectional design was conducted over a period of 4 months on 84 patients one month after CABG, who were selected using a convenience sampling method. Data were collected using a sociodemographic form, Charlson comorbidity index, Katz Index, and Lawton IADL Scale. The collected data were analyzed in SPSS software using descriptive and inferential statistics. Findings The majority of obese and overweight patients (94%), one month after surgery, were independent of their ADLs, while most of them were in need of help in their IADLs (88.1%). Logistic regression model showed that the variables of male gender (P=0.004, OR=10.51, CI 95%=2.15-15.41) and carotid artery involvement (P=0.01, OR=0.12, CI 95%= 0.02-0.64) were the predictors of ADLs and IADLs in these patients. Conclusion Obese and overweight people have impairments in performing IADLs. It is important to pay attention to the predictors including male gender and carotid artery involvement in their return to normal life after CABG.
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Hall, James R., Hoa T. Vo, Leigh A. Johnson, Robert C. Barber, and S. E. O'Bryant. "The Link between Cognitive Measures and ADLs and IADL Functioning in Mild Alzheimer's: What Has Gender Got to Do with It?" International Journal of Alzheimer's Disease 2011 (2011): 1–6. http://dx.doi.org/10.4061/2011/276734.
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Objectives. To investigate the link between neurocognitive measures and various aspects of daily living (ADL and IADL) in women and men with mild Alzheimer's disease (AD).Methods. Participants were 202 AD patients (91 male, 111 female) with CDR global scores of ≤1. ADLs and IADLs ratings were obtained from caregivers. Cognitive domains were assessed with neuropsychological testing.Results. Memory and executive functioning were related to IADL scores. Executive functioning was linked to total ADL. Comparisons stratified on gender found attention predicted total ADL score in both men and women. Attention predicted bathing and eating ability in women only. Language predicted IADL functions in men (food preparation) and women (driving).Conclusions. Associations between ADLs/IADLs and memory, learning, executive functioning, and language suggest that even in patients with mild AD, basic ADLs require complex cognitive processes. Gender differences in the domains of learning and memory area were found.
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Ouchi, Yoshitaka, Mari Kasai, Kei Nakamura, Masahiro Nakatsuka, and Kenichi Meguro. "Qualitative Assessment of Instrumental Activities of Daily Living in Older Persons with Very Mild Dementia: The Kurihara Project." Dementia and Geriatric Cognitive Disorders Extra 6, no. 2 (2016): 374–81. http://dx.doi.org/10.1159/000446769.
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Background/Aims: We investigated quantitative/qualitative changes of instrumental activities of daily living (IADL) in people with a Clinical Dementia Rating (CDR) of 0.5. Methods: IADLs were evaluated in older residents: CDR of 0 (healthy) and CDR 0.5 (questionable/very mild dementia). The subjects with CDR 0.5 were divided into 2 types: the very mild Alzheimer's disease (vmAD) type and the other type including very mild subcortical vascular dementia. IADLs were evaluated quantitatively using the Lawton and the original qualitative IADL scales. Results: CDR 0.5/vmAD type subjects had impairment of only one Lawton item (Shopping) compared to CDR 0 subjects. However, the CDR 0.5/vmAD type group and the CDR 0.5/other type group showed impairment of 3 items in the qualitative assessment (Shopping, Food preparation, and Mode of transportation). Conclusion: We suggest using both quantitative/qualitative IADL scales for assessing older adults with very mild dementia.
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Hsiao, Julia J., Po H. Lu, Joshua D. Grill, and Edmond Teng. "Longitudinal Declines in Instrumental Activities of Daily Living in Stable and Progressive Mild Cognitive Impairment." Dementia and Geriatric Cognitive Disorders 39, no. 1-2 (2014): 12–24. http://dx.doi.org/10.1159/000365587.
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Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of ‘essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials. © 2014 S. Karger AG, Basel
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Greenaway, Melanie C., Noah L. Duncan, Sherrie Hanna, and Glenn E. Smith. "Predicting functional ability in mild cognitive impairment with the Dementia Rating Scale-2." International Psychogeriatrics 24, no. 6 (2012): 987–93. http://dx.doi.org/10.1017/s1041610211002717.
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ABSTRACTBackground: We examined the utility of cognitive evaluation to predict instrumental activities of daily living (IADLs) and decisional ability in Mild Cognitive Impairment (MCI).Methods: Sixty-seven individuals with single-domain amnestic MCI were administered the Dementia Rating Scale-2 (DRS-2) as well as the Everyday Cognition assessment form to assess functional ability.Results: The DRS-2 Total Scores and Initiation/Perseveration and Memory subscales were found to be predictive of IADLs, with Total Scores accounting for 19% of the variance in IADL performance on average. In addition, the DRS-2 Initiation/Perseveration and Total Scores were predictive of ability to understand information, and the DRS-2 Conceptualization helped predict ability to communicate with others, both key variables in decision-making ability.Conclusions: These findings suggest that performance on the DRS-2, and specific subscales related to executive function and memory, is significantly related to IADLs in individuals with MCI. These cognitive measures are also associated with decision-making-related abilities in MCI.
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Sheehan, Connor, Benjamin W. Domingue, and Eileen Crimmins. "Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability." Journal of Aging and Health 31, no. 10 (2018): 1748–69. http://dx.doi.org/10.1177/0898264318793469.
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Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study ( N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability.
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Nikula, Suvi, Marja Jylhä, Carola Bardage, et al. "Are IADLs comparable across countries? Sociodemographic associates of harmonized IADL measures." Aging Clinical and Experimental Research 15, no. 6 (2003): 451–59. http://dx.doi.org/10.1007/bf03327367.
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Portela, Diana, Marta Almada, Luís Midão, and Elísio Costa. "Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data." International Journal of Environmental Research and Public Health 17, no. 20 (2020): 7387. http://dx.doi.org/10.3390/ijerph17207387.
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This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.
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Gildengers, A. G., D. Chisholm, M. A. Butters, et al. "Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression?" Psychological Medicine 43, no. 4 (2012): 801–11. http://dx.doi.org/10.1017/s0033291712001614.
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BackgroundWhile bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD.MethodWe recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects (‘controls’) were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs.ResultsThe BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years.ConclusionsOver 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
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Nguyen, Thu Thi Hoai, Anh Trung Nguyen, Thanh-Huyen Thi Vu, et al. "Association of Frailty Status and Functional Disability among Community-Dwelling People Aged 80 and Older in Vietnam." BioMed Research International 2021 (July 19, 2021): 1–6. http://dx.doi.org/10.1155/2021/7109452.
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Objectives. This study investigated associations between frailty and functional disability in elder suburban Vietnamese. Method. Cross-sectional analysis was carried out on 251 participants aged 80 and over in Soc Son district. We used the Instrumental Activities of Daily Living (IADL) scale including 8 items, and functional disability was defined as ≥3 IADL impairment. We defined frail as ≥3 out of 5 frailty components including weight loss > 5 % , weak grip, exhaustion, low walking speed, and low physical activity. Results. Of 251 participants with a mean age of 84.6, 11.2% was classified as frail and 64.5% had ≥3 IADLs. Among the frailty components, low walking speed and low physical activity were significantly associated with increased odds of having ≥3 IADLs: ORs (95% CI) were 4.2 (2.3-7.9) and 3.7 (1.7-8.2). Conclusion. Frailty is associated with the higher likelihood of having functional disability. Further longitudinal studies are needed to examine the causal this relationship.
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Tomaszewski Farias, Sarah, Tania Giovannetti, Brennan R. Payne, et al. "Self-perceived Difficulties in Everyday Function Precede Cognitive Decline among Older Adults in the ACTIVE Study." Journal of the International Neuropsychological Society 24, no. 1 (2017): 104–12. http://dx.doi.org/10.1017/s1355617717000546.
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AbstractObjectives: Careful characterization of how functional decline co-evolves with cognitive decline in older adults has yet to be well described. Most models of neurodegenerative disease postulate that cognitive decline predates and potentially leads to declines in everyday functional abilities; however, there is mounting evidence that subtle decline in instrumental activities of daily living (IADLs) may be detectable in older individuals who are still cognitively normal. Methods: The present study examines how the relationship between change in cognition and change in IADLs are best characterized among older adults who participated in the ACTIVE trial. Neuropsychological and IADL data were analyzed for 2802 older adults who were cognitively normal at study baseline and followed for up to 10 years. Results: Findings demonstrate that subtle, self-perceived difficulties in performing IADLs preceded and predicted subsequent declines on cognitive tests of memory, reasoning, and speed of processing. Conclusions: Findings are consistent with a growing body of literature suggesting that subjective changes in everyday abilities can be associated with more precipitous decline on objective cognitive measures and the development of mild cognitive impairment and dementia. (JINS, 2018, 24, 104–112)
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Stone, Lydia, Jessica Heward, Stella-Maria Paddick, et al. "Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training." Journal of Geriatric Psychiatry and Neurology 31, no. 5 (2018): 248–55. http://dx.doi.org/10.1177/0891988718790400.
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Background: Task shifting has been suggested as one way to help manage the increasing burden of dementia in sub-Saharan Africa (SSA). However, brief, easy-to-use and valid screening tools are needed to support this approach. Our team has developed an 11-item questionnaire to assess instrumental activities of daily living (IADLs) in SSA, the Identification and Intervention for Dementia in Elderly Africans (IDEA)-IADL questionnaire. We aimed to externally validate the questionnaire and develop a shorter, more efficient version. Methods: A community-based sample of 329 older adults in 4 rural villages was screened for dementia using the validated IDEA cognitive screen and the 11-item IDEA-IADL questionnaire. A stratified sample was assessed for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) dementia by a United Kingdom-based doctor, who was blinded to the results of screening. Area under the receiver operating characteristic (AUROC) curve analysis was used to assess validity, and factor analysis and regression modeling were used to develop a shorter version of the questionnaire. Results: A 3-item IDEA-IADL questionnaire was developed and externally validated in the study sample. The questionnaire was deemed to be valid and enhanced screening performance in 2 villages (AUROC: 0.857 and 0.895) but detracted from the accuracy of the IDEA cognitive screen in the other 2 villages (AUROC: 0.591 and 0.639). These differences appeared to be due to differences in interpretation of responses to questions by the assessors. Conclusions: A brief IDEA-IADLs scale was developed and worked well in some villages. However, our study highlights a training need if brief screening tools to assess IADLs are to be effectively used by nonspecialists in low-resource settings.
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Lupeanu, Elena, Mihaela Elena Ulmeanu, Anca Iovita, and Rodica Hnidei. "Aspects of Functional Abilities Changes in Aging." Applied Mechanics and Materials 859 (December 2016): 236–40. http://dx.doi.org/10.4028/www.scientific.net/amm.859.236.
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The aim of this study is to assess functional status and prevalence of functional limitations/disabilities in aging, in order to identify possible strategies in assistive technologies. Investigations were undertaken on 138 patients, men and women, aged between 45 and 90 years, divided into four age groups: group A patients aged 50 - 59 years; group B aged 60 - 69 years; group C aged 70 - 79 years; group D aged 80 - 92 years. The results showed significant reduction in the ability to carry out basic activities of daily living (ADL) in patients aged 80 - 90+ years compared to patients aged 45-59 years (p = 0.05) and those of 60-69 years old (p = 0.043). Ability to carry out instrumental activities of daily living (IADL) was significantly reduced (p = 0.0503) in patients aged 70-79 years compared with patients aged 45-59 years and 60-69 years. Patients older than 80 years showed significant reduction ability to conduct IADLs compared to patients aged 45-59 years (p = 0.0047), aged 60-69 years (p = 0.0049) and aged 70-79 years (p = 0.029). There was a significant negative correlation of ADL (r = - 0.25, p <0.01) and IADL (r = - 0.39; p <0.01) with patients age. In conclusion, ADLs decline appears relatively late, after 80 years, while IADLs begins at about the age of 70 years. Seniors which experience decline in ADLs and IADLs can benefit from a variety of assistive technologies which promote independence and safety as they compensate for sensory, physical and cognitive impairments.
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Chaurasia, Priyanka, Sally McClean, Chris D. Nugent, and Bryan Scotney. "A duration-based online reminder system." International Journal of Pervasive Computing and Communications 10, no. 4 (2014): 442–68. http://dx.doi.org/10.1108/ijpcc-10-2013-0029.
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Purpose – The purpose of this paper is to discuss an online sensor-based support system which the authors believe can be useful in such scenarios. Persons with a cognitive impairment, such as those with Alzheimer’s disease, suffer from deficiencies in cognitive skills which reduce their independence; such patients can benefit from the provision of further assistance such as reminders for carrying out instrumental activities of daily living (IADLs). Design/methodology/approach – The system proposed processes data from a network of sensors that have the capability of sensing user interactions and on-going IADLs in the living environment itself. A probabilistic learning model is built that computes joint probability distributions over different activities representing users’ behavioural patterns in performing activities. This probability model can underpin an intervention framework that prompts the user with the next step in the IADL when inactivity is being observed. This prompt for the next step is inferred from the conditional probability taken into consideration the IADL steps that have already been completed, in addition to contextual information relating to the time of day and the amount of time already spent on the activity. The originality of the work lies in combining partially observed sensor sequences and duration data associated with the IADLs. The prediction of the next step is then adjusted as further steps are completed and more time is spent towards the completion of the activity, thus updating the confidence that the prediction is correct. A reminder is only issued when there has been sufficient inactivity on the part of the patient and the confidence is high that the prediction is correct. Findings – The results of this study verify that by including duration information the prediction accuracy of the model is increased and the confidence level for the next step in the IADL is also increased. As such, there is approximately a 10 per cent rise in the prediction performance in the case of single sensor activation in comparison to an alternative approach which did not consider activity durations. Practical implications – Duration information to a certain extent has been widely ignored by activity recognition researchers and has received a very limited application within smart environments. Originality/value – This study concludes that incorporating progressive duration information into partially observed sensor sequences of IADLs has the potential to increase performance of a reminder system for patients with a cognitive impairment, such as Alzheimer’s disease.
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Chaurasia, Priyanka, Sally McClean, Chris D. Nugent, and Bryan Scotney. "A duration-based online reminder system." International Journal of Pervasive Computing and Communications 10, no. 3 (2014): 337–66. http://dx.doi.org/10.1108/ijpcc-07-2014-0042.
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Purpose – This paper aims to discuss an online sensor-based support system which is believed to be useful for persons with a cognitive impairment, such as those with Alzheimer’s disease, suffering from deficiencies in cognitive skills which reduce their independence. Such patients can benefit from the provision of further assistance such as reminders for carrying out instrumental activities of daily living (iADLs). Design/methodology/approach – The system proposed processes data from a network of sensors that have the capability of sensing user interactions and ongoing iADLs in the living environment itself. A probabilistic learning model is built that computes joint probability distributions over different activities representing users’ behavioural patterns in performing activities. This probability model can underpin an intervention framework that prompts the user with the next step in the iADL when inactivity is being observed. This prompt for the next step is inferred from the conditional probability, taking into consideration the iADL steps that have already been completed, in addition to contextual information relating to the time of day and the amount of time already spent on the activity. The originality of the work lies in combining partially observed sensor sequences and duration data associated with the iADLs. The prediction of the next step is then adjusted as further steps are completed and more time is spent towards the completion of the activity; thus, updating the confidence that the prediction is correct. A reminder is only issued when there has been sufficient inactivity on the part of the patient and the confidence is high that the prediction is correct. Findings – The results verify that by including duration information, the prediction accuracy of the model is increased, and the confidence level for the next step in the iADL is also increased. As such, there is approximately a 10 per cent rise in the prediction performance in the case of single-sensor activation in comparison to an alternative approach which did not consider activity durations. Thus, it is concluded that incorporating progressive duration information into partially observed sensor sequences of iADLs has the potential to increase performance of a reminder system for patients with a cognitive impairment, such as Alzheimer’s disease. Originality/value – Activity duration information can be a potential feature in measuring the performance of a user and distinguishing different activities. The results verify that by including duration information, the prediction accuracy of the model is increased, and the confidence level for the next step in the activity is also increased. The use of duration information in online prediction of activities can also be associated to monitoring the deterioration in cognitive abilities and in making a decision about the level of assistance required. Such improvements have significance in building more accurate reminder systems that precisely predict activities and assist its users, thus, improving the overall support provided for living independently.
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LECKEY, GEORGE S., and WILLIAM W. BEATTY. "Predicting functional performance by patients with Alzheimer's disease using the Problems in Everyday Living (PEDL) Test: A preliminary study." Journal of the International Neuropsychological Society 8, no. 1 (2002): 48–57. http://dx.doi.org/10.1017/s1355617701020057.
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Findings from a recent population-based survey indicate that about 33% of patients with dementia reside alone. Because many of these patients may not have a caregiver who visits them regularly, the need for a neuropsychological (NP) test to predict patients' functional competence to live alone safely is evident. In this study, we compared the accuracy of predicting Instrumental and Basic Activities (IADLs and ADLs) of 22 patients with Alzheimer's disease using several standard NP tests and the newly developed Problems in Everyday Living (PEDL) test. Performance of IADLs and ADLs as rated by caregivers was significantly correlated with performance on the PEDL, the Mini-Mental State Exam (MMSE), and with the Shipley Institute of Living Test of Verbal Abstraction (SILS-A), but not with vocabulary or naming. The PEDL was the best predictor of IADL scores (r = 0.71), compared to the MMSE (r = 0.52) and the SILS-A (r = 0.57), while the MMSE was the best predictor of ADL performance (r = 0.69), compared to the PEDL (r = 0.58) and the SILS-A (r = 0.50). (JINS, 2002, 8, 48–57.)
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Sigrist, Antonia de Azevedo Falcão, Ana Claudia Becattini Oliveira, and Helenice Charchat Fichman. "Patterns of instrumental activities of daily living between community-dwelling older adults." Dementia & Neuropsychologia 15, no. 3 (2021): 366–72. http://dx.doi.org/10.1590/1980-57642021dn15-030009.
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ABSTRACT The ability to perform instrumental activities of daily living (IADLs) is an important marker within the aging process, as it reflects the level of independence to perform in the real world. However, there is a scarcity of studies that investigate the different performance profiles among older adults. Objective: To investigate the heterogeneity present in the community of elderly people, grouping them based on characteristics and patterns observed through an objective performance-based assessment. Methods: Participants were selected according to the following inclusion criteria: fluency in Portuguese, 360 years, regular participation in a social program offered by the government of Rio de Janeiro, and absence of a caregiver. The evaluation of IADLs was determined by the total and brief version of the University of California, San Diego Performance-Based Skills Assessment (UPSA) and the Lawton and Brody IADL scale. The Brief Cognitive Screening Battery and the Mini-Mental State Examination were used to characterize the sample, in addition to the Geriatric Depression Scale. A total of 61 elderly people with an average age of 72.5 years, predominantly females (85.2%), and average education of 11.2 were evaluated and grouped according to their performance at UPSA through clustering analysis. Results: The analysis revealed three grouping patterns, subdividing the sample into subgroups that differed significantly in terms of age, education, global cognition, and all instrumental activities assessed by UPSA — planning, finance, communication, transportation, and household chores. Conclusions: This study was able to identify the heterogeneity present between the elderly people in the different factors that compose the IADLs through a performance-based assessment.
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Lau, Karen M., Mili Parikh, Danielle J. Harvey, Chun-Jung Huang, and Sarah Tomaszewski Farias. "Early Cognitively Based Functional Limitations Predict Loss of Independence in Instrumental Activities of Daily Living in Older Adults." Journal of the International Neuropsychological Society 21, no. 9 (2015): 688–98. http://dx.doi.org/10.1017/s1355617715000818.
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AbstractOlder adults with early forms of neurodegenerative disease are at risk for functional disability, which is often defined by the loss of independence in instrumental activities of daily living (IADLs). The current study investigated the influence of mild changes in everyday functional abilities (referred to as functional limitations) on risk for development of incident functional disability. A total of 407 participants, who were considered cognitively normal or diagnosed with mild cognitive impairment (MCI) at baseline, were followed longitudinally over an average 4.1 years (range=0.8–9.2 years). Informant-based ratings from the Everyday Cognition (ECog; Farias et al., 2008) and the Instrumental Activities of Daily Living (Lawton & Brody, 1969) scales assessed the degree of functional limitations and incident IADL disability, respectively. Cox proportional hazards models revealed that more severe functional limitations (as measured by the Total ECog score) at baseline were associated with approximately a four-fold increased risk of developing IADL disability a few years later. Among the ECog domains, functional limitations in Everyday Planning, Everyday Memory, and Everyday Visuospatial domains were associated with the greatest risk of incident functional disability. These results remained robust even after controlling for participants’ neuropsychological functioning on tests of executive functions and episodic memory. Current findings indicate that early functional limitations have prognostic value in identifying older adults at risk for developing functional disability. Findings highlight the importance of developing interventions to support everyday abilities related to memory, executive function, and visuospatial skills in an effort to delay loss of independence in IADLs. (JINS, 2015,21, 688–698)
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Marks, Timothy, Dorothy F. Edwards, Muhammad O. Al- heizan, and Gordon M. Giles. "CAN THE BRIEF INTERVIEW OF MENTAL STATUS (BIMS) IDENTIFY RISK FOR IMPAIRED IADLS DUE TO FUNCTIONAL COGNITIVE DEFICITS." Innovation in Aging 3, Supplement_1 (2019): S512. http://dx.doi.org/10.1093/geroni/igz038.1891.
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Abstract The Brief Interview of Mental Status (BIMS) was introduced to the Minimum Data Set (MDS) 3.0 as a cognitive screening tool. It includes temporal orientation and word recall (Saliba et al., 2012). This study examined the ability of the BIMS to identify impairment on performance-based functional cognitive screening tests that assess instrumental activities of daily living (IADLs). We recruited a cross-sectional sample of 200 participants who met the following inclusion criteria: age 55 and older, living independently in the community, and able to read and communicate in English.. Participants ranged in age from 55 to 92 years (Mean 70.96:SD = 8.56),were predominantly White (68%) and female (65%). Participants were administered the BIMS and a battery of performance-based tests of functional cognition -the Performance Assessment of Self Care Skills and the Weekly Calendar Planning Activity (WCPA). There was a mismatch in screening results: Among Individuals identified as cognitively intact on the BIMS 22-45% were found to be impaired on the PASS and/or the WCPA. Sensitivity of the BIMS to identify impaired IADL function did not exceed .06, although specificities were high (&lt; .95). These findings suggest that individuals categorized as cognitively normal by the BIMS may be impaired on more complex IADL tasks. Individuals classified as unimpaired on the BIMS, may benefit from more complex functional cognitive screening to further assess IADLs function to better estimate ability to live independently in the community. Performance based assessments can improve discharge planning by identifying elders at risk after hospitalization.
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Falci, Denise Mourão, Juliana Vaz de Melo Mambrini, Érico Castro-Costa, Josélia Oliveira Araújo Firmo, Maria Fernanda Lima-Costa, and Antônio Ignácio De Loyola Filho. "Use of psychoactive drugs predicts functional disability among older adults." Revista de Saúde Pública 53 (January 30, 2019): 21. http://dx.doi.org/10.11606/s1518-8787.2019053000675.
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OBJECTIVE: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17–2.13) and BADLs (HR = 1.43; 95%CI 1.05–1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07–1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16–1.98) and BADLs (HR = 1.44; 95%CI 1.10–1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49–6.59). CONCLUSIONS: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.
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Hu, Han, Yafei Si, and Bingqin Li. "Decomposing Inequality in Long-Term Care Need Among Older Adults with Chronic Diseases in China: A Life Course Perspective." International Journal of Environmental Research and Public Health 17, no. 7 (2020): 2559. http://dx.doi.org/10.3390/ijerph17072559.
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Background: China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. For policy planners, it is necessary to understand the different levels of needs of long-term care and provide long-term care insurance to ensure the long-term care needs of all people can be met. Methods: This study combines the 2013 wave of CHARLS survey and the Life Course Survey of 2014. The combination allows us to factor in both childhood and adulthood data to provide life-course analysis. We identified 7,734 older adults with chronic diseases for analysis. The need for long-term care is defined by the presence of functional limitations based on the performance of basic activities of daily living (ADLs) and of instrumental activities of daily living (IADLs). Two dummy variables, ADLs disability and IADLs disability, and two count variables, ADLs score and IADLs score, were defined to measure incidence and severity of long-term care need, respectively. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. Results: At least a little difficulty was reported in ADLs and IADLs in 20.44% and 19.25% of respondents, respectively. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Decomposition analyses revealed that family income, education attainment, aging, and childhood experience played a significant role in explaining the inequalities. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups.
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H, Clark, Schroeder R, and Martin P. "A-200 Which Domains of Neuropsychological Functioning are Most Strongly Related to Impairment in Instrumental Activities of Daily Living?" Archives of Clinical Neuropsychology 35, no. 6 (2020): 995. http://dx.doi.org/10.1093/arclin/acaa068.200.
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Abstract Objective The current study investigated relationships between neuropsychological test findings and instrumental activities of daily living (IADLs) in a mixed sample of Mild and Major Neurocognitive Disorder (NCD). Method Archival data from a memory disorder clinic were analyzed. Patients (n = 68, mean age = 72.3, mean education = 13.2 years, 26.5% Mild NCD, 73.5% Major NCD) minimally completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Delis-Kaplan Executive Function System (D-KEFS). Information on IADLs was obtained from family members via the Functional Activities Questionnaire (FAQ). Spearman correlations were calculated between individual IADLs from the FAQ, total FAQ ratings, RBANS index scores, and a composite executive functioning score (average scaled score on DKEFS Trail Making, Verbal Fluency, and Tower). Results Executive functioning was the only cognitive domain that significantly correlated (p &lt; .05) with total FAQ ratings. However, all cognitive domains except language significantly correlated with individual IADLs. Tracking current events correlated with immediate memory, while financial management correlated with delayed memory. Attending to, understanding, and discussing TV, books, and magazines correlated with executive functioning and immediate and delayed memory. Remembering events correlated with attention and executive functioning. Shopping alone correlated with immediate memory, attention, and executive functioning, while operating basic kitchen appliances correlated with visuospatial skills, attention, and executive functioning. Traveling also correlated with visuospatial skills and executive functioning. Conclusions Executive functioning was the only domain associated with overall daily functioning; however, all domains except language corresponded with individual IADLs. Current findings highlight the utility of neuropsychological test findings in understanding the nuances of deficits in daily functioning.
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Reichardt, Lucienne A., Jesse J. Aarden, Rosanne van Seben, et al. "Motivational factors mediate the association of general self-efficacy and performance outcomes in acutely hospitalised older patients." Age and Ageing 49, no. 5 (2020): 837–42. http://dx.doi.org/10.1093/ageing/afaa076.
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Abstract Objectives To study (i) the association of general self-efficacy (GSE) on the course of subjective (i.e. basic and instrumental activities of daily living (ADLs and IADLs) and objective physical performance outcomes (short physical performance battery (SPPB)) among older persons from discharge up to 3 months post-discharge and (ii) the extent to whether motivational factors such as depressive symptoms, apathy and fatigue mediate this association. Methods Prospective multi-centre cohort of acutely hospitalised patients aged ≥70 (Hospital-ADL study). Structural equation modelling was used to analyse the structural relationships. Results The analytic sample included 236 acutely hospitalised patients. GSE had a significant total effect on the course of subjective and objective performance outcomes (ADLs: β = −0.21, P &lt; 0.001, IADLs: β = −0.24, P &lt; 0.001 and SPPB: β = 0.17, P &lt; 0.001). However, when motivational factors as mediator were included into the same model, motivational factors (IADLs: β = 0.51, P &lt; 0.001; SPPB: β = 0.49, P &lt; 0.001) but not GSE remained significantly associated with IADLs (β = −0.06, P = 0.16) and SPPB (β = 0.002, P = 0.97). Motivational factors partially mediated the relationship between GSE and ADLs (β = −0.09, P = 0.04). The percentage of mediation was 55, 74 and 99% for ADLs, IADLs and SPPB, respectively. Conclusions Motivational factors and GSE are both associated with subjective and objective performance outcomes. However, the relationship between GSE and subjective and objective performance outcomes was highly mediated by motivational factors. Taken together, this suggests that GSE is important to being physically active but not sufficient to becoming more physical active in acutely hospitalised older patients; motivation is important to improving both subjective and objective performance.
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Nóbrega, Júlia Cristina Leite, Juliana Barbosa Medeiros, Tácila Thamires de Melo Santos, et al. "Socioeconomic Factors and Health Status Disparities Associated with Difficulty in ADLs and IADLs among Long-Lived Populations in Brazil: A Cross-Sectional Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110072. http://dx.doi.org/10.1177/00469580211007264.
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Objective: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. Method: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil’s Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using “R” statistical software. Results: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. Conclusion: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.
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Scott, Judith, and Ann Mayo. "Compromised Vision Impairs Successful Aging Among Assisted Living Residents." Innovation in Aging 4, Supplement_1 (2020): 530. http://dx.doi.org/10.1093/geroni/igaa057.1708.
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Abstract Community dwelling independent older adults’ successful aging is known to be hampered by sensory and cognitive impairments. However, little is known about to what degree these impairments affect successful aging among assisted living (AL) residents. The purpose of this quantitative study, conducted in three (AL) facilities, was to describe factors affecting successful aging. A total of 88 older adults (M=89.0, SD=7.54), mostly women (n=68), completed hearing (CALFRAST-Strong procedure at 75cm, 35cm, and 2cm), vision (Jaeger reading [proximate], Snellen Acuity [visual acuity]), and cognitive screening (MiniCog, Borson et al), as well as the Lawton Instrumental Activities of Daily Living (IADL) and Successful Aging Inventory (SAI, Troutman et al, 2011). Most (68%) demonstrated hearing loss &gt;25DB, with a significant difference demonstrated between age groups (age 65-89; n=38) (90-100; n=49) with the older group demonstrating worse hearing (F(1,80)=5.9, p=.017). Some vision compromise was noted for both reading (14.3%) and visual acuity (10.8%). Over one third of participants (34.1%) demonstrated compromised cognition. The SAI results indicated most participants were managing IADLs well (M=6.11, SD=1.42) and aging successfully (M=63.39, SD=9.04). Hearing, cognition and IADLs were not significantly related to successful aging. However, when compared to those without vision issues, participants with compromised vision, both reading and visual acuity, scored significantly lower on the SAI (reading F(1,75)= 24.9,p=.000; visual acuity F(1,28)=4.31, p=000). The infrastructure provided by AL settings may compensate for hearing, cognition, and IADL problems, but not as well for vision problems. Interventions supporting AL residents’ vision should be a priority to improve successful aging.
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McDaid, Edel, Aoife Johnston, Elaine Ross, and Lisa Cogan. "83 The Feasibility of an Interdisciplinary Led Community Based Functional Training Group for Frail Older Adults in a Post-Acute Orthogeriatric Unit." Age and Ageing 48, Supplement_3 (2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.46.
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Abstract Background Reduced ability to perform instrumental activities of daily living (IADLs) can lead to a difficult transition from hospital to home, increased dependence and diminished quality of life (1). A novel IADL group for frail older adults ‘Ready Steady Home’ was completed to facilitate transition from hospital to home. Methods A single centre prospective study was undertaken in a Post-Acute Orthogeriatric Rehabilitation Care unit. A sample of convenience was recruited over a 3 month period. All subjects invited to participate had been referred for Physiotherapy and Occupational Therapy, medically stable, able to give consent, mobile with/without an aid and had a goal of community ambulation and IADLS. The one hour intervention consisted of a car transfer, outdoor mobility on a busy footpath, road crossing, negotiating a busy shop, completing shopping task and financial management. A self-reported modified Client Satisfaction Questionnaire (CSQ-8) was completed by all subjects post intervention. Data was analysed using descriptive statistics. Results Twelve participants (female (12); mean age 83.7 years, mean LOS 32.75 days) completed the intervention and were included in the data. All were frail with a Clinical Frailty Scale score ≥ 5, mild (n=4), moderate (n=7) and severe frailty (n=1). Primary diagnosis was femoral fracture (n=7), hip surgery revision (n=2), deconditioning (n=2) and pelvic fracture (n=1). All used a unilateral (n=5) and/or bilateral mobility aid (n=7). The mean CSQ-8 score was 27/32 indicating high satisfaction with the intervention. No adverse events occurred. Common themes reported were improved confidence with community ambulation, preparation for home and re-integration into the community. Conclusion This study indicates that an interdisciplinary intervention addressing community based IADLS was feasible, safe and effective in a frail Orthogeriatric inpatient cohort. Further research is required to evaluate the effectiveness of this therapy intervention in improving hospital to home transition and potential reduction in LOS.
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Giebel, Clarissa M., Caroline Sutcliffe, and David Challis. "Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia." Journal of Geriatric Psychiatry and Neurology 30, no. 2 (2017): 96–103. http://dx.doi.org/10.1177/0891988716686835.
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Objectives: While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia. Methods: A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative’s everyday functioning. Results: Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative. Conclusion: Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.
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Yeager, Catherine A., and Lee Hyer. "Apathy in Dementia: Relations with Depression, Functional Competence, and Quality of Life." Psychological Reports 102, no. 3 (2008): 718–22. http://dx.doi.org/10.2466/pr0.102.3.718-722.
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This study set out to clarify the association of apathy and depression in dementia as well as apathy's association with basic (ADLs) and instrumental (IADLs) activities of daily living and quality of life. 68 outpatients with mild dementia were assessed on apathy, depression, global cognition, traditional ADLs/IADLs, complex daily living activities requiring intact executive functioning (DAD: Disability Assessment for Dementia Scale), and quality of life. The sample was stratified into high and low global cognition groups and compared. While no relationship was found between scores on apathy and depression in the high cognition group, there was a significant relationship between apathy and depression in the low cognition group. Further, high and low cognition groups differed in the relationship between apathy and ability to perform basic and complex activities of daily living. Specifically, in the high cognition group, increased apathy was correlated with diminished ability to perform traditional IADLs as well as those activities requiring intact executive functioning (i.e., DAD). In the low cognition group, increased apathy was associated with poor performance on traditional ADLs and IADLs, but was not related to performance on independent daily activities demanding good executive functioning. Finally, increased apathy was significantly associated with worse quality of life, but this held for the high cognition group only, suggesting that dementia patients with better cognition have insight into their deficits and, perhaps, experience poor quality of life as a result.
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Beard, John R., A. T. Jotheeswaran, Matteo Cesari, and Islene Araujo de Carvalho. "The structure and predictive value of intrinsic capacity in a longitudinal study of ageing." BMJ Open 9, no. 11 (2019): e026119. http://dx.doi.org/10.1136/bmjopen-2018-026119.
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ObjectivesTo assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.DesignStructural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.SettingsCommunity, United Kingdom.Participants2560 eligible participants aged over 60 years.Main outcome measuresActivities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsOne general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.ConclusionsThe WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
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Labra Pérez, José Antonio, and Julio Menor. "Development and Validation of a Performance-Based Test to Assess Instrumental Activities of Daily Living in Spanish Older Adults." European Journal of Psychological Assessment 34, no. 6 (2018): 386–98. http://dx.doi.org/10.1027/1015-5759/a000352.
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Abstract. A key feature of the autonomy and quality of life of the elderly is their ability to perform instrumental activities of daily living (IADLs). When older people have difficulty in performing IADLs, many of their social and community activities may be affected, leading to their progressive isolation from society. This study describes the development and validation of a test that assesses six areas of daily functioning in the elderly: use of medication and healthcare management, administrative, financial management, transportation, meal preparation, and shopping. The study evaluated 164 healthy individuals without cognitive impairment using an extensive cognitive battery. The construct validity and reliability of test were examined. Findings revealed a good internal consistency and high inter-rater and test-retest reliability. As for construct validity, the instrument tasks were grouped into two dimensions, based on the cognitive components involved in each task: fluid and episodic memory tasks and crystallized tasks. The developed instrument may be useful for evaluating IADLs in those elderly who live at home and are somewhat dependent.
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SEIDEL, DAVID, KATHRYN RICHARDSON, NATHAN CRILLY, FIONA E. MATTHEWS, P. JOHN CLARKSON, and CAROL BRAYNE. "Design for independent living: activity demands and capabilities of older people." Ageing and Society 30, no. 7 (2010): 1239–55. http://dx.doi.org/10.1017/s0144686x10000310.
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ABSTRACTThe ability to perform the instrumental activities of daily living (IADLs) is an important focus for the promotion of independent living in old age. If strategies to enable older people to remain in their own homes are to be developed, advances must be made in understanding the demands associated with IADLs. This paper reports on a study of how activity demands – the body postures, actions and hand functions involved in cooking, housework, laundering and shopping – relate to the capabilities of a sample of older people in Great Britain. Task data were analysed for 4,886 community-dwelling 55–93-year-olds who were enrolled in a follow-up survey to the 1996/97 Family Resources Survey. Logistic regression models were used to calculate adjusted odds ratios for associations between functional limitations and IADL difficulty. Attributable fraction estimates were also used to assess the population impact of the functional limitations. Comparable effect sizes were observed across activities for limitations in body postures (standing, reaching and bending/stooping), actions (lifting/lowering and holding/carrying) and hand functions. Most of the difficulties were attributable to limitations in body postures, primarily bending/stooping, whereas actions and hand functions accounted for much less difficulty. We present a matrix of the potential impact that design changes to alleviate each limitation would have on the ability to perform the activities studied. This can help to prioritise interventions aimed at supporting continued independent living.
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Saari, Toni, Ilona Hallikainen, Taina Hintsa, and Anne M. Koivisto. "Neuropsychiatric symptoms and activities of daily living in Alzheimer’s disease: ALSOVA 5-year follow-up study." International Psychogeriatrics 32, no. 6 (2019): 741–51. http://dx.doi.org/10.1017/s1041610219001571.
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ABSTRACTBackground:Neuropsychiatric symptoms (NPSs) in Alzheimer’s disease (AD) are related to activities of daily living (ADLs), but longitudinal studies are sparse.Objectives:We investigated which NPSs were related to decline in instrumental ADLs (IADLs) and basic ADLs (BADLs) in a 5-year follow-up of individuals with AD.Methods:ALSOVA 5-year follow-up study data of 236 individuals with very mild or mild AD at baseline and their caregiver were analyzed. IADLs and BADLs were assessed with Alzheimer’s Disease Cooperative Study ADL inventory, and NPSs with Neuropsychiatric Inventory at annual follow-up visits. Generalized estimating equations (GEEs) were used for longitudinal data analysis, and NPS–ADL networks were estimated to demonstrate symptom interactions.Results:Apathy [rate ratio (RR) 1.23, 95% CI 1.06–1.44, p = 0.007], aberrant motor behavior (RR 1.24, 95% CI 1.07–1.44, p = 0.005), and appetite disturbances (RR 1.22, 95% CI 1.06–1.41, p = 0.005) were related to impairment in BADLs, and the same symptoms (RR 1.13, 95% CI 1.07–1.21, p < 0.001; RR 1.13, 95% CI 1.07–1.20, p < 0.001; RR 1.14; 95% CI 1.08–1.21, p < 0.001, for apathy, aberrant motor behavior, and appetite disturbances, respectively), in addition to delusions (RR 1.09, 95% CI 1.03–1.15, p = 0.004), were related to IADL impairment. Symptom networks varied at different time points.Conclusion:As AD progresses, common (apathy) and uncommon NPSs (aberrant motor behavior, appetite disturbances, delusions) seem to be related to ADLs through various symptom interactions. Previous literature suggests that frontal pathology could underlie these relationships.
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Parker, Daniel C., Virginia B. Kraus, and Daniel Belsky. "QUANTIFICATIONS OF BIOLOGICAL AGING PREDICT DISABILITY AND MORTALITY IN OLDER ADULTS IN THE DUKE EPESE." Innovation in Aging 3, Supplement_1 (2019): S90. http://dx.doi.org/10.1093/geroni/igz038.343.
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Abstract Methods to quantify biological aging have been proposed to measure age-related decline in system integrity for population surveillance and evaluation of geroprotective therapies. However, quantifications of biological aging have been little-studied in geriatric populations. We conducted analysis of three clinical-biomarker-algorithm methods to quantify biological aging, the Klemera-Doubal Method (KDM) Biological Age, homeostatic dysregulation (HD), and Levine Method (LM) Biological Age in a cohort of N=1,374 older adults aged 71-102 years (35% male, 52% African American), the Duke-EPESE. We parameterized algorithms from analysis of US NHANES data (N=36,207). We conducted criterion validity analyses using measures of disability and mortality as end-points. We analyzed counts of ADLs and iADLs using negative binomial regression. We analyzed time-to-death using Cox regression. Models were adjusted for age, sex, and race/ethnicity. We evaluated algorithms derived from analysis of different biomarker groupings. We also compared algorithms derived from analysis of mixed age and race/ethnicity samples to algorithms derived from older-age (65+) and individual race/ethnicity samples. Duke-EPESE participants with older KDM Biological Age reported dependence in more ADLs and iADLs, and were at increased risk of death (ADL IRR=1.19 [1.12, 1.27]; IADL IRR=1.18 [1.10, 1.26]; mortality HR=1.09 [1.06, 1.13]). Quantifications of biological aging derived from analysis of a mixed-age and race/ethnicity sample predicted disability and mortality in African-American and white older adults.
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An, Ruopeng, Sharon M. Nickols-Richardson, Reginald J. Alston, Sa Shen, and Caitlin Clarke. "Fresh- and lean-pork intake in relation to functional limitations among US older adults, 2005–2016." Nutrition and Health 26, no. 4 (2020): 295–301. http://dx.doi.org/10.1177/0260106020940121.
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Background: Pork consumption, in particular fresh/lean-pork consumption, provides protein and other essential micronutrients that older adults need daily and may hold the potential to prevent functional limitations resulting from sub-optimal nutrition. Aim: Assess fresh/lean-pork intake in relation to functional limitations among older adults in the USA. Methods: Individual-level data came from the National Health and Nutrition Examination Survey (NHANES) 2005–2016 waves. Nineteen validated questions assessed five functional limitation domains: activities of daily living (ADLs); instrumental activities of daily living (IADLs); leisure and social activities (LSAs); lower extremity mobility (LEM); and general physical activities (GPAs). Logistic regressions were performed to examine pork, fresh-pork and fresh lean-pork intake in relation to functional limitations among NHANES older adults ( n = 6135). Results: Approximately 21, 18 and 16% of older adults consumed pork, fresh pork and fresh lean pork, respectively. An increase in pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 12%, IADLs by 10% and any functional limitation by 7%. An increase in fresh-pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 13%, IADLs by 10%, GPAs by 8%, and any functional limitation by 8%. Similar effects were found for fresh lean-pork consumption on ADLs, IADLs, GPAs and any functional limitation. Conclusion: This study found some preliminary evidence linking fresh/lean-pork consumption to a reduced risk of functional limitations. Future studies with longitudinal/experimental designs are warranted to examine the influence of fresh/lean-pork consumption on functional limitations.
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Kalligerou, F., R. Fieo, G. P. Paraskevas, et al. "Assessing functional status using the IADL-extended scale: results from the HELIAD study." International Psychogeriatrics 32, no. 9 (2019): 1045–53. http://dx.doi.org/10.1017/s1041610219001091.
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ABSTRACTObjectives:Instrumental activities of daily living (IADL) have been operationalized as exhibiting a greater level of complexity than basic ADL. In the same way, incorporating more advanced ADLs may increase the sensitivity of functional measures to identify cognitive changes that may precede IADL impairment. Towards this direction, the IADL-extended scale (IADL-x) consists of four IADL tasks and five advanced ADLs (leisure time activities).Design:Retrospective, cross-sectional study.Setting:Athens and Larissa, Greece.Participants:1,864 community-dwelling men and women aged over 64.Measurements:We employed both the IADL-x and IADL scales to assess functional status among all the participants. Diagnoses were assigned dividing the population of our study into three groups: cognitively normal (CN), mild cognitive impairment (MCI) and dementia patients. Neuropsychological evaluation was stratified in five cognitive domains: memory, language, attention-speed, executive functioning and visuospatial perception. Z scores for each cognitive domain as well as a composite z score were constructed. Models were controlled for age, sex, education and depression.Results:In both IADL-x and IADL scales dementia patients reported the most functional difficulties and CN participants the fewest, with MCI placed in between. When we restricted the analyses to the CN population, lower IADL-x score was associated with worse cognitive performance. This association was not observed when using the original IADL scale.Conclusion:There is strong evidence that the endorsement of more advanced IADLs in functional scales may be useful in detecting cognitive differences within the normal spectrum.
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Salter, Amber, Robert J. Fox, Tuula Tyry, Gary Cutter, and Ruth Ann Marrie. "New applications for independent activities of daily living in measuring disability in multiple sclerosis." Multiple Sclerosis Journal 27, no. 1 (2020): 97–106. http://dx.doi.org/10.1177/1352458519898591.
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Background: Disability outcome measures in multiple sclerosis (MS) focus heavily on ambulation; however, limitations in performing everyday activities encompass another type of disability. Objectives: The aim of this study was to examine the ability of instrumental activities of daily living (IADL) scale to discriminate between different levels of disability and to predict disability progression. Methods: The North American Research Committee on Multiple Sclerosis (NARCOMS) registry fall 2006 semi-annual survey asked participants to complete the RAND-12, Performance Scales, Patient Determined Disease Steps (PDDS), and IADL questionnaires. We modeled the trajectory of disability change, using the PDDS, over 12 years. Analyses used linear and repeated measures regression methods. Results: Of respondents ( n = 9931), 9559 (96%) completed the PDDS and IADL scale. Respondents were mostly female (76%), Caucasian (92%), and 52.3 (10.5) years old with moderate disability (median PDDS 4 (early cane)). Mean (SD) IADL total score was 20.5 (3.7). Discriminant ability of the IADL scale was higher than other measures considered at higher levels of disability. Adjusted longitudinal models showed that needing greater assistance on IADLs was independently predictive of trajectories of greater disability change. Conclusion: IADL scale had a greater ability to discriminate between higher disability levels than RAND-12 domains. The IADL scale may provide a useful and clinically relevant tool to measure disability in progressive MS populations.
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Ketterl, Tyler Garrett, Mary S. McCabe, Donald L. Rosenstein, et al. "Impact of cancer on physical and mental activities of daily living in young adult (YA) survivors." Journal of Clinical Oncology 37, no. 15_suppl (2019): 11517. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11517.
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11517 Background: Young Adult (YA) survivors face challenges unique from those survivors of childhood cancer or of middle and older age adults. The potential impact of cancer, its treatment or the lasting effects on daily mental and physical tasks are not fully understood. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and ≥1 year from therapy completion. Participants were randomly selected from tumor registries of 7 academic institutions. Enrolled participants were asked to complete an online patient reported outcomes (PRO) survey related to the effects of cancer and its treatment on daily functionality, finances, and cancer-related distress. All enrolled subjects had diagnostic and treatment information abstracted by a standardized protocol and entered into a database. Results: Enrollment and the online PRO survey was completed by 872 survivors (43.5% of eligible survivors). Survivors were 72.3% female, 90% non-Hispanic or Latino and the most common cancer for males and females were testicular and breast cancer respectively. Cancer, its treatment or the lasting effects limited the kind or amount of instrumental activities of daily living (IADLs) in 649 (76.3%) of survivors. Exposure to chemotherapy was associated with a 3.2-fold increased odds of interference with IADLs (CI 2.08-4.83, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. This impairment lasted longer than 1 year in 268 (41.3%) of survivors. Cancer, its treatment or the lasting effects interfered with their ability to perform any mental tasks as part of their IADLs in 454 (53.3%) of survivors. Exposure to chemotherapy was associated with a 2.8-fold increased odds of interference with mental impairment of IADLs (CI 1.94-3.96, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. Exposure to radiation was also associated with an increased odds of interference with mental impairment of daily activities (CI 1.05-1.91, p < 0.01) after controlling for diagnosis, age, gender, chemotherapy and surgery exposure. Conclusions: In YA cancer survivors, cancer, its treatment or the lasting effects of treatment commonly impact the daily physical and mental IADLs and many survivors report ongoing limitations > 1 year from therapy completion.
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Fujiwara, Yoshinori, Kumiko Nonaka, Masataka Kuraoka, et al. "The Impact of Taking Care of Grandchildren on Health Outcomes in Japanese Community-Dwelling Elderly." Innovation in Aging 4, Supplement_1 (2020): 349. http://dx.doi.org/10.1093/geroni/igaa057.1123.
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Abstract Taking care of grandchildren may provide health benefits to older adults due to keeping their social roles and feeling more generative; however, we have scarce knowledge of the relationships in Asian countries. This study addressed this question in older Japanese. The data was obtained from a two-year follow-up mail survey conducted in 2016 on 3,116 randomly selected older Japanese, aged 65-84 years, living in a metropolitan area. The main outcome was deterioration of health assessed by the Self-Rated Health (SRH), WHO-5, and Instrumental Activities of Daily Living (IADLs), defined as decline in 1 or more points obtained after 2 years of follow-up. The frequency of taking care of grandchildren was assessed as every day, 4-6 days per week, 1-3 days per week, 1-3 days per month, several days per year, and none. A multiple linear regression examined the impact of taking care of grandchildren as a predictor of protection of decline in SRH, WHO-5 and IADLs. The models were adjusted for confounding factors. Of 1,561 who responded to the follow-up survey, 959 people had grandchildren at baseline. The subjects had a mean age of 73.2±5.3 years, and mean scores of SRH:2.1±0.6; WHO-5;16.1±5.3, IADLs; 4.9±0.6 (higher scores represent higher evaluation). The higher frequency of taking care of grandchildren were longitudinally associated with less decline in SRH, WHO-5, and IADLs (standardized partial regression coefficient, β=-0.090, p=0.013; β =-0.023, p=0.547; β =-0.107, p=0.008, respectively). In conclusion, taking care of grandchildren might be a protective factor of comprehensive and functional health deterioration.
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Yang, Rumei, Dongjuan Xu, Haocen Wang, and Jiayun Xu. "Longitudinal trajectories of physical functioning among Chinese older adults: the role of depressive symptoms, cognitive functioning and subjective memory." Age and Ageing 50, no. 5 (2021): 1682–91. http://dx.doi.org/10.1093/ageing/afab135.
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Abstract Background and Objective Maintaining physical functioning (i.e. mobility, activities of daily living [ADLs], instrumental activities of daily living [IADLs]) in older adults is essential for independent living. However, little is known about how longitudinal trajectories of physical functioning differ by varying levels of depressive symptoms, subjective memory impairment and cognitive functioning. We aimed to examine whether, and to what degree, the rate of change in physical functioning over time was associated with depressive symptoms, subjective memory and cognitive functioning. Design A correlational longitudinal design. Methods The sample included 5,519 older adults (mean age = 68.13 years) from the China Health and Retirement Longitudinal Study (three waves: 2011–15) who self-reported their depressive symptoms, subjective memory impairment and physical functioning. Cognitive functioning was assessed through interview-based tests. Results There were significant increases in mobility impairment (β = 0.27, P &lt; 0.001), ADLs impairment (β = 0.05, P &lt; 0.001) and IADLs impairment (β = 0.03, P = 0.006) over time. Compared with the mean score at baseline in 2011, the mobility, ADLs and IADLs impairment increased by 13.32, 10.57 and 4.34% for every 2 years, respectively. Those with high depressive symptoms had accelerated rates of mobility (β = 0.212, P &lt; 0.001), ADLs (β = 0.104, P &lt; 0.001) and IADLs impairment (β = 0.076, P = 0.002). Those with poorer cognitive functioning had more rapid rates of mobility impairment. In contrast, those with differing levels of subjective memory impairment did not experience different physical functioning trajectories. Conclusions High depressive symptoms and poor cognitive functioning may be precursors to rapid declines in physical functioning. Proactive screening for these precursors may attenuate physical decline among Chinese older adults.
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Puente, Antonio Nicolas, Cutter A. Lindbergh, and L. Stephen Miller. "Personality's association with IADLs in community dwelling older adults." International Journal of Geriatric Psychiatry 30, no. 9 (2015): 950–56. http://dx.doi.org/10.1002/gps.4243.
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Wildes, Tanya M., Sascha Tuchman, Kathryn M. Trinkaus, and Graham Colditz. "Geriatric Assessment in Older Adults with Multiple Myeloma." Blood 128, no. 22 (2016): 3601. http://dx.doi.org/10.1182/blood.v128.22.3601.3601.
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Abstract Introduction: Multiple myeloma (MM) is a disease of older adults, yet standard baseline assessments do not include assessment of physiologic age or frailty. In older adults with cancer, geriatric assessment (GA) predicts treatment toxicity and survival. In MM, frailty is associated with treatment discontinuation, toxicity and survival (Palumbo Blood 2015). Studies of patient preferences have shown that maintenance of independence in daily activities is a high priority in older adults with serious medical conditions (Fried NEJM2002) We sought to examine GA factors associated with 1) autologous stem cell transplant (ASCT) eligibility and 2) increased functional dependence over follow-up. Methods: Patients (pts) with newly diagnosed MM aged 65 and older were enrolled in a prospective cohort study at 2 institutions. Pts underwent a brief, primarily self-administered geriatric assessment (GA) at baseline, 3- and 6-months of follow-up. GA included functional status (instrumental activities of daily living/IADLs), medications, cognition (Short Blessed Test), psychological state (Mental Health Inventory), the Timed Up and Go physical performance test (TUG) and the Charlson comorbidity index (CCI). Analyses were performed using SAS v9.4/Stata 14.1. Descriptive and inferential statistics were used to summarize and compare groups, as appropriate. Results: 40 pts enrolled, with a median age of 69.5 (range 65-84). 77.5% were white, 12.5% black and 10% other/unknown. 62.5% were male. Median MD-rated Karnofsky performance status (KPS) was 80 (range 50-100). Geriatric syndromes were common, with 62.5% of patients reporting dependence in one or more IADLs, 47.5% with one or more comorbidities, 28.5% reported one or more falls in the prior 6 months and 10% screened positive for cognitive impairment. Median number of medications was 9 (range 1-23). 26 pts (65%) were felt to be ASCT candidates by the treating physician, who was blinded to the GA. Factors associated with MD-determined ASCT candidacy were: fewer comorbidities (mean CCI 0.6 vs. 1.9. p=0.0065), higher MD-rated KPS (71% MDKPS ≥80 vs 47%, p=0.021 ) and faster TUG (mean 11.9 seconds vs 15.8, p=0.013). While 26 were considered eligible, only 21 pts (52.5%) ultimately underwent ASCT [attrition due to pt preference (2), progression (1), failed mobilization (1) and unknown (1)]. Increasing age (OR 0.77/year, 95%CI 0.601-0.988) and IADL dependence (OR 0.043, 95% CI 0.004-0.464), but not KPS or comorbidities, were independently associated with decreased odds of actually undergoing ASCT. We also examined factors associated with changes in functional status in the 36 patients who completed 6-month follow-up. 6 pts (16.7%) had a 2 point increase in dependence in IADLs. In a generalized linear model, undergoing ASCT and baseline comorbidities were independently associated with higher IADL scores at 6-months (p=0.036, p=0.033 respectively). All patients with an increase in IADL scores (increased functional dependence) had a change in treatment regimen due to toxicity. Age, International Staging System Stage, gender, deletion 17p and disease progression were not associated with increased functional dependence. Development of peripheral neuropathy was not associated with IADL dependence or falls. Conclusions: GA reveals that geriatric syndromes are common in older adults with multiple myeloma. GA may provide a framework to objectively define transplant eligibility. Increased functional dependence is associated with baseline comorbidities and undergoing ASCT. Further study is needed to examine the utility of GA in predicting treatment toxicity and survival. Disclosures Wildes: Carevive Systems: Consultancy.
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Morales, Meghan Jenkins, and Stephanie Robert. "Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum." Innovation in Aging 4, Supplement_1 (2020): 90. http://dx.doi.org/10.1093/geroni/igaa057.296.
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Abstract At some point in our lives, approximately 70% of us will need support to help with daily care. Without adequate assistance we may experience unmet care need consequences (UCNC) – such as skipping meals, going without clean clothes, or taking the wrong medication. This study examines the likelihood of experiencing UCNC related to gaps in assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) across long-term care arrangements: informal community care, paid community care, residential care, and nursing homes. We examine a sample of older adults receiving assistance in a care arrangement (N=2,499) from the nationally representative 2015 National Health and Aging Trends Study. Cross-sectional and longitudinal regression models, adjusting for differences in demographic and health/functioning characteristics, examine if type of care arrangement in 2015 is associated with UCNC in 2015 and change in UCNC by 2017. Holding all else constant, there were no significant differences in UCNC related to ADLs in 2015 across care arrangements. However, those receiving paid community care were more likely to experience UCNC related to IADLs (going without clean clothes, groceries, or a hot meal and making medication errors) compared to those receiving only informal care (OR=1.64, p&lt;.05) or residential care (OR=2.19, p&lt;.01). By 2017, paid care was also significantly associated with continued UCNC, but older adults in informal care arrangements were most likely to experience a new UCNC. Results suggest improving/expanding assistance with IADLs among community-dwelling older adults, and promoting equitable access to residential care, to reduce UCNC.
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Davis, Gershwin, Nelleen Baboolal, Vrijesh Tripathi, and Robert Stewart. "Health status risk factors and quality of life in 75–84-year-old individuals assessed for dementia using the short 10/66 dementia diagnostic schedule." PeerJ 9 (August 19, 2021): e12040. http://dx.doi.org/10.7717/peerj.12040.
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Background Trinidad is an island that not only has a population at high vascular risk but also one that is in epidemiological transition with high dementia prevalence. The aim of the study was to investigate modifiable risk factors associated with dementia in middle-old (75–84 years) individuals. Methods As part of a large national community survey of dementia prevalence in Trinidad, 811 people aged 75–84 years were evaluated for dementia using the 10/66 short algorithm. Demographic data collected included information on age, gender, ethnicity, religion, education, occupation, living accommodation, smoking, alcohol consumption, self-reported medical conditions, impairments and ability to do instrumental activities of daily living (IADL). Data were analysed using multivariable logistic regression models. Results Of the 811 participants, nearly 55% were female. The mean age was 78.8 (SD = 2.8) years and dementia was present in 198 (24.4%). Having less than ten years of education, being an agricultural worker, skilled labourer or housewife and having more than four co-morbidities were significantly associated with dementia. The odds ratio for dementia for those having self-reported stroke was 4.93 (95% CI [2.64–9.23]) and for diabetes was 1.76 (95% CI [1.17–2.65]) adjusting for age, age2, gender, ethnicity, religion, education and occupation. Impairment in eyesight, hearing, climbing stairs, and walking were also more common in the group with dementia. Ability to perform IADLs was linked with dementia. Individuals with dementia were more likely to be unable to perform any of the eight IADLs. Those who did not exercise at all (OR 6.95, 95% CI [2.02–23.90]) and those who did low exercise (OR 1.83, 95% CI [1.07–3.13]) compared to those who did moderate to high exercise were also more likely to have dementia. Conclusion In the middle-old population in Trinidad having diabetes and stroke, low IADL score, and no exercise were more common in people with dementia.