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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Lopez A, Tinella L, Caffò A, Bosco A. Measuring the reliability of proxy respondents in behavioural assessments: an open question. Aging Clin Exp Res 2023; 35:2173-2190. [PMID: 37540380 PMCID: PMC10520105 DOI: 10.1007/s40520-023-02501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND In behavioural assessment, information can be gathered from internally referenced self-reports or from proxy informants. AIMS This study aimed to fine-tune a brief but reliable method for evaluating the proxy accuracy in cases where responses obtained from adult and older adults' patient cannot be considered reliable. METHODS We generated a set of items reflecting both overt and covert behaviours related to the basic instrumental activities of daily living. The psychometric properties of the content, factorial, and criterium validity of these items were then checked. The Proxy Reliability Questionnaire-ProRe was created. We tested the frequency of "I don't know" responses as a measure of proxy reliability in a sample of healthy older adults and their proxies, and in a second sample of proxy respondents who answered questions about their parents. RESULTS As expected, response precision was lower for items characterizing covert behaviours; items about covert compared to overt behaviours generated more "I don't know" answers. Proxies provided less "I don't know" responses when evaluating the parent, they claimed they knew better. Moreover, we tried to validate our approach using response confidence. Encouragingly, these results also showed differences in the expected direction in confidence between overt and covert behaviours. CONCLUSIONS The present study encourages clinicians/researchers to how well the proxy the patient know each other, the tendency of proxies to exhibit, for example, response bias when responding to questions about patients' covert behaviours, and more importantly, the reliability of informants in providing a clinical assessment of neurocognitive diseases associated with aging.
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Affiliation(s)
- Antonella Lopez
- Faculty of Law, Giustino Fortunato University, Via Delcogliano, 12, Benevento, Italy
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Luigi Tinella
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Alessandro Caffò
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
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Córcoles-Jiménez MP, Candel-Parra E, Del Egido-Fernández MÁ, Villada-Munera A, Moreno-Moreno M, Piña-Martínez AJ, Jiménez-Sánchez MD, Azor-García RJ. Preventing Functional Urinary Incontinence in Hip-Fractured Older Adults Through Patient Education: A Randomized Controlled Trial. J Appl Gerontol 2020; 40:890-901. [PMID: 32865102 DOI: 10.1177/0733464820952608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate whether an educational intervention would reduce the incidence of functional urinary incontinence (UI) in older adults with a fall-related hip fracture. The project was conducted as a multicenter randomized controlled trial (RCT). A total of 109 patients that had been admitted to six hospitals in Castilla-La Mancha (Spain) for acute treatment of hip fracture, previously continent and without cognitive impairment, were enrolled and randomly assigned to the experimental group (EG) or the control group (CG). Intervention (on EG): urinary habit training (Nursing Interventions Classifications taxonomy) was performed during hospital stay (second to fourth postoperative day), with a telephonic reinforcement 10 days after discharge. The CG received routine care. Primary outcome measure: incidence of UI. Follow-up: telephone assessment 3 and 6 months after discharge (blinded evaluation). The incidence of UI at 6 months was 49% (CG) versus 25.5% (EG) (relative risk = 0.52, 95% confidence interval [0.3, 0.9]; number necessary to treat = 4). The mean of UI episodes was 0.54 (EG) versus 1.8 (CG), p = .007. The educational intervention prevents the development of UI and decreases the number of episodes in case of appearance, in a statistically significant way.
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Affiliation(s)
| | - Eduardo Candel-Parra
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | | | - Mónica Moreno-Moreno
- Gerencia de Atención Integrada de Albacete, Hospital General de Albacete, Albacete, Spain
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Factors associated with the night-time index fall in an older hip fracture population. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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da Costa EM, Godin I, Pepersack T, Dramaix M, Coppieters Y, Bantuelle M, Levêque A. Influence of Proxies on the Reported Frequency of Falls, Fear of Falling and Activity Restriction in Older People. Health (London) 2014. [DOI: 10.4236/health.2014.612186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kaspers PJ, Pasman HRW, Onwuteaka-Philipsen BD, Deeg DJ. Changes over a decade in end-of-life care and transfers during the last 3 months of life: a repeated survey among proxies of deceased older people. Palliat Med 2013; 27:544-52. [PMID: 22988043 DOI: 10.1177/0269216312457212] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the ageing population, older people are living longer with chronic diseases. Especially in the last year of life, this can result in an increased need for (complex) end-of-life care. AIM To study potential changes in received end-of-life care and transfers by older people during the last 3 months of life between 2000 and 2010. DESIGN A repeated survey in 2000 and 2010. PARTICIPANTS Data were collected from a sample of proxies of deceased sample members of the Longitudinal Aging Study Amsterdam in 2000 (n = 270; response = 79%) and 2010 (n = 168; response = 59%). RESULTS Compared to 2000, in 2010, older people had a significantly lower functional ability 3 months before death. Over the 10-year period, people were significantly less likely to receive no care (12% vs 39%) and more likely to receive formal home care (45% vs 15%). Older people aged over 80 years, females, and those in the 2010 sample were more likely to receive formal home and institutional care (formal home care - age > 80 years, odds ratio: 3.7, male odds ratio: 0.74, 2010 - odds ratio: 6.9; institutional care - age > 80 years, odds ratio: 11.6, male odds ratio: 0.34, 2010 - odds ratio: 2.5) than informal or no care. Regardless of the study year, older people receiving informal home care were more likely to die in hospital (odds ratio: 2.3). CONCLUSION Two scenarios of care in the last 3 months of life seem to arise: staying at home as long as possible with a higher chance of hospital death or living in a residential or nursing home, reducing the chance of hospital death.
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Affiliation(s)
- Pam J Kaspers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
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Siordia C. On the different scenarios of disagreement between self- and informant-reports on an aged adults ability to perform activities of daily living. Maturitas 2012; 73:167-70. [DOI: 10.1016/j.maturitas.2012.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 06/13/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research; Duke-National University of Singapore Graduate Medical School; Singapore
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Wolinsky FD, Bentler SE, Hockenberry J, Jones MP, Obrizan M, Weigel PAM, Kaskie B, Wallace RB. Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. BMC Geriatr 2011; 11:43. [PMID: 21846400 PMCID: PMC3167753 DOI: 10.1186/1471-2318-11-43] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 08/16/2011] [Indexed: 11/24/2022] Open
Abstract
Background Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines. Methods The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop. Results The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline. Conclusions Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.
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Affiliation(s)
- Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
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Halanych JH, Shuaib F, Parmar G, Tanikella R, Howard VJ, Roth DL, Prineas RJ, Safford MM. Agreement on cause of death between proxies, death certificates, and clinician adjudicators in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Epidemiol 2011; 173:1319-26. [PMID: 21540327 DOI: 10.1093/aje/kwr033] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Death certificates may lack accuracy and misclassify the cause of death. The validity of proxy-reported cause of death is not well established. The authors examined death records on 336 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a national cohort study of 30,239 community-dwelling US adults (2003-2010). Trained experts used study data, medical records, death certificates, and proxy reports to adjudicate causes of death. The authors computed agreement on cause of death from the death certificate, proxy, and adjudication, as well as sensitivity and specificity for certain diseases. Adjudicated cause of death had a higher rate of agreement with proxy reports (73%; Cohen's kappa (κ) statistic = 0.69) than with death certificates (61%; κ = 0.54). The agreement between proxy reports and adjudicators was better than agreement with death certificates for all disease-specific causes of death. Using the adjudicator assessments as the "gold standard," for disease-specific causes of death, proxy reports had similar or higher specificity and higher sensitivity (sensitivity = 50%-89%) than death certificates (sensitivity = 31%-81%). Proxy reports may be more concordant with adjudicated causes of death than with the causes of death listed on death certificates. In many settings, proxy reports may represent a better strategy for determining cause of death than reliance on death certificates.
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Affiliation(s)
- Jewell H Halanych
- School of Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294-4410, USA.
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Ayalon L, Covinsky KE. Spouse-rated vs self-rated health as predictors of mortality. ACTA ACUST UNITED AC 2010; 169:2156-61. [PMID: 20008702 DOI: 10.1001/archinternmed.2009.386] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The Health and Retirement Study is a national sample of Americans older than 50 years and their spouses. The present study evaluated cross-sectional and longitudinal data from January 2000 through December 2006. The objective of the study was to evaluate the roles of spouse-rated vs self-rated health as predictors of all-cause mortality among adults older than 50 years. METHODS A total of 673 dyads of married couples were randomly selected to participate in a Health and Retirement Study module examining spouse-rated health. For each couple, one member was asked to rate his or her overall health status, and his or her spouse was asked to report the partner's overall health status. Mortality data were available through 2006. RESULTS Our findings demonstrate that spouse-rated health (area under the curve, 0.75) is as strong a predictor of mortality as self-rated health (area under the curve, 0.73) (chi(2)(1) = 0.36, P = .54). Combining spouse-rated and self-rated health predicts mortality better than using self-rated health alone (area under the curve, 0.77) (chi(2)(1) = 6.72, P = .009). CONCLUSIONS Spouse ratings of health are at least as strongly predictive of mortality as self-rated health. This suggests that, when self-rated health is elicited as a prognostic indicator, spouse ratings can be used when self-ratings are unavailable. Both measures together may be more informative than either measure alone.
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Elinge E, Stenvall M, von Heideken Wågert P, Löfgren B, Gustafson Y, Nyberg L. Daily life among the oldest old with and without previous hip fractures. Scand J Occup Ther 2009; 12:51-8. [PMID: 16392760 DOI: 10.1080/11038120410020674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this cross-sectional study was to describe the oldest old, with and without previous hip fracture with regard to their ability to perform personal and instrumental activities of daily living (ADL); home adaptations received; possession of assistive devices; perceived health and morale. A random sample drawn from the population of 85-year-olds, all 90-year-olds and all > or =95-year-olds (n =253) in Umeå, a city in northern Sweden, were examined. Data obtained from assessments and interviews carried out in the participants' homes, as well as data from medical charts, were analysed. Those with an earlier hip fracture (n = 58) had more difficulties in performing both personal and instrumental ADLs than those without (n = 195) but regarding individual home adaptations and the possession of assistive devices for personal care, no differences were detected between the groups. Self-perceived health and morale were equally good in both groups. The conclusion drawn is that lifelong consequences, in the form of reduced abilities to perform ADLs and wheelchair dependency are common among the oldest old after a hip fracture. Therefore, trials concerning the effects of more extensive and prolonged rehabilitation following hip fracture would be of great interest
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Affiliation(s)
- Eva Elinge
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden.
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Elliott MN, Beckett MK, Chong K, Hambarsoomians K, Hays RD. How do proxy responses and proxy-assisted responses differ from what Medicare beneficiaries might have reported about their health care? Health Serv Res 2008; 43:833-48. [PMID: 18454770 DOI: 10.1111/j.1475-6773.2007.00820.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Assess proxy respondent effects on health care evaluations by Medicare beneficiaries. DATA SOURCE 110,215 respondents from the nationally representative 2001 CAHPS((R)) Medicare Fee-for-Service Survey. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS We compare the effects of both proxy respondents and proxy assistance (reading, writing, or translating) on 23 "objective" report items and four "subjective" global measures of health care experiences using propensity-score-weighted regression. We assess whether proxy effects differ among spouses, other relatives, or nonrelatives. PRINCIPAL FINDINGS Proxy respondents provide less positive evaluations of beneficiary health care experiences than otherwise similar self-reporting beneficiaries for more subjective global ratings (average effect of 0.21 standard deviations); differences are smaller for relatively objective and specific report items. Proxy assistance differences are similar, but about half as large. Reports from spouse proxy respondents are more positive than those from other proxies and are similar to what would have been reported by the beneficiaries themselves. Standard regression techniques may overestimate proxy effects in this instance. CONCLUSIONS One should treat proxy responses to subjective ratings cautiously. Even seemingly innocuous reading, writing, and translation by proxies may influence answers. Spouses may be accurate proxies for the elderly in evaluations of health care.
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Affiliation(s)
- Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
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Hung SY, Pickard AS, Witt WP, Lambert BL. Pain and depression in caregivers affected their perception of pain in stroke patients. J Clin Epidemiol 2007; 60:963-70. [PMID: 17689813 DOI: 10.1016/j.jclinepi.2006.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 12/14/2006] [Accepted: 12/20/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Informal caregivers often serve as proxy raters of Health-Related Quality of Life (HRQL) when patients cannot report on their own behalf. Caregiver depression has been associated with bias in proxy ratings, but few studies have examined the role of caregiver pain. The aim of this study was to determine if caregiver depressive symptoms and/or pain systematically affected patient-proxy agreement on patient HRQL after stroke. STUDY DESIGN AND SETTINGS Secondary data analysis of 95 stroke patients and their caregivers (dyads) at 6 months poststroke. Caregiver depressive symptoms were measured by Center for Epidemiologic Studies Depression Rating Scale, and pain was measured using EQ-5D. Using multivariate regression, we examined the effect of caregiver depressive symptoms and pain on patient-proxy difference scores on Health Utilities Index 3 (HUI3) attributes and Short Form-36 domains of vitality and social functioning. RESULTS Caregiver depressive symptoms and pain were associated with significant differences in patient-proxy scores on HUI3 pain (P<0.05). Depressed caregivers underestimated pain experienced by patients, and caregivers with pain overestimated patient pain. Additionally, an interaction between caregiver depressive symptoms and pain was identified. CONCLUSION Presence of pain and depressive symptoms in caregivers can significantly affect perceptions of pain in stroke patients. Results suggest that caregivers with pain and/or depression may provide more biased proxy assessments of pain.
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Affiliation(s)
- Shih-Ying Hung
- Department of Social and Administrative Sciences in Pharmacy, University of Wisconsin at Madison, College of Pharmacy, Madison, WI 53705-2222, USA.
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Shaver JC, Allan DE. Care-receiver and caregiver assessments of functioning: Are there gender differences? Can J Aging 2005; 24:139-50. [PMID: 16082617 DOI: 10.1353/cja.2005.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In situations where care-receivers cannot respond to questions about their functional status, caregiver proxies are often substituted. Yet studies addressing caregiver-care-receiver agreement remain limited in scope, focusing primarily on cognitive functioning and caregiver relationship. This study broadens the range of research in this area by examining caregiver and care-receiver reports of individual IADL and AADL items by gender of care-receiver. As well, the degree to which the care-receiver's age and mental and physical health status influence agreement are investigated. Data for this study come from a sample of 388 Manitoba older adults aged 65 and over. Results (using Cohen's kappa) suggest less agreement on the presence of disability for men than for women, particularly among those aged 75-84. Differences by health status were also revealed. The implications of the findings for assessments of functioning are considered.
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Affiliation(s)
- Julie C Shaver
- Centre on Aging, Sedgewick Building, Room A104, University of Victoria, PO Box 1700, Station CSC, Victoria, BC, V8W 2Y2, Canada.
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Castle N. Are family members suitable proxies for transitional care unit residents when collecting satisfaction information? Int J Qual Health Care 2005; 17:439-45. [PMID: 15951312 DOI: 10.1093/intqhc/mzi056] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the agreement and association of elders' responses with family member proxy responses using the same, previously validated satisfaction instrument on both groups of respondents. METHODS Satisfaction data came from transitional care unit residents and family members (N = 462 paired responses) from one facility and were collected between 1999 and 2000. The satisfaction questionnaire consisted of 17 items evaluating the art of care, technical quality, efficacy, amenities of the care environment, and global satisfaction. Bias indexes and intraclass correlation coefficients were used to examine the satisfaction scores. RESULTS In general, proxy satisfaction ratings were higher than ratings of residents. The results also show that proxy ratings varied less from resident ratings for the amenity items, which were considered the most concrete items. Proxy ratings were much higher for the art of care and efficacy domain items, which were considered the least concrete items. CONCLUSION The results of this investigation show that proxy ratings do not necessarily substitute for resident ratings.
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Affiliation(s)
- Nicholas Castle
- Department of Health Policy and Management, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Jenkins KR, Fultz NH. Functional impairment as a risk factor for urinary incontinence among older Americans. Neurourol Urodyn 2005; 24:51-5. [PMID: 15578629 DOI: 10.1002/nau.20089] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms. METHODS Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms. RESULTS A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain. CONCLUSIONS Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.
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Affiliation(s)
- Kristi Rahrig Jenkins
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan 48106, USA.
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Martínez-Martín P, Benito-León J, Alonso F, Catalán MJ, Pondal M, Tobías A, Zamarbide I. Patients', doctors', and caregivers' assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov Disord 2004; 18:985-92. [PMID: 14502665 DOI: 10.1002/mds.10479] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This multicenter study sought to analyze the validity and reliability of the Unified Parkinson's Disease Rating Scale (UPDRS)-section 2 (Activities of Daily Living, ADL) as applied by patients and caregivers. Sixty pairs of PD patients-caregivers were enrolled for study purposes. Neurologists used a set of scales to determine disease severity and patients' functional state. Patients and caregivers used adapted versions of the UPDRS-section 2 in tandem with other measures. Wilcoxon and Mann-Whitney tests, weighted kappa, intraclass and Spearman's correlation coefficients, as well as multivariate linear regression models were applied. On the whole, PD patient self-assessment and caregiver evaluation of patients' disability showed close concordance with neurologists' ratings. Correlation between caregiver ratings and clinical evaluation tended to be slightly lower than that for patient-based self-assessment. Depression showed a positive correlation with disability and had a nonsystematic influence on UPDRS-section 2 (ADL) scores. As expected, there was a significant correlation between perceived disability and health-related quality of life measures. Caregiver burden did not reduce the level of agreement with neurologists as to the overall rating of any given patient's disability. In PD, UPDRS-section 2-based assessment of disability by patients themselves and caregivers is a valid and reliable outcome.
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Affiliation(s)
- Pablo Martínez-Martín
- National Center for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain.
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Martínez-Martín P, Benito-León J, Alonso F, Catalán MJ, Pondal M, Zamarbide I. Health-related quality of life evaluation by proxy in Parkinson's disease: Approach using PDQ-8 and EuroQoL-5D. Mov Disord 2003; 19:312-8. [PMID: 15022186 DOI: 10.1002/mds.10656] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Patient- and caregiver-based scores were compared and agreement levels ascertained to determine the reliability of proxy evaluation of Parkinson's Disease (PD) patients' health-related quality of life (HRQoL) using the EuroQoL and PD questionnaire (PDQ)-8. Of 72 patient-caregiver pairs, 64 (88.88%) returned the questionnaires. The degree of agreement varied for individual dimensions. Proxy evaluation of PD patients' HRQoL showed limitations mainly with assessments using the EuroQoL and especially in patients with severe disease and depression.
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Affiliation(s)
- Pablo Martínez-Martín
- Neuroepidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain.
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Klinkenberg M, Smit JH, Deeg DJH, Willems DL, Onwuteaka-Philipsen BD, van der Wal G. Proxy reporting in after-death interviews: the use of proxy respondents in retrospective assessment of chronic diseases and symptom burden in the terminal phase of life. Palliat Med 2003; 17:191-201. [PMID: 12701851 DOI: 10.1191/0269216303pm661oa] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates the quality of data obtained from after-death interviews with significant others of deceased older persons regarding the prevalence of chronic diseases and symptoms in the terminal phase of life. These data are compared with reports from physicians and earlier self-reports from the deceased person. There were significant increases in nonresponse and nonavailability of significant others for decedents who had been divorced or had never been married, thus introducing some selection bias. At the level of the total sample, significant others seem to give accurate information about the prevalence of chronic diseases when compared with self-reports and reports from physicians. At the level of the individual sample member, after-death interviews with significant others provide valid information for the assessment of the prevalence of malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease and cerebrovascular disease, but not for osteo- and rheumatoid arthritis and artherosclerotic disease. At the level of the total sample, the prevalence of symptoms assessed by significant others did not differ greatly from the assessment made by physicians. However, at the level of the individual sample member, the validity of symptom assessment by significant others could not be supported by data obtained from the physicians. With regard to the type of significant others interviewed, children reported more symptoms than partners. The use of significant others in after-death interviews can be a valid method with regard to the assessment of chronic diseases and symptoms on a group level. On an individual level this can be concluded only for chronic diseases with clearly observable consequences.
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Affiliation(s)
- M Klinkenberg
- Department of Social Medicine and Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
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