Home and Clinical Assessments of Instrumental Activities of Daily Living: What Could Explain the Difference between Settings in Frail Older Adults, If Any? (original) (raw)
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Age and Ageing, 1997
Objectives: to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support. Design: a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65-84 (City and Hackney and Braintree). The follow-up interviews took place 2.5-3 years after the baseline interviews. Setting: City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers. Subjects: 630 people aged 85+ at baseline (70% response rate), and 78% of survivors re-interviewed at follow-up; 464 people aged 65-84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65-84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed. Main outcome measures: scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used. Conclusions: decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services.
International Journal of Environmental Research and Public Health
Assessing motor competence is essential for evaluating the effectiveness of physical activity interventions that aim to maintain or improve older adults’ function. However, assessing motor competence in older adults who have difficulties walking or standing is challenging, because few instruments or guidelines are appropriate for these frail older adults. This article aims to describe challenges in evaluating motor function among frail older adults, discuss strategies for adapting motor function assessments to their home settings, and provide recommendations for future clinical trials so that older adults with ambulatory difficulties can benefit from motor function assessment and physical activity programs. Data came from the baseline assessment of 116 participants of an ongoing clinical trial, “Promoting Seniors’ Health with Home Care Aides (Pro-Home)”. Our results demonstrated that the Pro-Home study involved participants who would be typically excluded from clinical trials and th...
Archives of Physical Medicine and Rehabilitation, 1999
Objective: To test the Frail Elderly Functional Assessment (FEFA) questionnaire for responsiveness (sensitivity to change) to low-level functional tasks in a frail elderly cohort and to evaluate its validity over the telephone or when administered to a caregiver proxy. Subjects: Fifty-eight elderly patients from three urban inpatient rehabilitation settings and an outpatient geriatrics center. Methods: A prospective, clinical, comparative trial. The FEFA questionnaire was administered serially. For validity, subjects were observed performing the tasks on the questionnaire within 24 hours of each interview. For responsiveness, repeat measures were performed within a 1-to 2-week period. Validity and sensitivity to change (responsiveness) of the questionnaire were determined by correlating patient responses to direct observations by rehabilitation staff. Responsiveness was also determined based on the Guyatt technique that divides clinically significant change by the normal variance, ~/(2× [mean squared error])!/2, as well as by measures of effect size, standardized response means, and relative efficiency tests for responsiveness. To evaluate FEFA validity in alternative settings, kappa statistic and regression analyses were used based on the previously validated interviewer-administered format. Results: Responsiveness was excellent with effect size (.35), standardized response means (.48), and relative efficiency (2.67) tests as well as Guyatt (1.26). There was 83% agreement when compared with FEFA task performance. Regression between change in FEFA score versus performance testing was significant (r 2 = .33;p = .01). ANOVA was significant at ap = .03 for FEFA scores at first measure in rehabilitation compared to second. Correlation for caregiver proxy administration was .92 (p-.0001) and for telephone administration was .99 (p < .0001). Conclusions: The FEFA questionnaire, previously demonstrated to be reliable and valid, is sensitive to functional change
Functional Differences Found in the Elderly Living in the Community
Sustainability
Introduction: Successful aging lies in cognitive and functional maintenance, and in the optimal performance of daily tasks that keep the elderly free of disability and dependence. However, there is little evidence for functional differences for gender and age, and how cognitive and physical demands in past working lives can affect them, to design more personalized occupational therapy interventions to prevent functional and cognitive impairment. Method: This observational descriptive study evaluated 367 older adults living in a community with subjective memory complaints and scored between 24 and 35 with the Spanish version of the “Mini-Mental State Examination (MEC-35)”. Basic activities of daily living (BADL) were studied with the Barthel Index, while instrumental ADL (IADL) were examined with the Lawton–Brody scale. Functional differences for gender, age, and physico-mental occupation were examined. Results: The significant differences found for gender indicated that men did bett...
Journal of Clinical Epidemiology, 1999
The objective of this study was to determine the validity of French and English versions of the Older American Resources and Services (OARS) activities of daily living (ADL) questionnaire using a premorbid reference period among older emergency department (ED) patients. A sample of 404 ED patients aged 65 and over participating in a study of functional decline was invited to participate in a clinical assessment shortly after their ED visit. The OARS ADL questionnaire was administered either to the patient or a proxy informant at the ED visit. The clinical assessment was conducted by a nurse, blind to the OARS score, using the Functional Autonomy Measurement System (SMAF). Disability scores for the OARS and SMAF were computed, based on the patient's premorbid status. Assessments were conducted in 213 patients (52.7%). The OARS summary scores, a total and an ordinal score, were highly correlated with the SMAF total disability score (Spearman's r of 0.80 and 0.79, respectively). Similar correlations were found for French and English versions. The OARS ADL questionnaire with a premorbid reference period appears to be valid when administered in the ED, both in French and English.
Prevalence of Functional Impairment among Frail Elderly
The Egyptian Journal of Hospital Medicine, 2014
Background Frailty is a state of vulnerability describes a syndrome characterized by progressive multi system decline, loss of physiologic reserve, and increase vulnerability to disease and death. Frailty has emerged as a condition associated with an increased risk of functional decline among the elderly population, which may be differentiated from aging, disability, and comorbidity. Objectives: The aim of this study is to assess the prevalence of functional impairment and cognitive functions among frail elderly. Methods:We examined104 frail elderly. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. physical function was assessed using Activities of daily living (ADL) and Instrumental activities of daily living (IADL). The cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results:The mean age of the studied population was 69 years, 53.85% were males, 46.15% were females, the majority of our participants were illiterates (89.4%), and were living with family (84.62%), only 6.73% were smokers. 36.5% of frail participants were assisted in activity of daily living (ADL) and 7.7% were dependents, while 63.5% were assisted in instrumental activity of daily living (IADL) and 8.7% were dependents; the sample participants in general had borderline scores for MMSE, indicating a cognitive performance in the lower normal range. Conclusions Frail elderly had low normal score on MMSE, and high prevalence of functional impairment.
Geriatrics & gerontology international, 2015
To present practical predictors for the difficulty of carrying out basic activities of daily living (ADL) among the old-old during a 2-year period. Assessment was carried out using data obtained from the Tosa Longitudinal Aging Study, a community-based cohort survey on geriatric functions in the elderly. Predictor variables measured at baseline included age; sex; height; weight; blood pressure; oxygen saturation; neurobehavioral functions, such as Mini-Mental State Examination, Kohs Block Design test, Timed Up and Go test, button score, functional reach test, geriatric depression scale, cardio-ankle vascular index, ankle brachial pressure index; and blood chemical results, such as hemoglobin, fasting blood sugar, hemoglobin A1c, serum lipids, serum albumin and serum creatinine. The outcome variable was the presence of difficulties while carrying out basic ADL after 2 years. Age of ≥85 years, Timed Up and Go test of ≥15 s, button score of >17 s and presence of knee pain were indep...
BMC Geriatrics, 2013
Background: The intervention; "Continuum of Care for Frail Older People", was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person's own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL). Methods: The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six-and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR). Results: A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three-and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20-4.68) and (2.04, 95% CI; 1.03-4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27-0.98) compared to the control group. Conclusions: The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society. Trial registration: ClinicalTrials.gov: NCT01260493
Health Problems of Civilization, 2021
Authors' contribution Wkład autorów: A. Study design/planning zaplanowanie badań B. Data collection/entry zebranie danych C. Data analysis/statistics dane-analiza i statystyki D. Data interpretation interpretacja danych E. Preparation of manuscript przygotowanie artykułu F. Literature analysis/search wyszukiwanie i analiza literatury G. Funds collection zebranie funduszy Summary Background. This study aimed to assess the prevalence of functional impairments in people over 65 years of age. Material and methods. The study included 504 people (329 women, 175 men) aged over 65 years living in the Subcarpathian region of Poland. The data was obtained through the use of a diagnostic survey using the direct questionnaire technique. The survey included the following research tools: the Barthel scale, the Lawton scale, the Geriatric Depression Scale, the Abbreviated Mental Test Score, and an interview questionnaire of the authors' own construction. Results. Respondents capable of performing basic everyday activities comprised more than half of the studied population (58.53%; n=295), those partially impaired constituted 35.32% (n=178), and 6.15% (n=31) were fully impaired. The vast majority of participants (n=458; 90.87%) needed help in performing complex activities. Higher Barthel scale scores indicating better performance in basic everyday activities was obtained by seniors with normal vision and hearing, fewer diseases, and higher education. Conclusions. The most frequent deficits in performing basic life activities were controlling urine, moving on flat surfaces, and climbing and descending stairs. Determinants of functional disability among the study subjects were advancing age, female gender, low education level, widowhood, more illnesses, and cognitive and emotional decline.