Psychometric Properties of the Functional Capacity Card Sort for Caregivers of People With Dementia

Caregiver appraisal influences care decisions and may place the person with dementia at risk. The Functional Capacity Card Sort (FCCS) was developed to determine caregiver appraisal. The objective of this study was to examine FCCS psychometric properties and utility, using data from a cross-sectional study ( N = 86). The FCCS had moderately positive association (convergent validity) with a related activities of daily living (ADL) index ( r = .43, p < .0001), weak negative association (discriminant validity) with an unrelated neuropsychiatric symptom index ( r = −.14, p = .16), and strong caregiver agreement (interrater reliability) in ranking cards from high to low function, Kendall’s W(5, 72) = 0.83, p = .0001. When compared with occupational therapy assessment, the FCCS distinguished caregiver concordant estimation (17%), underestimation (22%), and overestimation (61%) of function. The FCCS is a valid and reliable tool used in conjunction with formal assessment to identify caregiver over- or underestimation, which has implications for patient safety and caregiver education.

Comparing day care at green care farms and at regular day care facilities with regard to their effects on functional performance of community-dwelling older people with dementia

Day care at green care farms (GCFs) is a new care modality for community-dwelling older people with dementia. In view of the more physical and normal daily life activities available at GCFs than at RDCFs, we investigated whether functional decline differed between subjects from both day care settings. In this observational cohort study, primary caregivers of 47 subjects from GCFs and 41 subjects from RDCFs rated the subjects’ functional performance three times during one year. They also provided information on the subjects’ diseases and medication use. Generally, no significant change over time in functional performance, the number of diseases and the number of medications was observed, and no differences in these rates of change were found between subjects from both day care settings. This study suggests that GCFs are not more effective in maintaining functional performance or slowing down its decline in community-dwelling older people with dementia than RDCFs.

A measurement model of youth physical activity using pedometer and self, parent, and peer reports

BACKGROUND

Because no single measure is able to accurately assess all types of physical activity (PA), some researchers advocate use of multiple methods and multiple informants to measure PA. However, little research has tested the validity of proxy reports of youth PA.

PURPOSE

The current study determined whether peer, parent, and self-reports reflects a latent measure of youth PA. As a test of construct validity, pedometer data were included in the model and covaried with the second-order target youth PA factor to determine the relationship between the youth PA factor and an objective measure of PA.

METHOD

Participants included 291 target youth (ages 10, 12, or 14 years), a peer, and a parent of each target child (N = 873). Each participant reported about target children's vigorous PA during the past 7 days, days of PA in a typical week, and PA compared to others the same age and sex. Pedometers recorded the average number of steps taken per day by target youth over 7 days.

RESULTS

Analyses indicated an acceptable fit of the model to the data, as all variables loaded significantly on their respective factors, and all factors had significant loadings on the higher-order target PA factor. A moderate correlation was observed between the higher-order youth PA factor and the pedometer measure.

CONCLUSION

Combining multiple reports of youth PA has the potential to yield a more comprehensive measure of youth PA but may not be practical for all studies.

Alive and well: the state of behavioral gerontology in 2011

In this paper, the authors present a brief personal account of the senior author's 30 years of exploration in behavioral gerontology. The main thesis of the paper is that behavioral methods and interventions have found a home both in mainstream gerontology and at the National Institutes of Health (NIH). There are three sections: (a) a personal vignette discussing the problems inherent in using operant terminology in a nonoperant world; (b) a discussion, with examples from NIH sources, of the Institutes' views on behavior change; and (c) using Burgio and Burgio (1986) as a reference point, the authors show evidence of progress and vitality of behavioral gerontology in 2011.

Behavioral symptoms of dementia: a dyadic effect of caregivers' stress process?

This study used multilevel modeling to evaluate a newly revised model in which dementia caregivers' stress process variables-perceived stress and emotional-behavioral responses-were posited as predictors of behavioral symptoms of dementia (BSD) within community-based dyads. Secondary analyses were conducted on data from a primary two-group (experimental and control) trial, in which experimental participants received a home monitoring system for managing nighttime activity in individuals with dementia. Models indicated that caregivers' trajectories did not differ significantly between groups over time; however, the time-by-group interaction of BSD approached significance. Because BSD were not targeted, this indicated that the system may have indirectly lowered BSD. In addition, caregivers' perceived stress and emotional-behavioral responses predicted BSD, on average (across all occasions) and from occasion to occasion, with higher levels associated with worse BSD. These limited results provide support for further research to investigate the nature of these relationships.

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.