Validation of the World Health Organization Disability Assessment Schedule 2.0 among older adults in an Asian country

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) as a measure among elderly population. A review

OBJECTIVES

To review the World Health Organization Disability Assessment Schedule (WHODAS2.0) application in elderly population.

METHODS

A review of English articles was performed using the following databases: PubMed/Medline, Scopus, Web of Science, Cochrane, Embase. Only articles assessing disability through WHODAS2.0 in elderly population (>60-years-old) were included according to PRISMA Statement.

RESULTS

37 papers satisfied the inclusion criteria reporting 125.624 cases of elderly whose disability was assessed using WHODAS2.0 in different versions (36-items-version in 15 studies; 12-items-version in 15 papers; both versions in 3 articles; data unavailable in 4 studies). Four different aims were recognized: WHODAS 2.0 was used in 12 studies to assess the prevalence of disability, 25 studies of association between disability and environmental or medical conditions; 9 studies of validation of WHODAS and 2 studies to verify the outcome of therapies on functioning. Conclusions: WHODAS2.0 is a valid measure of disability among elderly, able to identify the relation between disability, and medical and environmental factors. Unfortunately, only few Countries apply the "bio-psycho-social" approach to social and health policies context. Therefore, it is recommended to adopt a rehabilitation perspective in every legislation. These results could serve as baseline data to monitor the application of WHODAS2.0 over the coming years.

Mapping the World Health Organization Disability Assessment Scale 2.0 to the EQ-5D-5L in patients with mental disorders

OBJECTIVE

The current study aims to develop an algorithm for mapping the WHODAS 2.0 to the EQ-5D-5 L for patients with mental disorders.

METHODS

This cross-sectional study was conducted at the Institute of Mental Health and Community Wellness Clinics in Singapore between June 2019 and November 2022. We included four regression methods including the Ordinary Least Square (OLS) regression, the Tobit regression model (Tobit), the robust regression with MM estimator (MM), and the adjusted limited dependent variable mixture model (ALDVMM) to map EQ-5D-5 L utility scores from the WHODAS 2.0.

RESULTS

A total of 797 participants were included. The mean EQ-5D-5 L utility and WHODAS 2.0 total scores were 0.615 (SD = 0.342) and 11.957 (SD = 8.969), respectively. We found that the EQ-5D-5 L utility score was best predicted by the robust regression model with the MM estimator. Our findings suggest that the WHODAS 2.0 total scores were significantly and inversely associated with the EQ-5D-5 L utility scores.

CONCLUSION

This study provides a mapping algorithm for converting the WHODAS 2.0 scores into EQ-5D-5 L utility scores which can be implemented using a simple online calculator in the following web application: https://eastats.shinyapps.io/whodas_eq5d/.

Health and disability - a multi-group latent class analysis of the World Health Organization Disability Assessment Schedule 2.0 among those with mental and physical health conditions

BACKGROUND

This study aims to identify disability classes among people with schizophrenia spectrum disorder, depression, anxiety or diabetes via the WHODAS 2.0; investigate the invariance of disability patterns among the four diagnostic groups; and examine associations between disability classes and sociodemographic variables.

METHODS

Patients seeking treatment for schizophrenia spectrum disorder, depression, anxiety or diabetes (n=1076) were recruited. Latent class analysis was used to identify disability classes based on WHODAS 2.0 responses. Measurement invariance was tested using multi-group latent class analysis. Associations between classes and sociodemographic variables were tested via multinomial logistic regression.

RESULTS

A five-class solution was identified; examination of model invariance showed that the partially constrained five-class model was most appropriate, suggesting that class structure was consistent while class membership differed across diagnostic groups. Finally, significant associations were found between class membership and ethnicity, education level, and employment status.

CONCLUSIONS

The results show the feasibility of using the WHODAS 2.0 to identify and compare different disability classes among people with mental or physical conditions and their sociodemographic correlates. Establishing a typology of different disability profiles will help guide research and treatment plans that tackle not just clinical but also functional aspects of living with either a chronic psychiatric or physical condition.

What patient-reported outcome measures may be suitable for research involving older adults with frailty? A scoping review

INTRODUCTION

The need to develop and evaluate frailty-related interventions is increasingly important, and inclusion of patient-reported outcomes is vital. Patient-reported outcomes can be defined as measures of health, quality of life or functional status reported directly by patients with no clinician interpretation. Numerous validated questionnaires can thus be considered patient-reported outcome measures (PROMs). This review aimed to identify existing PROMs currently used in quantitative research that may be suitable for older people with frailty.

METHOD

PubMed and Cochrane were searched up to 24/11/22. Inclusion criteria were quantitative studies, use of a PROM, and either measurement of frailty or inclusion of older adult participants. Criteria were created to distinguish PROMs from questionnaire-based clinical assessments. 197 papers were screened. PROMs were categorized according to the domain assessed, as derived from a published consensus 'Standard Set of Health Outcome Measures for Older People'.

RESULTS

88 studies were included. 112 unique PROMs were used 289 times, most frequently the SF-36 (n = 21), EQ-5D (n = 21) and Barthel Index (n = 14). The most frequently assessed outcome domains included Mood and Emotional Health and Activities of Daily Living, with fewer assessments of Participation in Decision-Making and Carer Burden.

CONCLUSIONS

PROM usage in frailty research is highly heterogeneous. Frequently used PROMs omit important outcomes identified by older adults. Further research should evaluate the importance of specific outcomes and identify PROMs relevant to people at different stages of frailty. Consistent and appropriate PROM use in frailty research would facilitate more effective comparisons and meaningful evaluation of frailty interventions.

Extraction methods, multiple biological activities, and related mechanisms of Momordica charantia polysaccharide: A review

Momordica Charantia Polysaccharide (MCP) is a key bioactive compound derived from bitter melon fruit. This review summarizes the advancements in MCP research, including extraction techniques, biological activities, and mechanisms. MCP can be extracted using various methods, and has demonstrated hypoglycemic, antioxidant, anti-inflammatory, and immunoregulatory effects. Research suggests that MCP may regulate metabolic enzymes, oxidative stress reactions, and inflammatory pathways. The review highlights the potential applications of MCP in areas such as anti-diabetes, antioxidant, anti-inflammatory, and immunoregulatory research. Future research should focus on elucidating the molecular mechanisms of MCP and optimizing extraction methods. This review provides a foundation for further research and utilization of MCP.

Validation of the 12-item World Health Organization Disability Assessment Schedule 2.0 in individuals with schizophrenia, depression, anxiety, and diabetes in Singapore

BACKGROUND

There is limited evidence on the reliability and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Asian patient population with mental and physical disorders. The current study aimed to examine the psychometric properties of the WHODAS 2.0 among patients with schizophrenia, depression, anxiety, and diabetes.

METHODS

A total of 1076 patients (M  =  40.9 years, SD  =  14.7) were recruited from the outpatient clinics of a tertiary psychiatric hospital and a primary care clinic. Internal consistency and test-retest reliability, structural validity, convergent validity, agreement, and floor and ceiling effects were examined.

RESULTS

Our confirmatory factor analysis (CFA) showed that the 1-factor model fits our data. Multigroup CFA demonstrated metric and scalar invariance, indicating the scores can be compared across the four conditions. The WHODAS 2.0 scale had excellent reliability in the overall sample and good to excellent reliability across conditions. The test-retest reliability and agreement between self-administered and interviewer-administered modes were good. The WHODAS 2.0 scores had moderate to strong correlations with the Social and Occupational Functioning Scale and the Sheehan Disability Scale scores in the overall sample and across four conditions.

CONCLUSION

Findings suggest that the WHODAS 2.0 is a valid tool to measure functioning and disability in those with schizophrenia, anxiety, depression, and diabetes in an Asian patient population.

Characteristics, comorbidity burden and outcomes in centenarians undergoing surgery in a university hospital: A case series

Introduction

As the population ages, so too does the age of those requiring surgery. People over the age of 100, centenarians, often have a greater degree of comorbidity and frailty than their younger counterparts but may also have a greater incidence of events requiring surgical intervention. There is, however, a dearth of literature describing the clinical course and practical considerations for this vulnerable population undergoing surgery. We aimed to describe the demographics of centenarians undergoing surgery, the procedures they receive, their intraoperative anaesthesia management, and their postoperative outcomes.

Presentation of cases

A retrospective cohort study was completed to understand key perioperative and intraoperative variables linked to improved outcomes. Of the 25 patients included in this study, 22 (88%) were female and the median age was 101 years. Emergency cases predominated (72%) and 44% of surgeries occurred after hours. 60% underwent an intermediate risk surgery, and no centenarians underwent high risk surgery in this study period.

Discussion

64% of patients experienced at least one episode of intraoperative hypotension, with a median 3.5 epochs per patient. 68% of patients experienced postoperative complications and 20% of patients had a complication of Clavien-Dindo severity ≥ III. In centenarians, the risk of high severity postoperative complications was independent of the intrinsic procedural risk.

Conclusion

Centenarian patients have an elevated burden of comorbidity, presenting often in the emergent setting. However, age alone should not preclude surgical intervention as expert multidisciplinary care can have acceptable outcomes.

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Centenarian patients undergoing surgery are frail

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Most centenarian patients experience postoperative complications

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Surgery in centenarians can be feasible and undertaken safely

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Appropriate patient selection leads to acceptable outcomes

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Centenarians should not be denied surgery based on age alone

Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees

Background

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees.

Aims

The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention.

Method

A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0.

Results

The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution.

Conclusions

The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.

Prevalence, Lifestyle Correlates, and Psychosocial Functioning Among Multi-Ethnic Older Adults with Mild Cognitive Impairment in Singapore: Preliminary Findings from a 10/66 Population Study

Asia, which has the highest increase in dementia prevalence, is unfortunately lacking recent up-to-date research, with regions of Southeast Asia being the most inadequate. Preventive approaches, such as the understanding of Mild Cognitive Impairment (MCI), are currently the most effective approach in reducing the risk or delaying the onset of dementia but are not adequately understood. Additionally, there is a paucity of research examining lifestyle and sociodemographic correlates of MCI that are relevant to the local population of Singapore. To address these gaps, this study aimed to explore: 1) the prevalence of MCI and Amnestic Mild Cognitive Impairment (aMCI), 2) the psychosocial and lifestyle correlates of MCI and aMCI. Data were drawn from the Well-being of the Singapore Elderly (WiSE) population study, which is a single-phase cross-sectional household survey conducted among older adult residents aged 60 years and above. Analyses revealed that the weighted MCI prevalence (1.2%) was lower than global figures. Few sociodemographic and lifestyle habits were related to MCI prevalence, as only age and physical activeness emerged as significant correlates. Despite the low prevalence of MCI, individuals with MCI experienced marked disability, clinical levels of depression and anxiety, which are all concerning finds. Due to the exploratory and cross-sectional nature of the study, future longitudinal research could further refine our understanding of MCI and confirm the present findings.

Living arrangements and cognitive abilities of community-dwelling older adults in Singapore

AIM

Dementia is a growing public health concern. It is necessary to focus on factors that may help preserve cognitive function in late life. Limited research has examined how living arrangements are associated with cognitive function in older adults. This study aims to further our understanding of this association in community-dwelling older adults in a multi-ethnic Asian population.

METHODS

Data were obtained from a cross-sectional population survey of 2548 adults aged 60 and older with standardized instruments. Living arrangements were classified as living with adult children and grandchildren, living with adult children only, living with a spouse/partner only, living alone, living with other relatives, and living with non-relatives.

RESULTS

Cognitive function was significantly predicted by living arrangements among community-dwelling older adults. Multivariate linear regression analyses revealed that older adults in multigenerational family households had significantly poorer cognitive function than those living with a spouse/partner (β = 0.54, P < 0.02) and those living with non-relatives (β = 1.08, P < 0.02). This association was independent of the influence of age, gender, ethnicity, education, employment status, marital status, depression, disability, chronic health conditions, and self-reported health.

CONCLUSION

Older adults living in multigenerational households seem to be disadvantaged in their cognitive function. However, we cannot conclude this based on the evidence because of the cross-sectional nature of the data. Further research is needed to reasonably determine the relationship between living arrangements and cognitive function. Regardless, these findings add to the growing understanding of the complex relationship between living arrangements and cognition in older adults and could provide a basis to design effective strategies to delay cognitive decline in community-dwelling older adults.