Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country

OBJECTIVE

To investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.

METHODS

Dementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben's advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.

RESULTS

PwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.

CONCLUSION

Results reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Effect of food insecurity on the cognitive problems among elderly in India

BACKGROUND

Food Insecurity (FI) is a crucial social determinant of health, independent of other socioeconomic factors, as inadequate food resources create a threat to physical and mental health especially among older person. The present study explores the associations between FI and cognitive ability among the aged population in India.

METHODS

To measure the cognitive functioning we have used two proxies, word recall and computational problem. Descriptive analysis and multivariable logistic regression was used to understand the prevalence of word recall and computational problem by food security and some selected sociodemographic parameters. All the results were reported at 95% confidence interval.

RESULTS

We have used the data from the first wave of longitudinal ageing study of India (LASI), with a sample of 31,464 older persons 60 years and above. The study identified that 17 and 5% of the older population in India experiencing computational and word recall problem, respectively. It was found that respondents from food secure households were 14% less likely to have word recall problems [AOR:0.86, 95% CI:0.31-0.98], and 55% likely to have computational problems [AOR:0.45, 95% CI:0.29-0.70]. We also found poor cognitive functioning among those experiencing disability, severe ADL, and IADL. Further, factors such as age, education, marital status, working status, health related factors were the major contributors to the cognitive functioning in older adults.

CONCLUSION

This study suggest that food insecurity is associated with a lower level of cognition among the elderly in India, which highlight the need of food policy and interventional strategies to address food insecurity, especially among the individuals belonging to lower wealth quintiles. Furthermore, increasing the coverage of food distribution may also help to decrease the burden of disease for the at most risk population. Also, there is a need for specific programs and policies that improve the availability of nutritious food among elderly.

How Does Diabetes Accelerate Normal Aging? An Examination of ADL, IADL, and Mobility Disability in Middle-aged and Older Adults With and Without Diabetes

OBJECTIVES

To build an age norm to quantify and compare the different progression rates of disability in people with and without diabetes.

METHODS

Data were extracted from 5,131 adults aged 50 and older from the Taiwan Longitudinal Study in Aging (TLSA) conducted in 1996. Using multilevel mixed models, the disabilities were measured in 1999, 2003, and 2007.

RESULTS

Diabetes accelerated the occurrence and progression of disabilities during aging. Participants with diabetes developed to mobility, IADL, and ADL at the age of 55, near the age of 60, and near the age of 70, respectively. Diabetes accelerated the onset of disabilities of mobility by 3 years, IADL by 7 years, and ADL by 11 years. In the fully adjusted model, diabetes remains a robust predictor for levels of disability (Mobilityβ_DM = 1.668, p < 0.001, IADLβ_DM = 1.031, p < 0.001) (IADβ_DM = 0.690, p < 0.001), and rate of change for developing mobility disability (Mobilityβ_DM*age = 0.088, p < 0.001).

CONCLUSIONS

This study showed that diabetes accelerated the occurrence and progression of disabilities starting in middle age. A three to eleven years of acceleration on disability development on mobility, IADL, and ADL was observed.

Trends in the Social Class Inequalities in Disability and Self-Rated Health: Repeated Cross-Sectional Surveys from Finland and Sweden 2001-2018

Objectives: To assess time trends in the social class inequalities and in total inequality in disability and self-rated health (SRH) in two oldest old populations.

Methods: The data came from the Finnish Vitality 90+ Study (2001, 2003, 2007, 2010, 2014 and 2018; n = 5,440) and from the Swedish Panel Study of Living Conditions of the Oldest Old (2002, 2004, 2011 and 2014; n = 1,645). Inequalities in mobility and activities of daily living (ADL) disability and SRH were examined cross-sectionally and over time using relative and absolute measures.

Results: Lower social classes had greater mobility and ADL disability and worse SRH than higher social classes and the inequalities tended to increase over time. Findings were remarkably similar in both studies and with absolute and relative measures. Total inequality, referring to the variance in health outcome in the total population, remained stable or decreased.

Conclusion: The study suggests that the earlier findings of improved mobility and ADL are largely driven by the positive development in higher social classes while findings of decline in SRH are related to the worsening of SRH in lower social classes

Personality and functional impairment. Evidence from the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge.

METHODS

Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10-item Big Five Inventory (BFI-10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted.

RESULTS

Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index).

CONCLUSIONS

This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms.

Functional decline after surgery in older patients with head and neck cancer

INTRODUCTION

In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer.

METHODS

We present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively.

RESULTS

In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12).

CONCLUSION

Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.

A clinical score to predict mortality in patients after acute heart failure from Japanese registry

Aims

Clinical scores that consider physical and social factors to predict long‐term observations in patients after acute heart failure are limited. This study aimed to develop and validate a prediction model for patients with acute heart failure at the time of discharge.

Methods and results

This study was retrospective analysis of the Kitakawachi Clinical Background and Outcome of Heart Failure Registry database. The registry is a prospective, multicentre cohort of patients with acute heart failure between April 2015 and August 2017. The primary outcome to be predicted was the incidence of all‐cause mortality during the 3 years of follow‐up period. The development cohort derived from April 2015 to July 2016 was used to build the prediction model, and the test cohort from August 2016 to August 2017 was used to evaluate the prediction model. The following potential predictors were selected by the least absolute shrinkage and selection operator method: age, sex, body mass index, activities of daily living at discharge, social background, comorbidities, biomarkers, and echocardiographic findings; a risk scoring system was developed using a logistic model to predict the outcome using a simple integer based on each variable's β coefficient. Out of 1253 patients registered, 1117 were included in the analysis and divided into the development (n = 679) and test (n = 438) cohorts. The outcomes were 246 (36.2%) in the development cohort and 143 (32.6%) in the test cohort. Eleven variables including physical and social factors were set into the logistic regression model, and the risk scoring system was created. The patients were divided into three groups: low risk (score 0–5), moderate risk (score 6–11), and high risk (score ≥12). The observed and predicted mortality rates were described by the Kaplan–Meier curve divided by risk group and independently increased (P < 0.001). In the test cohort, the C statistic of the prediction model was 0.778 (95% confidence interval: 0.732–0.824), and the mean predicted probabilities in the groups were low, 6.9% (95% confidence interval: 3.8–10%); moderate, 30.1% (95% confidence interval: 25.4%–34.8%); and high, 79.2% (95% confidence interval: 72.6%–85.8%). The predicted probability was well calibrated to the observed outcomes in both cohorts.

Conclusions

The Kitakawachi Clinical Background and Outcome of Heart Failure score was helpful in predicting adverse events in patients with acute heart failure over a long‐term period. We should evaluate the physical and social functions of such patients before discharge to prevent adverse outcomes.

Psychological and behavioral responses during the COVID-19 pandemic among individuals with mobility and/or self-care disabilities

Background

The lockdowns during the COVID-19 pandemic created major obstacles for individuals with disabilities to obtain support in their daily living.

Objectives

This study was to examine the psychological and behavioral responses of US individuals with mobility and/or self-care disabilities during the pandemic.

Methods

From a nationally representative longitudinal survey (n = 6403) administered during the pandemic, individuals were classified at baseline as having no mobility/self-care disability (ADL = 0, n = 4975), mobility or self-care disability (ADL = 1, n = 1061), and both mobility and self-care disabilities (ADL = 2, n = 367). Weighted mean of baseline mental distress scores (PHQ4), psychological risk factors (loneliness, stress, perceived COVID risk), resilience, and coping were compared among these groups. Random effects models were employed to assess the effects of disability and disability-moderated effects of risk factors on mental distress.

Results

At baseline, mental distress increased with greater ADL disabilities (Mean[95%CI] = 1.88[1.77, 1.98], 2.54[2.29, 2.79], and 3.55[3.01, 4.08] for ADL = 0, 1, and 2, respectively, p < .0001). Loneliness, stress, and perceived risk increased with ADL disabilities, but resilience and social coping decreased with it (p's < 0.0001). In the random-effects models, greater ADL disabilities, higher psychological risks, and use of cannabis and other recreational drugs were associated with greater mental distress. Greater ADL disabilities augmented the detrimental effects of risk factors on mental health, but resilience protected mental health both independently and through a buffering effect on its risk factors across all groups.

Conclusion

Individuals with mobility and/or self-care disability tend to have poorer mental health and are differentially more affected by its risk factors. Mental health professionals should address these modifiable factors in interventions.

Motor performance after treatment of pilocytic astrocytoma in the posterior fossa in childhood

Background

Pilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long‐term outcome is sparse.

Aims

The aim was to investigate if patients treated for pilocytic astrocytoma in the posterior fossa had motor complications, including balance, motor and process skills.

Methods and Results

This descriptive single‐centre study includes eight children and 12 adults, treated for pilocytic astrocytoma as children. Motor performance was investigated with Bruininks–Oseretsky Test of Motor Proficiency, Second Edition, and dynamic balance with the mini‐balance evaluation systems test. Physiological cost index, six‐minute walk test, hand grip strength and assessment of motor and process skills were also evaluated. Ten patients reported motor difficulties, mainly from the upper limbs. The motor performance test showed results within normal limits except for manual dexterity, which was significantly below mean (p = .008). In the dynamic balance test patients had significantly lower results compared with controls (p = .036). Physiological cost index, six‐minute walk tests and hand grip strength showed results within normal limits. In the Assessment of Motor and Process Skills, patients over 16 years had significantly lower results compared with test norms for motor activities of daily living (ADL) and 30% of all patients scored below the cut‐off level for difficulties with motor skills.

Conclusions

Motor performance for patients treated for pilocytic astrocytoma in the posterior fossa in childhood is satisfactory but some patients display difficulties with balance, manual dexterity and ADL motor skills. Thus, it is important to identify those in need of motor follow‐up and training.

Development and validation of a prediction model of poor performance status and severe symptoms over time in cancer patients (PROVIEW+)

BACKGROUND

Predictive cancer tools focus on survival; none predict severe symptoms.

AIM

To develop and validate a model that predicts the risk for having low performance status and severe symptoms in cancer patients.

DESIGN

Retrospective, population-based, predictive study.

SETTING/PARTICIPANTS

We linked administrative data from cancer patients from 2008 to 2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of an outcome at 6 months following diagnosis and recalculated after each of four annual survivor marks. Model performance was assessed using discrimination and calibration plots. Outcomes included low performance status (i.e. 10-30 on Palliative Performance Scale), severe pain, dyspnea, well-being, and depression (i.e. 7-10 on Edmonton Symptom Assessment System).

RESULTS

We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%); and lung (13%)). At diagnosis, the predicted risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13%, and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms); the corresponding discrimination for each outcome model had high AUCs of 0.807, 0.713, 0.709, 0.790, and 0.723, respectively. Generally these covariates increased the outcome risk by >10% across all models: lung disease, dementia, diabetes; radiation treatment; hospital admission; pain; depression; transitional performance status; issues with appetite; or homecare.

CONCLUSIONS

The model accurately predicted changing cancer risk for low performance status and severe symptoms over time.

Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study

BACKGROUND

More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome.

OBJECTIVE

To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years.

METHODS

A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires.

RESULTS

Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions.

CONCLUSIONS

Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

Who lives in care homes in Greenland? A nationwide survey of demographics, functional level, medication use and comorbidities

BACKGROUND

Greenland is facing an ageing population, and little is known about the characteristics of the elderly population in Greenland. This study offers both a comparison and a description of the demographics, causes of admission, comorbidities and medication of the residents in care homes in the capital, major and minor towns in four of the five administrative regions of Greenland.

METHODS

The study was conducted from 2010 to 2016 as a descriptive questionnaire-based cross-sectional study. Data from eligible residents from eight care homes were collected from the regular care staff. Data were categorised into three groups based on town size for analysis.

RESULTS

244 (100 %) of eligible residents participated in the study. Nearly 100 % were of Greenlandic ethnicity based on parents' place of birth, and 62 % were women. The median age at admission/study was 69/71 years for men and 77/79 years for women (both p = 0.001). The median Body Mass Index was 25.6 kg/m2, more than half of the population were previous- or never-smokers and less than ten per cent consumed more than ten drinks of alcohol per week. The most common causes of admission were dementia (25.4 %), stroke (19.3 %) and social causes (11.1 %), while stroke (30.7 %), dementia (29.5 %) and musculoskeletal diseases (25.8 %) were the most common diagnoses at the time of the study. The Barthel Index was used to estimate the residents' level of independence, and residents in smaller towns were found to have a higher level of independence than residents in the capital. The median number of prescribed medications was five, and more residents in the capital were prescribed more than ten medications than elsewhere in Greenland.

CONCLUSIONS

This study is the first to describe care home residents in Greenland. We found a population younger than residents in comparable Danish care homes and that women were older than men at admission. In addition, care home residents in the capital had a lower level of independence and a higher number of prescribed medications, which could relate to differences in morbidity, access to health care services and differences in social circumstances influencing the threshold for care home admission.

Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam

Spinal cord injury (SCI) is defined as temporary or permanent changes in spinal cord function and reflex activity. The objective of this study is to evaluate health-related quality of life (HRQoL) and activities of daily living (ADL) among postoperative surgery patients with complete cervical SCI in Vietnam and to explore the factors associated with these indices. A cross-sectional study was conducted on 88 adults in Vietnam from June 2018 to June 2019. The EQ-5D-5L, ADL, and instrumental activities of daily living (IADL) were applied. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL, ADL, and IADL. Results: Participants who were in American Spinal Cord Injury Association (ASIA) scale group A (ASIA-A) had the lowest ADL, IADL index, and HRQOL score (p < 0.001). HRQoL and ADL were affected by health insurance coverage, occupation, type of fracture, and IADL. Meanwhile, IADL was significantly associated with living areas and ASIA. Low HRQoL among patients suffering from SCI was observed. Attention should be given to outcomes related to a disability during clinical treatment and should be treated effectively in the recovery.

Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer)

BACKGROUND

While radiation therapy (RT) improves function, and quality of life for patients with advanced cancers, patients frequently experience a period of acute toxicity during which functional abilities may decline. Little is understood about changes in functional outcomes after RT in older adults. This study aims to examine changes in daily function at 1 and 6 months following RT.

METHODS

We reviewed the charts of 117 patients who underwent palliative RT on a prospective registry. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scores ranging from 0 to 6 and 0-8, respectively, were collected at baseline, one-month, and six months post-RT. Patients were classified as low deficit for ADL/IADL if they had 0-1 deficits and high deficit if they had 2+ deficits.

RESULTS

One-hundred seventy RT courses were identified; 99 were evaluable at each time point. The median age was 67 years. At baseline, 29.5 and 29.9% of patients were classified as high-deficit for ADL and IADL functioning, respectively. At one-month, the majority of patients who were low-deficit at baseline remained so for both measures while approximately one quarter of high-deficit patients showed improvement. Most patients identified as low-deficit at one-month remained so at six-months, while no high-deficit patients improved from one- to six-months. Factors associated with high ADL and IADL deficits included: time (six months), increasing age, and Hispanic/other race. Compared to those with ECOG score of 3, patients with lower scores (0-2) had lower odds of high deficit.

CONCLUSION

ADL and IADL tools may be useful in describing changes in daily function after palliative RT and in identifying groups of patients who may benefit from additional supportive geriatric care interventions.

Predictors for functional decline after an injurious fall: a population-based cohort study

Background

The functional consequences of injurious falls are well known. However, studies of the factors that can modify trajectories of disability after an injury from a fall are scarce.

Aims

We aimed to investigate whether sociodemographic and health-related factors may impact this association.

Methods

The study population consisted of 1426 community-dwelling older adults (≥ 60 years) from the SNAC-K cohort study in Stockholm, Sweden. Functional status over 12 years of follow-up was assessed using the number of limitations in basic and instrumental activities of daily living. Sex, cohabitation status, physical activity, and self-rated health were assessed at baseline. Injurious falls were defined as falls requiring healthcare and were assessed over 3 years starting at baseline. Data were analyzed using linear-mixed effects models.

Results

The fastest increase in the number of disabilities was observed in those who had endured an injurious fall and were living alone (β coefficient = 0.408; p < 0.001), been physically inactive (β coefficient = 0.587; p < 0.001), and had poor self-rated health (β coefficient = 0.514; p < 0.001). The negative impact of these factors was more pronounced among fallers compared to non-fallers.

Discussion

Living alone, being physically inactive, and having poor self-rated health magnifies the negative effect of an injurious fall on functional status. Among individuals who endure an injurious fall, the heterogeneity in long-term functional status is substantial, depending on the individuals’ characteristics and behaviors.

Conclusions

These findings emphasize the need for a person-centered approach in care provision and can guide secondary prevention within health care.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01747-1) contains supplementary material, which is available to authorized users.

Patient Involvement During a Pathway of Home-Based Reablement for Older Persons: A Longitudinal Single-Case Study

Background

In recent years, home-based reablement has become an increasingly popular way to provide rehabilitation services. This health care service aims to enable older persons to live longer at home while reducing the need for institutionalization. To ensure the provision of high-quality services, there is a continual need for research on issues of user involvement and co-creation during the pathway of the reablement process.

Purpose

This study focused on user involvement and participation with health care professionals during the reablement process.

Methods

This was a longitudinal, instrumental single-case study, in which one 85-year-old female patient was followed over the pathway of a six-week reablement process. Data were collected at three stages, including the goal-mapping phase, evaluation phase, and three weeks after completing reablement.

Results

Our analyses revealed two themes for the goal-mapping phase (dialogue led by the care provider and main goal), three themes for the implementation phase (the home as the preferred setting, little influence on organizational factors, and participation, influence, and motivation), and three themes for the evaluation phase (patient understanding as a precondition, motivated by weak paternalism, and self-determination requires clear communication).

Conclusion

The patient becomes involved through a partly co-creation process. During this time, they are involved, motivated, and influenced over the pathway of reablement. Health care providers must avoid implementing too much control during the pathway of home-based reablement, as patients have contextual knowledge that care providers do not possess.

Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk - A randomized controlled trial

BACKGROUND

Older nursing home residents are often characterized by multimorbidity and dependency in activities of daily living. Most exercise studies in this setting aim at residents who are still able to walk despite the huge group of residents that is unable to walk. Thus, little is known about the effectiveness to improve cognitive and motor functions as well as well-being within this target group, e.g., by use of chair-based exercises. The aim of this study was to determine the effects of a 16-week multicomponent chair-based exercise intervention on motor functions, cognition and well-being for nursing home residents who are unable to walk.

METHODS

A two-arm single-blinded multicenter randomized controlled trial integrated N = 52 nursing home residents with a mean age of 81 ± 11 years (63% female), randomly assigned to a training (n = 26, 16 weeks; twice a week; 60 min) or a wait-list control group (n = 26). The intervention followed the F.I.T.T. principles (frequency, intensity, time and type) and was continuously adapted to residents' performance level. The outcomes motor function (hand grip strength, sitting balance, manual dexterity), cognitive performance (cognitive status, working memory) and psychosocial resources (physical and mental well-being (SF12), satisfaction with life (SWLS), depressive symptoms (CES-D)) were assessed at baseline (pre-test) and after 16-weeks (post-treatment). Statistics were performed using ANOVA for repeated measures.

RESULTS

The results of the ANOVA showed significant improvements of the intervention group for hand grip strength (Pre: M = 12.67, SD = 5.28; Post: M = 13.86, SD = 4.79; Group × Time: F(1, 17) = 10.816, p = .002, η_p² = 0.241), manual dexterity (Pre: M = 4.50, SD = 5.17; Post: M = 5.30, SD = 4.25; Group × Time: F(1, 7) = 9.193, p = .008, η_p² = 0.365), cognition (Pre: M = 10.31, SD = 6.87; Post: M = 11.06, SD = 7.50; Group × Time: F(1, 15) = 12.687, p = .001, η_p² = 0.284), and depression (Pre: M = 5.19, SD = 5.12; Post: M = 4.38, SD = 4.62; Group × Time: F(1, 14) = 5.135, p = .031, η_p² = 0.150) while the values of the control group decreased.

CONCLUSION

The multicomponent chair-based intervention over 16 weeks was able to improve motor functions and cognition in nursing home residents who are unable to walk. Other psychological factors remained stable within the intervention group, which can be interpreted as a good result for this target group. All of the investigated parameters showed a significant decrease in the control group. The intervention seemed to cause physiological adaptations even in very old age. Study results encourage to further differentiate the heterogeneous group of nursing home residents concerning mobility aspects and to include chair-based interventions as feasible program to prevent further decline of functional performance and maintain independence in activities of daily living for a better physical and mental well-being.

Effects of 1 Year of Lifestyle Intervention on Institutionalized Older Adults

The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years; SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services.

Risk factors of the poor long-term prognosis of osteoporotic vertebral fractures: A multicenter cohort study

INTRODUCTION

The presence of existing osteoporotic vertebral fracture (OVF) increases the mortality risk. However, the influence of the characteristics of OVF is unclear. This study aimed to investigate the influence of new OVF on patients' long-term prognosis using our past cohort study.

METHOD

This is an extension study of our cohort study carried out between 2005 and 2007. In the present extension study, of 420 patients, 197 whose contact information was available at the 6-month follow-up were included in the telephone survey in 2018. Five patients refused to participate in the survey, and 82 could not be contacted. Eventually, 110 patients were enrolled. Of the Demographic data, radiological findings, medical history, and clinical outcome were investigated at injury onset and at the 6-month follow-up. A proportional hazard model was used to investigate the risk factors for mortality.

RESULTS

Among 110 patients, 33 died. Male sex and low body mass index (BMI <18.5 kg/m²) were significant risk factors for mortality [hazard ratio (HR) = 6.40, 1.01-40.50; 5.24, 1.44-19.04, respectively]. The history of stroke and liver disease increased the risk of mortality (HR = 13.37, 1.93-92.7; 6.62, 1.15-38.14, respectively). As regards radiological findings, local kyphosis progression per 1° or ≥7° were significant risk factors of mortality (HR = 1.20, 1.06-1.36; 5.38, 1.81-16.03, respectively).

CONCLUSIONS

A telephone survey at 12 years after the occurrence of OVF analyzed risk factors for mortality and showed that a progression of local kyphosis in fractures between injury onset and 6 months after injury was a risk factor of poor prognosis.

Numerical activities of daily living: a short version

Specific impairments in numerical functions may cause severe problems in everyday life that cannot be inferred from the available scales evaluating instrumental activities of daily living. The Numerical Activities of Daily living (NADL) is a battery designed to assess the patient's performance in everyday activities involving numbers (Informal Test) and in more scholastic capacities (Formal Test). A downside of this battery is its duration (45 min). The aim of the present study is to build a shorter version of NADL to make it more suitable for clinical and research purposes. The shortening procedure involved only the Formal test, and followed two steps: (i) a correlation of subtests with the general scores, and (ii) an item-analysis within the subtests previously showing higher correlations. Correlations between NADL-Short and NADL original version, and the new cut-offs were calculated. Lastly, the relationship between NADL-Short and other brief cognitive screening tests used in the clinical practice was evaluated in neurological patients and healthy controls. The NADL-Short includes the original Informal Test and the shortened Formal Test. It is a quick and easy clinical tool (15 min) to assess numerical abilities applied to informal and formal situations. It correlates highly with the original battery (Kendall's tau greater than 0.6 across tasks) and the cut-offs correctly identify impaired performance (accuracy of 95% or above). Correlation analysis showed a low positive correlation between NADL-Short and other brief cognitive scales. These findings suggest that it is appropriate to use specific tools to make inferences about a person's numerical abilities.

The association between nutritional status and functional limitations among centenarians: a cross-sectional study

Background

Although there have been studies on the association between nutritional status and functional limitations, there were few studies on Asian centenarians in community. Therefore, this study aims to identify associations between nutritional status and functional limitations among centenarians in China.

Methods

This cross-sectional study was conducted with the data from the China Hainan Centenarian Cohort Study. These data ultimately included basic characteristics, hematologic indicators, and chronic disease status for 1,002 centenarians. The nutritional status was evaluated using the Mini Nutritional Assessment Short-Form scale. The functional limitations were assessed using the activities of daily living (ADL) scale, namely Barthel Index and Lawton Scale. The association between nutritional status and ADL was assessed using multivariate logistic regression models.

Results

In this study, the prevalence of malnutrition was 20.8 % among centenarians, basic ADL (BADL) limitation was 28.6 %, and instrumental ADL (IADL) limitation was 64.7 %. As the nutritional status deteriorated, the risk of ADL limitations increased in total population (BADL limitation: OR = 17.060, 95 % CI: 8.093-35.964; IADL limitation: OR = 11.221, 95 % CI: 5.853-21.511; p for trend < 0.001). Similar results were found in both men and women after stratifying sex but were more prominent in women.

Conclusions

Malnutrition is associated with functional limitations among centenarians in China and more pronounced among women.

Evaluating best evidence in occupational therapy for patients with hip replacement: guidelines

Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research and Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.

Validation of perceived physical fatigability using the simplified-Chinese version of the Pittsburgh Fatigability Scale

BACKGROUND

The Pittsburgh Fatigability Scale (PFS) was developed to capture fatigue and demand in a single tool, filling a gap that no validated questionnaire existed to measure perceived fatigability. Since fatigability is a more sensitive measure of a person's susceptibility to fatigue, we validated the simplified-Chinese version of the PFS among Chinese community-dwelling older adults.

METHODS

This cross-sectional study was conducted in an urban community in Beijing between November 2018 and July 2019. The PFS was translated into simplified-Chinese by the translation, retro-translation method. Internal consistency of the Physical subscale of the PFS was evaluated by Cronbach's alpha. Convergent validity and discriminant validity were evaluated against physical performance measures (i.e., Short Physical Performance Battery & Timed Up and Go Test) and daily living performance (i.e., Barthel Index & Instrumental activity of daily living).

RESULTS

Our study included 457 participants, including 182 men (39.8%) and 275 women (60.2%). The age range of the included participants was 61-96 years (mean = 84.8 years, SD = 5.8 years). The simplified-Chinese version of PFS Physical scores showed strong internal consistency (Cronbach's alpha = 0.81). Higher PFS Physical scores were associated with worse physical performance, and daily living performance (|correlation coefficient| range: 0.36-0.56, p < .001). Age- and sex-adjusted PFS Physical scores had moderate to good overall discrimination for correctly classifying people by their physical performance and daily living performance (AUCs range 0.70-0.87, p < .001).

CONCLUSIONS

The PFS simplified-Chinese version is a valid instrument to assess perceived physical fatigability in Chinese-speaking older adults with good convergent validity. Thus, the PFS, with low cost and greater feasibility, is a desired tool to measure fatigability in large population studies.

Effect of heart failure and malnutrition, alone and in combination, on rehabilitation effectiveness in patients with hip fracture

BACKGROUND & AIMS

Heart failure and malnutrition are known to each negatively affect a patient's ability to improve their activities of daily living (ADL) through rehabilitation. Here, we investigated whether the negative effects of malnutrition and heart failure on ADL are additive in patients after hip fracture.

METHODS

This retrospective observational cohort study included 155 patients with hip fracture admitted to convalescent rehabilitation wards. Nutritional status was measured with the Geriatric Nutritional Risk Index (GNRI). Heart failure was assessed using plasma B-type natriuretic peptide (BNP) levels. Based on their GNRIs and BNP levels, patients were classified into four groups: a high GNRI (≥92)-low BNP (<100 pg/ml) group (n = 54); high GNRI-high BNP (≥100 pg/ml) group (n = 7); low GNRI (<92)-low BNP group (n = 67); and low GNRI-high BNP group (n = 27). The main outcome was rehabilitation effectiveness (REs). To confirm above hypothesis, heart failure was also assessed by American College of Cardiology/American Heart Association (ACC/AHA) stage classification, whereas nutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), either.

RESULTS

REs in the high GNRI-low BNP group, high GNRI-high BNP group, low GNRI-low BNP group, and low GNRI-high BNP group were 64.8 ± 22.6%, 36.0 ± 22.0%, 40.6 ± 23.6% and 28.5 ± 25.9%, respectively. REs was higher in the high GNRI-low BNP group than in other three groups, and REs in the low GNRI-low BNP group was higher than in the low GNRI-high BNP group. When we evaluated heart failure by ACC/AHA stage classification instead of BNP, or evaluated nutrition by MNA-SF instead of GNRI, the similar results were demonstrated. Multiple linear regression analyses revealed that age (p < 0.01), handgrip strength (p < 0.01), GNRI (p < 0.05), and BNP (p < 0.01) were significantly associated with REs.

CONCLUSIONS

These results suggest that malnutrition and heart failure are independently associated with REs and that they have an additive negative effect on improvement of ADL in elderly patients with hip fractures.

Relationship between Mobility-Related Activities of Daily Living and Health-Related Quality of Life among Healthy Older Adults: A Cross-Sectional Study Using Structural Equation Modeling

Objective: To develop a conceptual model that confirms whether mobility-related activities of daily living (ADLs) abilities are strongly associated with reduced health-related quality of life (HRQOL) in older adults. Methods: A total of 153 participants (63 men, 90 women) were analyzed. The mobility-related ADL survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. The Japanese version (v1.2) of the Medical Outcomes Study 36-item Short-Form Health Survey was administered to evaluate HRQOL. Structural equation modeling was performed to test a hypothetical model: mobility-related ADL abilities would influence HRQOL. Results: The chi-square value was not significant (chi-square = 9.463, p = .305), and goodness-of-fit values were high, implying that the model was validated; goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.949; comparative fit index, 0.996; and root mean square error of approximation, 0.035. Results showed that mobility-related ADL abilities influenced the physical health including physical function and general health in HRQOL. Conclusions: This study developed the conceptual model confirming the influence of mobility-related ADL abilities especially on physical health. Further intervention studies on instructions/training for physical activity of healthy older adults should assess this causal relationship.