Functional assessment in geriatrics. A review of progress and directions

Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle?

Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.

Machine Learning-Based Predicted Age of the Elderly on the Instrumented Timed Up and Go Test and Six-Minute Walk Test

A decrease in dynamic balance ability (DBA) in the elderly is closely associated with aging. Various studies have investigated different methods to quantify the DBA in the elderly through DBA evaluation methods such as the timed up and go test (TUG) and the six-minute walk test (6MWT), applying the G-Walk wearable system. However, these methods have generally been difficult for the elderly to intuitively understand. The goal of this study was thus to generate a regression model based on machine learning (ML) to predict the age of the elderly as a familiar indicator. The model was based on inertial measurement unit (IMU) data as part of the DBA evaluation, and the performance of the model was comparatively analyzed with respect to age prediction based on the IMU data of the TUG test and the 6MWT. The DBA evaluation used the TUG test and the 6MWT performed by 136 elderly participants. When performing the TUG test and the 6MWT, a single IMU was attached to the second lumbar spine of the participant, and the three-dimensional linear acceleration and gyroscope data were collected. The features used in the ML-based regression model included the gait symmetry parameters and the harmonic ratio applied in quantifying the DBA, in addition to the features of description statistics for IMU signals. The feature set was differentiated between the TUG test and the 6MWT, and the performance of the regression model was comparatively analyzed based on the feature sets. The XGBoost algorithm was used to train the regression model. Comparison of the regression model performance according to the TUG test and 6MWT feature sets showed that the performance was best for the model using all features of the TUG test and the 6MWT. This indicated that the evaluation of DBA in the elderly should apply the TUG test and the 6MWT concomitantly for more accurate predictions. The findings in this study provide basic data for the development of a DBA monitoring system for the elderly.

The Effectiveness of Pelvic Floor Muscle Training in Men after Radical Prostatectomy Measured with the Insert Test

A commonly used physiotherapeutic method for the treatment of urinary incontinence (UI) after radical prostatectomy (RP) is pelvic floor muscle training (PFMT). The aim of this study was to evaluate the effectiveness of PFMT by enhanced biofeedback using the 1h pad-weighing test. The following factors were taken into consideration in the analysis of PFMT effectiveness: the relevance of the patients’ age, time from RP, BMI, mental health, functional state, and depression. A total of 60 post-RP patients who underwent 10-week PFMT were studied. They were divided into groups: A (n = 20) and B (n = 20) (random division, time from RP: 2−6 weeks) and group C (time from RP > 6 weeks). Group B had enhanced training using EMG biofeedback. UI improved in all groups: A, p = 0.0000; B, p = 0.0000; and C, p = 0.0001. After the completion of PFMT, complete control over miction was achieved by 60% of the patients in group A, 85% in group B, and 45% in group C. There was no correlation between the results of PFMT efficacy and patients’ age, BMI, time from RP, mental health, functional state, and depression. PFMT is highly effective in UI treatment. The enhancement of PFMT by EMG biofeedback seems to increase the effectiveness of the therapy.

Association between social network and functional disability in brazilian elderly

OBJECTIVE

to verify the association between social network and functional disability in elderly Brazilians.

METHODS

a cross-sectional study with secondary data of 11,177 elderly people, available on Brazilian Institute of Geography and Statistics' website. Social network components were having trusted friends/relative, living with their spouse, practicing social activity, performing voluntary or paid work. The outcome was functional disability, measured by the difficulty in performing instrumental and basic activities of daily living. Logistic regression models were used.

RESULTS

disability prevalence for instrumental activities was 28.0% (95%CI: 26.7-29.4), and for basic activities, 15.5% (95%CI: 14.4-16.6). Not having components social network components was associated with greater chances of functional disability, especially among women.

CONCLUSION

there was an association between not having social network components with functional disability. There are differences in this association according to sex. Strengthening actions that expand social network can reduce the chance of this outcome in elderly people.

Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study

Background

Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.

Objective

This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.

Design

For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.

Data sources

Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.

Results

In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.

Limitations

A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.

Conclusions

Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.

Future work

Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.

Study registration

This study is registered as PROSPERO CRD42015024492.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

Serum Biomarkers Associated with Malnutrition and Nutritional Risk in Elderly Primary Care Patients: A Cross-sectional Study from Bosnia and Herzegovina

BACKGROUND

The aim of the study was to determine the ability of ferritin, haemoglobin, albumin and total cholesterol to identify nutritional risk and malnutrition among elderly primary care patients.

METHODS

The cross-sectional study included 446 elderly adults over 65 years of age from four areas of Bosnia and Herzegovina. In addition to anthropometric, functional, cognitive and biochemical indicators, nutritional status was evaluated using 24-hour recall of meals, the Mini Nutritional Assessment (MNA), and Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II).

RESULTS

Malnourished/at-risk study respondents had lower mean levels of haemoglobin (P=0.001) and total cholesterol (P<0.001), compared to those with normal nutritional status. Albumin levels significantly differed regarding nutritional status (P=0.004), but not nutritional risk level (P=0.521). Significant differences in serum ferritin levels were not found between malnourished and normally nourished study respondents (P=0.779) Determinants of albumin level were eating more than three meals a day (P<0.001), fewer than two portions of fruit and vegetables a day (P=0.024), drinking one glass of wine (P<0.001) and reporting functional independence (P=0.011). The AUC curves for serum ferritin, albumin and total cholesterol levels in men and women, as well as for haemoglobin levels in women, were poor to fair (AUC<0.800).

CONCLUSION

Although ferritin, haemoglobin, albumin and total cholesterol may be useful biomarkers of nutritional status, their accuracy in diagnosing malnutrition and nutritional risk among elderly primary health care patients is limited.

Conceptualizing caregiving activities for persons with dementia (PwD) through a patient work lens

Informal caregivers are an integral part of care delivery for persons with dementia (PwD). Informal caregivers take part in a wide range of care activities both individually and collaboratively with other caregivers. Caregiving often involves high demands in the face of limited resources, which can lead to stress, burden, and burnout. To support caregivers, we need to conceptualize caregiving activities they perform, and the networks and roles through which they perform work. We performed a directed content analysis on interview data from twenty caregivers and applied a human factors approach to characterize informal caregiving work. Our results revealed 1) nuances in caregiving roles, 2) differences in caregiving networks, and 3) 13 categories of caregiving activities characterized by time commitments; physical, cognitive and socio-behavioral demands; and varying network dependencies. These findings can be applied in future studies to evaluate the needs of caregiving networks and how to better support them.

Rahman MH, Mohammed Z, You YX. Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

Handgrip Strength Cut-Off Values for the Undernutrition Risk Screening among Elderly Men and Women in Bosnia and Herzegovina

OBJECTIVES

To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina.

DESIGN

Cross-sectional study.

SETTING

Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina.

PARTICIPANTS

300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer.

RESULTS

According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65-74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65-74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65-74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65-74 years), 19.50 kgF (≥75 years for women).

CONCLUSION

HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in Bosnia and Herzegovina.

Advance care planning dispositions: the relationship between knowledge and perception

BACKGROUND

Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them.

METHODS

Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception.

RESULTS

Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors.

CONCLUSION

Although the direction of the association's causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.

Eliciting Naturalistic Conversations: A Method for Assessing Communication Ability, Subjective Experience, and the Impacts of Noise and Hearing Impairment

Purpose The purpose of this study was to introduce a method of eliciting conversational behavior with many aspects of realism, which may be used to study the impacts of hearing impairment and noise on verbal communication; to describe the characteristics of speech and language participants produced during the task; and to assess participants' engagement and motivation while completing the task. Method Twenty young adults with normal hearing and 20 older adults with hearing impairment took part in face-to-face conversations while completing a referential communication puzzle task designed to elicit natural conversational speech production and language with a number of realistic characteristics. Participants rated the difficulty and relevance of acoustic scenes for communication and their engagement in conversations. Results The communication task elicited speech production in a natural conversational register and language with many realistic characteristics, including complex linguistic constructions and typical disfluencies found in everyday speech, and approximately balanced contributions within dyads. Subjective ratings suggest that the task is robust to learning and fatigue effects and that participants remained highly engaged throughout the experiment. All participants were able to maintain successful communication regardless of background noise level and degree of hearing impairment. Conclusions The communication task described here may be used as part of a functional assessment of the ability to communicate in the presence of noise and hearing impairment. Although existing speech assessments have many strengths, they do not take into account the inherently interactive nature of spoken communication or the effects of motivation and engagement.

Mortality in people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 6,724 patients with 2 years follow-up

Purpose

Cognitive impairment is common in older people admitted to hospital, but the outcomes are generally poorly understood, and previous research has shown inconsistent associations with mortality depending on the type of cognitive impairment examined and duration of follow-up. This study examines mortality in older people with any cognitive impairment during acute hospital admission.

Patients and methods

Prospective cohort of 6,724 people aged ≥65 years with a structured cognitive assessment on acute admission were included in this study. Cognitive spectrum disorder (CSD) was defined as delirium alone, known dementia alone, delirium superimposed on known dementia, or unspecified cognitive impairment. Mortality associated with different types of CSD was examined using a non-proportional hazards model with 2-year follow-up.

Results

On admission, 35.4% of patients had CSD, of which 52.6% died within 2 years. After adjustment for demographics and comorbidity, delirium alone was associated with increased mortality in the 6 months post-admission (HR =1.45, 95% CI 1.28-1.65) and again after 1 year (HR =1.44, 95% CI 1.17-1.77). Patients with known dementia (alone or with superimposed delirium) had increased mortality only after 3 months from admission (HR =1.85, 95% CI 1.56-2.18 and HR =1.80, 95% CI 1.52-2.14) compared with patients with unspecified cognitive impairment after 6 months (HR =1.55, 95% CI 1.21-1.99). Similar but partially attenuated associations were seen after adjustment for functional ability.

Conclusion

Mortality post-admission is high in older people with CSD. Immediate risk is highest in those with delirium, while dementia or unspecified cognitive impairment is associated with medium- to long-term risk. These findings suggest that individuals without dementia who develop delirium are more seriously ill (have required a larger acute insult in order to precipitate delirium) than those with pre-existing brain pathology (dementia). Further research to explain the mortality patterns observed is required in order to translate the findings into clinical care.

Validity, Reliability, and Diagnostic Accuracy of Ratings of Perceived Exertion to Identify Dependence in Performing Self-care Activities in Older Women

BACKGROUND

Dependence in self-care activities among older women has been previously evaluated through performance-based tests. However, these tests have presented inability to accurately distinguish between dependent and independent older adults in performing activities of daily living.

AIM

To examine the validity, reliability, and diagnostic accuracy of rating of perceived exertion (RPE) to identify dependence in performing self-care activities in older women.

METHODS

Thirty-five older women performed two different constant-load tasks (walking on treadmill at 4 km/h for five minutes and arm curls with two kg for one minute), reporting RPE at the end, in four sessions. Performance-based tests (30-second chair stand and 6-minute walk) were also evaluated. Katz Index and Lawton and Brody questionnaires were applied to evaluate the dependence level in performing basic and instrumental activities of daily living.

RESULTS

RPE was greater on the first session (RPE 14 ± 2) than second session (RPE 13 ± 2), while it was similar through other sessions, with high values of intraclass coefficient correlation (0.96-0.99). Basic activities of daily living and instrumental activities of daily living presented high correlations with RPE measures (0.75-0.82), whereas performance-based tests presented moderate correlations (0.47-0.59). RPE responses explained the most variance in identifying dependence in self-care activities and presented high diagnostic accuracy to differentiate dependent from independent older women. So the hypotheses had been confirmed that RPE responses in constant-load exercise are better predictors of dependence in self-care activities than performance-based tests.

CONCLUSIONS

RPE of constant-load physical tasks was valid, reliable, and accurate in identifying dependence in performing self-care activities in older women; therefore, it is possible to use the perceived exertion to identify dependence in performing activities of daily living in older women.

Evaluation of water balance in a population of older adults. A case control study

Older adults are at risk for dehydration and its' potentially life-threatening consequences. Unrecognized dehydration can complicate chronic medical problems and increase morbidity. The objective of the study was to estimate water balance, intake and loss in elderly people living in Greece using the Water Balance Questionnaire (WBQ). WBQ was administered in winter to 108 independents (65-81yrs) (Group A), 94 independents (82-92yrs) (Group B) and 51 hospitalized (65-92yrs) (Group C). A database from previous study of 335 adults (18-65yrs) (Control Group) used for comparison. Mean estimates of water balance, intake and loss were, respectively, for Group A -749 ± 1386 mL/day, 2571 ± 739 mL/day and 3320 ± 1216 mL/day, for Group B -38 ± 933 mL/day, 2571 ± 739 mL/day and 3320 ± 1216 mL/day, for Group C 64 ± 1399 mL/day, 2586 ± 1071 mL/day and 2522 ± 1048 mL/day and for Control Group -253 ± 1495 mL/day, 2912 ± 1025 mL/day and 3492 ± 2099 mL/day. Significant differences were detected in water balance, intake and loss (p < 0.01). Water balance and water intake in Group A was the lowest. For Groups A, B, C and Control, contribution of solid foods to water intake was 36%, 29%, 32%, 25%, of drinking water was 32%, 48%, 45%, 47%, of beverages was 32%, 23%, 23% and 28% respectively. Significant differences observed in the contribution of drinking water and beverages (p < 0.01). Group A had lower water balance and water intake. Groups B and C had lower water intake from beverages.

(Where) Is Functional Decline Isolating? Disordered Environments and the Onset of Disability

The onset of disability is believed to undermine social connectedness and raise the risk of social isolation, yet spatial environments are seldom considered in this process. This study examines whether unruly home and neighborhood conditions intensify the association between disability onset and several dimensions of social connectedness. I incorporate longitudinal data from the National Social Life, Health, and Aging Project, which contains environmental evaluations conducted by trained observers ( N = 1,558). Results from Poisson, ordinal logistic, and linear regression models reveal heterogeneous consequences of disablement: disability onset was associated with reduced core network size, fewer friends, lower likelihood of social interaction, and less overall social connectedness-though mainly when accompanied by higher levels of household disorder. There was limited evidence that neighborhood disorder moderated consequences of disability. Findings point to the importance of the home as an environmental resource and underscore important contextual contingencies in the isolating consequences of disability.

Alpha band EEG coherence in healthy nonagenarians

ABSTRACT Electroencephalographic (EEG) coherence is a parameter that enables evaluation of cerebral connectivity. It may be related to the functional state of the brain. In the elderly, it may reflect the neuronal loss caused by aging. Objective To describe characteristics of coherence in nonagenarians. Methods We evaluated interhemispheric coherence for the alpha band in 42 cognitively normal individuals aged 90 to 101 years. Coherence values in the occipital electrode (O1O2), in the resting state with closed eyes, were calculated by means of spectral analysis using digital EEG EMSA 32 channels, 12 bits and a frequency of 200 Hz. Results The mean coherence value for the alpha band at O1O2 was 0.65 (SD 0.13). No significant differences were found between men and women. Conclusions The findings from this study did not show any decrease in interhemispheric coherence for the alpha band in cognitively normal nonagenarians. This may be useful as a standard value for this age group.

Factors Associated with Residential Long-Term Care Wait-List Placement in North West Ontario

This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study's analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.

Predictors of poor cognitive status among older Malaysian adults: baseline findings from the LRGS TUA cohort study

BACKGROUND

Concepts of successful aging (SA), usual aging (UA), and mild cognitive impairment (MCI) have been developed to identify older adults at high risk of Alzheimer's diseases (AD), however, the predictors have rarely been investigated in a single study. Thus, this study aims to explore the risk factors of MCI as compared to UA and SA among older adults, in a large community based cohort study in Malaysia.

METHOD

1993 subjects from four states in Malaysia were recruited. A comprehensive interview-based questionnaire was administered to determine socio-demographic information, followed by assessments to evaluate cognitive function, functional status, dietary intake, lifestyle and psychosocial status. Risk factors of cognitive impairment were assessed using the ordinal logistic regression (OLR).

RESULT

The prevalence of SA, UA and MCI in this study was 11, 73 and 16 % respectively. OLR indicated that higher fasting blood sugar, hyperlipidemia, disability, lower education level, not regularly involved in technical based activities, limited use of modern technologies, lower intake of fruits and fresh fruit juices and not practicing calorie restriction were among the risk factors of poor cognitive performance in this study.

CONCLUSION

This study will be a stepping stone for future researchers to develop intervention strategies to prevent cognitive decline.

Old(er) care home residents and sexual/intimate citizenship

Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy. When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity. We review the (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally). We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.

Approaches in methodology for population-based longitudinal study on neuroprotective model for healthy longevity (TUA) among Malaysian Older Adults

A number of longitudinal studies on aging have been designed to determine the predictors of healthy longevity, including the neuroprotective factors, however, relatively few studies included a wide range of factors and highlighted the challenges faced during data collection. Thus, the longitudinal study on neuroprotective model for healthy longevity (LRGS TUA) has been designed to prospectively investigate the magnitude of cognitive decline and its risk factors through a comprehensive multidimensional assessment comprising of biophysical health, auditory and visual function, nutrition and dietary pattern and psychosocial aspects. At baseline, subjects were interviewed for their status on sociodemographic, health, neuropsychological test, psychosocial and dietary intake. Subjects were also measured for anthropometric and physical function and fitness. Biospecimens including blood, buccal swap, hair and toenail were collected, processed and stored. A subsample was assessed for sensory function, i.e., vision and auditory. During follow-up, at 18 and 36 months, most of the measurements, along with morbidity and mortality outcomes will be collected. The description of mild cognitive impairment, successful aging and usual aging process is presented here. A total 2322 respondents were recruited in the data analysis at baseline. Most of the respondents were categorized as experiencing usual aging (73 %), followed by successful aging (11 %) and mild cognitive impairment (16 %). The LRGS TUA study is the most comprehensive longitudinal study on aging in Malaysia, and will contribute to the understanding of the aging process and factors associated with healthy aging and mental well-being of a multiethnic population in Malaysia.

Measurement Properties of the Short Multidimensional Observation Scale for Elderly Subjects (MOSES

This study evaluated the five-factor measurement model of the abbreviated Multidimensional Observation Scale for Elderly Subjects (MOSES), originally proposed by Pruchno, Kleban, and Resch in 1988. Modifications of the five-factor model were examined and evaluated with regard to their practical significance. A confirmatory second-order factor analysis was performed to examine whether the correlations among the first-order factors were adequately accounted for by a global dysfunction factor. Findings indicated that the proposed measurement model was replicated adequately. Although post hoc modifications resulted in significant improvements in overall model fit, the minor parameters had only a trivial influence on the major parameters of the baseline model. Results from the second-order factor analysis showed that a global dysfunc tion factor accounted adequately for the intercorrelations among the first-order factors.

Identifying Dimensions of Physical (Motor) Functional Capacity in Healthy Older Adults

This study addressed the dimensionality and construct validity of physical functional capacity within the context of performance-based measures. Sixty-two individuals (M= 70yrs), classified as "healthy" based on several screening procedures, completed a battery of standard neuromuscular and physical performance tests. Scores were submitted to a principal components factor analysis to examine and describe potential dimensions of physical functional capacity. Orthogonal and oblique rotations of axes were performed. Six interpretable and meaningful factors were extracted from the orthogonal rotation and identified as strength, unimanual dexterity, mobility/agility, static balance, general upper-extremity control, and movement planning speed. The results indicated that physical functioning in older persons is a multidimensional construct. Moreover, assessment techniques involving performance-based measures should be designed to diagnose physical functional status in separate motor dimensions and plan intervention approaches accordingly.

A Theoretical Model of Functional Performance in Persons with Alzheimer Disease

This paper reports on a qualitative study that defined a theoretical model as a first step in the development of a functional performance measure for clients with Alzheimer disease. A consensus panel of caregivers used the grounded theory approach to identify the basic sub-components of functional performance that are affected by Alzheimer disease. A model of functional performance which can be applied to any basic activity of daily living was derived from these data. The model comprised three axes: behavioural, environmental and quality of performance. A second panel of caregivers validated the model. This study provided the framework for the Functional Performance Measure to be tested in a subsequent study.

Dimensões da Qualidade de Vida e Apoio Social dos Pacientes Hospitalizados nas Unidades de Assistência à Saúde do Algarve

RESUMO Este estudo avaliou a relação entre qualidade de vida e rede de apoio social dos pacientes das unidades de cuidados continuados do Algarve, através de WHOQOL-BREF e ASSIS. Participaram 92 pacientes, com idades entre 34-101 anos: muito idosos (40,2%), sexo feminino (58,7%), viúvas (40,2%), classe média-alta (46,8%), coabitando com o cônjuge (43,2%), e parcialmente dependentes (72,5%). As redes de apoio emocional, material e informativo eram compostas maioritariamente por familiares. Observamos relações significativas entre o apoio informativo e os domínios físico, relações sociais e ambiente da qualidade de vida (p<0,05). Os resultados sugerem uma percepção e satisfação com a saúde razoáveis, mas inferiores no domínio físico. A necessidade de apoio informativo esteve negativamente associada aos domínios psicológico e relações sociais da qualidade de vida.

Geriatric conditions, rather than multimorbidity, as predictors of disability and mortality among octogenarians: A population-based cohort study

AIM

To examine the impact of geriatric conditions and multimorbidity on the risk of incident disability and mortality among young-old and old-old adults.

METHODS

The present study used nationally-representative data from the "Survey of Health and Living Status of the Elderly in Taiwan" for the years 2003 and 2007. Non-disabled older adults were divided into two age groups (65-79 years and ≥80 years). Chronic morbidities and geriatric conditions were assessed in 2003. Incident disability was defined as dependency in one or more activities of daily living in 2007. Vital statistics of the participants was linked to death registration data through 31 December 2007. Multivariable logistic regression and Cox regression were used to determine the effect of multimorbidity and geriatric conditions on health outcomes.

RESULTS

Among those aged 65-79 years (n = 1874), the presentation of multimorbidity or two or more geriatric conditions was related to incident disability. Among octogenarians, the presentation of one or more geriatric conditions, but not multimorbidity, was shown to be independently associated with the risk of disability. Multimorbidity was related to a higher adjusted risk of mortality in the young-old group (hazard ratio 1.54; 95% confidence interval 1.1-2.2) but not in the old-old group. Among octogenarians, those with two or more geriatric conditions had a higher adjusted risk of mortality (hazard ratio 1.7; 95% confidence interval 1.2-2.5), compared with those with 0-1 geriatric conditions.

CONCLUSIONS

The risk of incident disability and mortality increased in octogenarians with geriatric conditions, but not in cases with multimorbidity.

Funções executivas, atividades da vida diária e habilidade motora de idosos com doenças neurodegenerativas

Objetivo: Analisar as funções executivas de idosos com doença de Parkinson (DP – com e sem quadro demencial) e doença de Alzheimer (DA), e confrontar os escores dos participantes no que se refere às atividades funcionais da vida diária e à habilidade motora em situações de dupla tarefa. Métodos: Sob um desenho transversal, 54 idosos foram divididos em quatro grupos: G1, composto por 11 sujeitos com DP; G2, formado por 10 sujeitos com demência de Parkinson; G3, composto por 13 participantes com DA; e G4, formado por 20 idosos saudáveis. Os procedimentos metodológicos envolveram análise das funções cognitivas pré-frontais dos sujeitos, da realização das atividades da vida diária e da habilidade motora em situações de dupla tarefa. A análise dos dados envolveu a estatística descritiva (média e erro-padrão) e inferencial (teste ANOVA e pós-teste de Scheffé), admitindo significância de 5% (p < 0,05) e intervalo de confiança de 95%. Resultados: As funções cognitivas pré-frontais apresentaram diferença significativa entre os grupos, sobretudo nas comparações envolvendo G2 e G3, em relação a G1 e G4 (p = 0,001). Os grupos com déficit cognitivo apresentaram pior rendimento na realização das atividades da vida diária, com menor escore do G2, na qual há junção de déficit cognitivo e motor (p = 0,001). Em situações de dupla tarefa, G2 e G3 apresentaram maiores dificuldades que os demais grupos (p < 0,05). Conclusão: Distúrbios pré-frontais repercutem negativamente nas atividades funcionais e na habilidade psicomotora dos indivíduos. Quando não vinculado a quadro demencial, os pacientes com DP apresentaram escores cognitivos pré-frontais e independência funcional semelhantes aos de idosos saudáveis.

Sidney Katz, MD: a new paradigm for chronic illness and long-term care

Dr. Sidney Katz's legacy to the field of gerontology is internationally recognized as his success at developing standardized measures and processes, beginning with the activities of daily living index, for the functional assessment of older adults with chronic conditions necessitating long-term services and supports. That work served as the bedrock for his subsequent major accomplishments, which improved rehabilitation services through interdisciplinary team work and attention to the patient-family constellation; reformed the regulation of nursing homes, refocusing it on resident outcomes and quality of life; and promulgated the concept of active life expectancy as a new approach to measuring the quality of later life. Few other scholars and researchers in the history of the field of aging can claim one, much less multiple monumental contributions leading to major advances in the treatment of chronic illness and the quality of long-term care.

The Judgment Test of the Neuropsychological Assessment Battery (NAB): psychometric considerations in an assisted-living sample

A total of 82 older adults recruited from assisted-living facilities completed the Judgment subtest of the Neuropsychological Assessment Battery. The internal consistency reliability of Judgment scores in this sample, as estimated by Cronbach's α, was .83. Significant and strong Judgment score correlations with measures of general cognitive functioning and instrumental activities of daily living provided evidence of construct validity. Furthermore, participants who exhibited the capacity to consent to the evaluation performed significantly better on the Judgment subtest than did participants who did not exhibit consent capacity. Finally, Judgment scores predicted a significant proportion of variance in both instrumental and basic activities of daily living over and above the variance accounted for by scores on measures of general cognitive functioning and executive functioning. This study presents promising preliminary evidence of the incremental validity of Judgment subtest scores for predicting both basic and instrumental activities of daily living in an assisted-living sample.

Assessing Smart Phones for Generating Life-space Indicators

Life-space is a promising method for estimating older adults' functional status. However, traditional life-space measures are costly and time consuming because they often rely on active subject participation. This study assesses the feasibility of using the global positioning system (GPS) function of smart phones to generate life-space indicators. We first evaluated the location accuracy of smart phone collected GPS points versus those acquired by a commercial GPS unit. We then assessed the specificity of the smart phone processed life-space information against the traditional diary method. Our results suggested comparable location accuracy between the smart phone and the standard GPS unit in most outdoor situations. In addition, the smart phone method revealed more comprehensive life-space information than the diary method, which leads to higher and more consistent life-space scores. We conclude that the smart phone method is more reliable than traditional methods for measuring life-space. Further improvements will be required to develop a robust application of this method that is suitable for health-related practices.

Association between vitamin A, vitamin E and apolipoprotein E status with mild cognitive impairment among elderly people in low-cost residential areas

RATIONALE

The influence of nutritional parameters and genetic susceptibility on poor cognitive impairment has been documented; however, the association between lipid-soluble vitamins with genetic susceptibility on mild cognitive impairment (MCI) has not yet been studied extensively.

OBJECTIVES

The aim of the present study was (i) to determine the prevalence of MCI and its associated risk factors and (2) to investigate the influence of the apolipoprotein E (APOE) ε4 allele on peripheral vitamin A and E concentration in MCI and non-MCI groups.

METHODS

A total of 333 subjects aged 60 years and above, residing in public housing areas in Kuala Lumpur, Malaysia were interviewed to obtain information on their neuropsychological status. Fasting venous blood was taken for determination of vitamin A and vitamin E concentration using high-performance liquid chromatography. Restriction fragment length polymorphism analysis was performed to determine the APOE genotypes.

RESULTS

The prevalence of MCI was 21.1%. Binary logistic regression indicated that the predictors of MCI were being married, overweight or obesity, and had vitamin A deficiency. In non-MCI subjects, vitamin E levels were lower among APOEε4 allele carriers as compared to the non-carriers (P < 0.05).

CONCLUSION

The study highlighted the importance of maintaining good nutritional status and vitamin A status for optimal cognitive function. The presence of APOEε4 allele has a prominent role in affecting vitamin E levels, particularly among cognitively healthy elderly in our unique population.

Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: a systematic review

This systematic review assessed whether nutritional screening tools (NSTs) predict mortality, functional decline, and move to higher level care in older adults residing in the community or in institutions. In total, 37 prospective studies published between 1999 and 2012 met inclusion criteria and were included in this review. The most commonly used NST in these studies was the Mini Nutritional Assessment (MNA). Comparison of NSTs was limited by variation in follow-up time, lack of uniform definition of functional decline, and biases in many studies. Results of MNA, MNA-Short Form (MNA-SF), and Geriatric Nutrition Risk Index (GNRI) assessments were significantly associated with subsequent mortality, with good negative predictive power (∼0.83), but only modest positive predictive power (PPV∼0.32). MNA-SF and MNA results had a low to moderate association with functional decline (PPV∼0.34). Move to higher level care was less strongly associated with NST scores (PPV∼0.25). Overall, there is evidence that NSTs can predict those at low risk of mortality, functional decline, and, to a lesser extent, move to higher level care in older people.

The Brief Cognitive Assessment Tool (BCAT): a new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living

The Brief Cognitive Assessment Tool (BCAT) is a new screening measure for cognitive dysfunction that emphasizes contextual memory and executive control functions. A total of 104 older adults referred for neuropsychological evaluation were recruited from assisted-living facilities. Psychometric analyses confirmed strong evidence for reliability, construct validity, and predictive validity. The BCAT's utility for identifying dementia versus mild cognitive impairment was excellent, with a sensitivity of .99, a specificity of .77, and an area under the receiver-operating characteristic (ROC) curve of .95. Executive control, contextual memory, and attentional capacity items were the best predictors of diagnostic category and of instrumental activities of daily living.

Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

BACKGROUND

Infectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward.

METHODS

Overall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality.

RESULTS

Of these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality.

CONCLUSION

Bacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal disease, bacteraemia of unknown focus and severe cognitive impairment adversely affects the outcome of elderly patients with bacteraemia admitted to an Internal Medicine ward.

Functional Disability and Associated Chronic Conditions among Geriatric Populations in a Rural Community of India

BACKGROUND

Geriatric population and chronic diseases are increasing throughout the world especially in developing countries like India. Because of social change and urbanization, disability is also a problem in India. As the major reasons for geriatric disabilities are chronic diseases, a study was undertaken.

OBJECTIVES

To find out the prevalence of different chronic diseases and disability among the geriatric population in a rural community of India and to determine the association between chronic diseases and disability of the geriatric population.

METHOD

A cross-sectional, observational community based study was conducted in a rural area of West Bengal, India through house to house visit for Clinical examination, observation and interview with a predesigned pre-tested proforma

RESULTS

Out of 495 study population, 80 (16.16%) were found to be functionally disabled as per ADL scale and more than half (56.2%) of them had 3 or more chronic conditions. 92.5% of study populations had one or more chronic conditions

CONCLUSION

Association between different risk factors and disability was found with age, sex, anaemia, Chronic Obstructive Pulmonary Diseases(C.O.P.D), scabies, hypertrophy of prostate, ischaemic heart disease, osteoporosis, osteoarthritis and acid peptic disorder were the risk factors of disability. These data suggest the significant chronic conditions and risk factors associated with disability. Measures to reduce such chronic conditions and impairment would be the useful approach for the prevention of disability.

Prevalence of gender disparities and predictors affecting the occurrence of mild cognitive impairment (MCI)

The aims were to investigate the prevalence of mild cognitive impairment (MCI) within gender disparities in Malaysian older adults, and to determine the predictors of MCI according to gender disparities. A community-based sample of urban, multiethnic dwelling elderly aged 60 years of age and above from Cheras, Kuala Lumpur was recruited. Prevalence of all-type MCI, amnestic-type MCI (am-MCI) and non-amnestic-type MCI (nam-MCI) was assessed using comprehensive neuropsychological batteries. The association between demography, socioeconomic status, lifestyle practices, and nutritional status and health risk factors with MCI were examined. Predictors of MCI occurrence between gender disparities were determined. The prevalence of all-type MCI, am-MCI and nam-MCI was 21.1%, 15.4% and 5.7%, respectively. Binary logistic regression indicated that hypercholesterolemia is the significant predictor for MCI in men after adjustment for age, ethnicity and total years of education. While, in women, MCI was best predicted by married status, without exercise practice, overweight and obesity. These results suggest that approximately one-fifth of the studied elderly people had MCI. Predictors for MCI are totally different between men and women. It is critical to identify those at higher risk for MCI in order to implement preventative measures to delay or reverse this abnormal condition.

Case study in treatment of diabetic foot ulcer with alimentary gelatin

The patient with diabetic foot ulceration is undoubtedly one of the major challenges faced by nurses and physicians working in the field of wound treatment. About 15% of diabetic patients experience foot ulceration in the course of their disease. This article reports the adoption of an unconventional treatment, based on gelatin, in a case of a stagnant diabetic foot ulcer, resulting in the successful healing of the wound and the limb being saved. Gelatin is fundamentally denatured collagen; its presence is paramount in the natural healing process, and this may be one of the reasons that the treatment obtained a good result. The fact that the gelatin used is of animal origin does not appear to compromise the outcome of treatment.

Cellular telephones measure activity and lifespace in community-dwelling adults: proof of principle

OBJECTIVES

To describe a system that uses off-the-shelf sensor and telecommunication technologies to continuously measure individual lifespace and activity levels in a novel way.

DESIGN

Proof of concept involving three field trials of 30, 30, and 21 days.

SETTING

Omaha, Nebraska, metropolitan and surrounding rural region.

PARTICIPANTS

Three participants (48-year-old man, 33-year-old woman, and 27-year-old male), none with any functional limitations.

MEASUREMENTS

Cellular telephones were used to detect in-home position and in-community location and to measure physical activity. Within the home, cellular telephones and Bluetooth transmitters (beacons) were used to locate participants at room-level resolution. Outside the home, the same cellular telephones and global positioning system (GPS) technology were used to locate participants at a community-level resolution. Physical activity was simultaneously measured using the cellular telephone accelerometer.

RESULTS

This approach had face validity to measure activity and lifespace. More importantly, this system could measure the spatial and temporal organization of these metrics. For example, an individual's lifespace was automatically calculated across multiple time intervals. Behavioral time budgets showing how people allocate time to specific regions within the home were also automatically generated.

CONCLUSION

Mobile monitoring shows much promise as an easily deployed system to quantify activity and lifespace, important indicators of function, in community-dwelling adults.

Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database

BACKGROUND/OBJECTIVES

Routine nutrition screening is recommended for all older patients admitted to hospital however data on the prevalence of malnutrition in rehabilitation settings is sparse. This study assessed the nutritional status of older patients admitted to rehabilitation hospitals over a 5 year period and described the association between nutritional status and length of hospital stay (LOS) in this context. The usefulness of a recently revised version of the shortened MNA (MNA-SF) was also investigated.

METHODS

A retrospective analysis was conducted of patients aged 65 + y admitted to two rehabilitation hospitals in New South Wales, Australia between 1st March 2003-30th June 2004, and 11th January 2005-10th December 2008. Nutritional status was determined on admission by trained dietitians using the full MNA instrument and the MNA-SF. Information on diagnosis-related grouping and length of stay (LOS) was obtained.

RESULTS

Data was available for 2076 patients with a mean age of 80.6 (27.7) y. Thirty-three percent and 51.5% of patients were classified as malnourished and at nutritional risk, respectively. Controlling for date of admission and diagnosis related grouping, LOS was higher in malnourished and at risk groups compared to their well nourished peers (P < 0.001) by 18.5 and 12.4 days, respectively. MNA-SF demonstrated high sensitivity but relatively low specificity against the full MNA.

CONCLUSION

The majority of older patients in the rehabilitation setting are nutritionally compromised which adversely influences LOS. In order to encourage more widespread screening, the MNA-SF may be able to replace the full MNA.

Relationship between anaemia and cognitive functions in elderly people

BACKGROUND

The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people.

METHODS

This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folstein's Mini-Mental State Examination (MMSE).

RESULTS

The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring.

CONCLUSION

In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.

Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature

BACKGROUND

The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.

METHODS

English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.

RESULTS

In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.

CONCLUSION

Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.

Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study

Background

District nurses (DNs) provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs) have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions.

Methods

Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM) was used in the analyses.

Results

The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment.

Conclusion

The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to stay in charge of the medical treatment. The complexity of the situation made it problematic for the FP to make adequate decisions about the goal of the medical treatment. The goal of the treatment had to be constantly evaluated based on information from the DN and other care providers, and thus this information was absolutely crucial.

Well-being of family caregivers of persons with late-stage Huntington's disease: lessons in stress and coping

The utility of a stress-process model in predicting health and quality-of-life outcomes for family caregivers of persons with Huntington's disease (HD) was tested. HD is an inherited neurodegenerative disease that poses particular challenges to patients and families. Seventeen family caregivers were interviewed and completed scales measuring stressors, appraisals, protective factors, and outcomes. No direct relationship between stress and caregiver well-being was found; the impact of stressors was mediated by appraisals and protective factors. Bivariate correlation analysis revealed significant positive relationships between satisfaction with emotionally supportive communication and life satisfaction. Significant positive correlations were found between positive appraisals of the benefits of the caregiving experience and life satisfaction and health. Mastery was significantly positively correlated with life satisfaction and negatively correlated with depressive symptoms; similar results were found between spirituality and outcome measures. Caregivers' interpretations appeared to have a more significant impact on well-being than did objective characteristics of the experience.

Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes

The aim of this study is to produce the relation between cognitive and functional performance and some biochemical parameters in elderly population. So, we searched for the correlation between the activities of daily living (ADL), mini-mental state examination (MMSE) and body weight, age, hemoglobin, albumin, serum sodium level of 180 elderly people in five nursing homes. Face-to-face interviews and questionnaires were applied to evaluate ADL. To evaluate the cognitive function we used the MMSE. The average age of 180 people contacted was 71.5+/-5.1 (+/-S.D.), ranging 65-91 years; 112 of them were women (62.2%), 68 were men (37.8%). Of these elderly people, 25% had no medically diagnosed illnesses, whereas 17 of them (9.4%) were bedridden. There was a positive correlation between ADL and hemoglobin, albumin, body weight, cognitive function parameters and a negative one with age and serum sodium. There was a positive correlation between cognitive functions and hemoglobin, body weight, ADL and a negative one with serum sodium. Hemoglobin concentrations indicating anemia were observed in 30% of subjects, 3.9% of them had hyponatremia and 26.7% displayed a hypernatremia. There was a positive correlation between cognitive and physical function scores and hemoglobin, albumin levels in elderly patients. These results suggest that restoration of hemoglobin and albumin levels could improve cognitive and physical functional status in the elderly population.

Hypermagnesemia predicts mortality in elderly with congestive heart disease: relationship with laxative and antacid use

The aim of this study was to evaluate the role of magnesium levels on 3-year survival in the elderly with congestive heart failure (CHF) admitted to the Rehabilitative Cardiology Unit of S. Maugeri Foundation Scientific Institute of Telese/Campoli. All elderly patients > or = 65 years old with a diagnosis of CHF underwent clinical and instrumental examination, and their demographics, co-morbidity, and in-hospital and 3-year mortality rates were recorded. Hypomagnesemia was found in 4.8%, normomagnesemia in 67.5%, and hypermagnesemia in 27.8% of subjects. The hypomagnesemic group was excluded for numerical exiguity; the analysis was performed on a total of 199 elderly patients. Hypermagnesemia was found in 29.1% and normomagnesemia in 70.9%. At the univariate analysis no differences were found in hypermagnesemia in respect to normomagnesemia group, except for slightly higher levels of creatininemia (1.35 +/- 0.61 vs. 1.13 +/- 0.55 mg/dL, respectively; p < 0.02), greater disability (lost ADL, 2.69 +/- 1.57 vs. 2.15 +/- 1.56, respectively; p < 0.05), more mortality for CHF (32.6 vs. 48.3%; p < 0.05), and higher antacid and laxative use (82.7 vs. 24.8%, respectively; p < 0.0001). Patients with higher magnesium showed less probability to survive at a 3-year follow-up than did patients with lower levels (17.32 +/- 15.93 vs. 22.46 +/- 16.16 months; p < 0.05), and this finding remained significant in the multivariate analysis after adjusting for some confounders. Finally hypermagnesemia should also be considered in the absence of pre-existing renal failure clinical evidence because of its negative prognostic value, especially in elderly patients with CHF. The shown relationship between hypermagnesemia and laxative/antacid use should induce physicians to pay more attention to abuse of these drugs.

The MNA, but not the DETERMINE, screening tool is a valid indicator of nutritional status in elderly Africans

OBJECTIVES

We compared the validity of existing nutrition screening tools for use in older South Africans.

METHODS

This was a cross-sectional study in 283 free-living and institutionalized black South Africans > or = 60 y of age. Trained fieldworkers administered a 24-h recall, the DETERMINE and Mini-Nutritional Assessment (MNA) screening tools, and performed anthropometric measurements and physical function tests. Biochemical indicators assessed included serum albumin, hemoglobin, ferritin, vitamin B12, red blood cell folate, cholesterol, and vitamin C. The six-item Cognitive Impairment Test was used to assess cognitive function.

RESULTS

The MNA score was positively and significantly associated with anthropometric measurements, cognitive function, instrumental activities of daily living and, in women only, percentage of body fat, handgrip strength, and activities of daily living. Compared with the MNA, the DETERMINE instrument had a low positive predictive value (55.6%) and specificity (11.2%), resulting in a high rate of false positives classified as being malnourished.

CONCLUSION

The MNA, but not the DETERMINE, screening tool is appropriate for use in identifying older black South Africans who are malnourished or at risk of malnutrition.