1
|
Camp N, Johnston J, Lewis MGC, Zecca M, Di Nuovo A, Hunter K, Magistro D. Perceptions of ADLs and In-Home ADL monitoring technology among Community-Dwelling Older Adults: a qualitative study (Preprint). JMIR Aging 2021; 5:e33714. [PMID: 35511248 PMCID: PMC9121226 DOI: 10.2196/33714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/21/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances.
Collapse
Affiliation(s)
- Nicola Camp
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Julie Johnston
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | | | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Alessandro Di Nuovo
- Institute of Electrical and Electronics Engineers, Sheffield Hallam University, Sheffield, United Kingdom
| | - Kirsty Hunter
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Daniele Magistro
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| |
Collapse
|
2
|
Camp N, Lewis M, Hunter K, Johnston J, Zecca M, Di Nuovo A, Magistro D. Technology Used to Recognize Activities of Daily Living in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E163. [PMID: 33379319 PMCID: PMC7795436 DOI: 10.3390/ijerph18010163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 02/03/2023]
Abstract
The use of technology has been suggested as a means of allowing continued autonomous living for older adults, while reducing the burden on caregivers and aiding decision-making relating to healthcare. However, more clarity is needed relating to the Activities of Daily Living (ADL) recognised, and the types of technology included within current monitoring approaches. This review aims to identify these differences and highlight the current gaps in these systems. A scoping review was conducted in accordance with PRISMA-ScR, drawing on PubMed, Scopus, and Google Scholar. Articles and commercially available systems were selected if they focused on ADL recognition of older adults within their home environment. Thirty-nine ADL recognition systems were identified, nine of which were commercially available. One system incorporated environmental and wearable technology, two used only wearable technology, and 34 used only environmental technologies. Overall, 14 ADL were identified but there was variation in the specific ADL recognised by each system. Although the use of technology to monitor ADL of older adults is becoming more prevalent, there is a large variation in the ADL recognised, how ADL are defined, and the types of technology used within monitoring systems. Key stakeholders, such as older adults and healthcare workers, should be consulted in future work to ensure that future developments are functional and useable.
Collapse
Affiliation(s)
- Nicola Camp
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (K.H.); (J.J.)
| | - Martin Lewis
- Department of Sport and Exercise Science, University of Derby, Derby DE22 1GB, UK;
| | - Kirsty Hunter
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (K.H.); (J.J.)
| | - Julie Johnston
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (K.H.); (J.J.)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, UK;
| | | | - Daniele Magistro
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK; (N.C.); (K.H.); (J.J.)
| |
Collapse
|
3
|
Yong B, Lin R, Xiao H. Factors associated with nursing home adjustment in older adults: A systematic review. Int J Nurs Stud 2020; 113:103790. [PMID: 33161332 DOI: 10.1016/j.ijnurstu.2020.103790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND An ageing population has resulted in increased numbers of older adults moving to a nursing home, and the challenges triggered by relocation are highlighted. Various factors are identified to be associated with relocation and psychological adjustment to living in a nursing home. However, no systematic review has synthesised the evidence, and its associated factors remain unclear. OBJECTIVE To examine and synthesise the best available evidence on the factors associated with adjustment to living in a care facility. DESIGN Systematic review. DATA SOURCES Nine electronic databases were searched from database inception to March 2020: Pubmed, Embase, CINAHL, PsycINFO, Cochrane library, China National Knowledge Infrastructure, China Wanfang Database, Chinese Biomedical Literature Database, Chinese Periodical Full-text Database. REVIEW METHODS The references listed in the included studies were manually checked. The quality of the eligible studies was assessed using the 11-item checklist of the Agency for Healthcare Research and Quality. RESULTS A total of 20 studies were included in this review, with 17 cross-sectional studies, and three longitudinal study. 19 studies were rated as moderate quality and the other one was high quality. 17 measures were used to assess nursing home adjustment. Six distinct categories of the associated factors for nursing home adjustment were identified: demographic characteristics (n = 11), physiological factors (n = 3), psychological factors (n = 9), social factors (n = 9), relocation factors (n = 6), and facility factors (n = 5). CONCLUSIONS Decision-making control, self-efficacy, social support, activities of daily living, and length of stay should all be taken into account when assisting resident scoping with a relocation to a nursing home. Infuture research, multiple areas can be considered when improving the level of nursing home adjustment, as well as interventions and health policies. REGISTRATION NUMBER PROSPERO CRD 42018115935. TWEETABLE ABSTRACT A systematic review of the factors associated with adjustment to living in a care facility.
Collapse
Affiliation(s)
- Binbin Yong
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rongjin Lin
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, NO 1 Xuefu North Road, University Town, Shangjie Zhen, Minhou County, Fuzhou City, Fujian Province, China.
| |
Collapse
|
4
|
Berkers E, Cloïn M, Pop I. Informal help in a local setting: The Dutch Social Support Act in practice. Health Policy 2020; 125:47-53. [PMID: 33012538 DOI: 10.1016/j.healthpol.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022]
Abstract
The Dutch Social Support Act provides municipal social support for people that experience limitations in daily life and cannot rely on informal help from their social network to compensate these limitations. In this paper, we study whether the probability and intensity (number of services) of receiving municipal social support for daily limitations is affected by informal help by the social network (i.e. family, friends and neighbors). This study took place in Breda, a middle large city in the South of the Netherlands. We combined data from the Municipal Personal Records Database, the registration containing information on demographics and municipal social support receipt of all inhabitants, with data from the Municipality Policy Monitor, a survey containing information on daily limitations and informal help (n = 5256). We find that people experiencing daily limitations are more likely to receive municipal social support and also receive a higher number of support services (intensity). However, the perceived help from family and friends does not decrease either the probability or intensity of receiving municipal social support. Informal help from neighbors decreased the likelihood of receiving of municipal social support, but not the intensity. This implies that the overall relation between daily limitations and municipal social support is not different for people who indicate that they can or cannot rely on their informal network for help.
Collapse
Affiliation(s)
- Eline Berkers
- Department of Sociology, Tilburg University, the Netherlands; Tranzo, Tilburg University, the Netherlands.
| | | | - Ioana Pop
- Department of Sociology, Tilburg University, the Netherlands.
| |
Collapse
|
5
|
Schluter PJ, McAuliffe MJ, Askew DA, Jamieson HA. Hearing ability is not a risk factor for admission to aged residential care of older persons in New Zealand. Sci Rep 2019; 9:17272. [PMID: 31754118 PMCID: PMC6872587 DOI: 10.1038/s41598-019-53457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/01/2019] [Indexed: 11/22/2022] Open
Abstract
Aged residential care (ARC) admission needs are increasing beyond the available capacity in many countries, including New Zealand. Therefore, identifying modifiable factors which may prevent or delay ARC admissions is of international importance. Hearing impairment is common among older adults and thought to be an important predictor, although the current evidence-base is equivocal. Using the largest national database to date, competing-risk regression analysis was undertaken on 34,277 older adults having standardised home care assessments between 1 July 2012 and 31 May 2014, aged ≥65 years, and still living in the community 30 days after that assessment. Minimal hearing difficulty was reported by 10,125 (29.5%) participants, moderate difficulty by 5,046 (14.7%), severe difficulty/no hearing by 1,334 (3.9%), while 17,769 (51.8%) participants reported adequate hearing. By 30 June 2014, the study end-point, 6,389 (18.6%) participants had an ARC admission while 6,082 (17.7%) had died. In unadjusted competing-risk regression analyses, treating death as a competing event, hearing ability was significantly associated with ARC admission (p < 0.001). However, in adjusted analyses, this relationship was completely confounded by other variables (p = 0.67). This finding implies that screening for hearing loss among community-living older adults is unlikely to impact on ARC admission rates.
Collapse
|
6
|
Hermans S, Sevenants A, Declercq A, Van Broeck N, Deliens L, Cohen J, Van Audenhove C. Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals. Int J Integr Care 2019; 19:3. [PMID: 30971869 PMCID: PMC6450250 DOI: 10.5334/ijic.4186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Nursing home residents are a vulnerable and frail segment of the population, characterised by their complex and palliative care needs. To ensure an integrated approach to palliative care for this target group, working on a collaborative basis with multiple providers across organisational boundaries is necessary. Considering that coordinators of palliative networks support and coordinate collaboration, the research question is: 'how do network coordinators perceive the process of collaboration between organisations in Flemish palliative networks?' METHODS A dual-phase sequential mixed-methods design was applied. First, the coordinators of each of the fifteen palliative networks in Flanders completed a survey in which they evaluated ten aspects of collaboration for two types of cooperation: between nursing homes and home care, and between nursing homes and hospitals. Next, the survey results thus obtained were discussed to improve understanding in a focus group composed of the above coordinators, and which was analysed on the basis of content analysis. RESULTS In both forms of cooperation, the 'formalisation' and 'governance' were the aspects that yielded the lowest mean scores. The coordinators in the focus group expressed a need for more formalised interaction among organisations with regard to palliative care, the establishment of formal channels of communication and the exchange of information, as well as the development of shared leadership. CONCLUSIONS The perspectives of the coordinators on inter-organisational collaboration are a valuable starting point for interventions directed at the stronger integration of palliative care for residents of long term-care facilities.
Collapse
Affiliation(s)
- Sofie Hermans
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Aline Sevenants
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Anja Declercq
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Nady Van Broeck
- KU Leuven – University of Leuven, Department of Clinical Psychology, Tiensestraat, Leuven, BE
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, BE
- Department of Internal Medicine, Ghent University, Ghent, BE
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, BE
| | - Chantal Van Audenhove
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| |
Collapse
|
7
|
Flanagan P, Kelly R. Discharge Home From Hospital: How DIRE Can It Be? J Appl Gerontol 2019; 38:530-552. [DOI: 10.1177/0733464817723089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: An easy-to-use “DIRE” questionnaire tool was developed to predict an adverse event (AE) within 30 days following discharge from a hospital to the community, among frail elderly individuals aged 65+ years. Methods: Hospital-administered RAI-HC (Residential Assessment Instrument for Home Care) assessment data from 1,433 individuals were used to develop the tool. Results: The DIRE tool outperformed two other instruments that have been used to predict risk in similar populations. Furthermore, the DIRE index was validated on a hold-out sample and in a bootstrapping analysis. Discussion: In addition to its effectiveness in predicting an AE, the added advantages of the DIRE assessment is that only a small amount of data is required and the data are readily available to clinicians at the point of hospital discharge.
Collapse
Affiliation(s)
- Priti Flanagan
- Fraser Health Authority, Burnaby, British Columbia, Canada
| | - Ronald Kelly
- Fraser Health Authority, Burnaby, British Columbia, Canada
| |
Collapse
|
8
|
Chen B, Huang Y, Wang D, Deng W. Comparison of Performance-Based Observed Assessment, Self-Report, and Paper–Pencil Measures of Everyday Problem Solving in Chinese Older Adults. JOURNAL OF ADULT DEVELOPMENT 2018. [DOI: 10.1007/s10804-018-9305-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
Provencher V, Béland F, Demers L, Desrosiers J, Bier N, Ávila-Funes JA, Galand C, Julien D, Fletcher JD, Trottier L, Hami B. Are frailty components associated with disability in specific activities of daily living in community-dwelling older adults? A multicenter Canadian study. Arch Gerontol Geriatr 2017; 73:187-194. [DOI: 10.1016/j.archger.2017.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/14/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
|
10
|
Kelly S, O'Brien I, Smuts K, O'Sullivan M, Warters A. Prevalence of frailty among community dwelling older adults in receipt of low level home support: a cross-sectional analysis of the North Dublin Cohort. BMC Geriatr 2017; 17:121. [PMID: 28592236 PMCID: PMC5463412 DOI: 10.1186/s12877-017-0508-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty. METHODS A total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis. RESULTS The cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65-84 years. However, in the oldest age groups, namely 90-94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508. CONCLUSION A high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.
Collapse
Affiliation(s)
- Sara Kelly
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Irene O'Brien
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Karla Smuts
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland.,Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Maria O'Sullivan
- Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Austin Warters
- Health Service Executive Healthcare Facility, Ballymun, Dublin 9, Ireland.
| |
Collapse
|
11
|
Ran L, Jiang X, Li B, Kong H, Du M, Wang X, Yu H, Liu Q. Association among activities of daily living, instrumental activities of daily living and health-related quality of life in elderly Yi ethnic minority. BMC Geriatr 2017; 17:74. [PMID: 28330442 PMCID: PMC5361829 DOI: 10.1186/s12877-017-0455-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background The health-related quality of life (HRQoL) of the elderly population of Yi ethnic minority, which is the seventh largest nationality in China, has been rarely reported. This study was designed to explore the HRQoL of the elderly Yi ethnicity and association between their HRQOL and functional abilities. Methods A total of 291 Yi ethnic residents were randomly recruited from 12 rural counties in Yunnan province and divided into different age groups. Local residents in Yunnan province and the elderly from Hangzhou were enrolled as controls. The MOS 36-Item Short Form Health Survey (SF-36), activities of daily living (ADL), instrumental activities of daily living (IADL) scales were utilized to evaluate the HRQoL and functional ability. One-way ANOVA was used to statistically compare the ADL and IADL among different age groups. The influential variables on HRQOL were analyzed by multiple linear regression analysis. Pearson correlation analysis was used to analyze the association among HRQoL, ADL and IADL. Results The HRQoL of the elderly Yi minority was significantly lower than those of local residents in Yunnan province and the elderly counterparts in Hangzhou. The IADL ability of the elderly Yi minority was low, whereas they could perform most items of ADL. ADL, IADL, and education level were positively associated with HRQoL, whereas age, chronic diseases, and the frequency of medication use were negatively correlated with HRQoL. Conclusion The HRQoL and functional capacity of the elderly Yi ethnic minority were lower compared with their counterparts in Yunnan province and Hangzhou. The low level of IADL indicated that the elderly Yi participants had a high risk of cognitive impairment. Much attention should be diverted to influential factors of the HRQoL. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0455-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lingyun Ran
- Nursing School of Kunming Medical University, Kunming, Yunnan Province, China.
| | - Xiaodong Jiang
- Chongqing Three Gorges Medical College, Chongqing, China
| | - Baogang Li
- Nursing School of Kunming Medical University, Kunming, Yunnan Province, China
| | - Hongqian Kong
- Public Health School of Kunming Medical University, Kunming, China
| | - Mengqi Du
- No.1 High School, Kunming, Yunnan, China
| | - Xiaolan Wang
- Nursing School of Kunming Medical University, Kunming, Yunnan Province, China
| | - Hua Yu
- Nursing School of Kunming Medical University, Kunming, Yunnan Province, China
| | - Qin Liu
- Tumor Hospital of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| |
Collapse
|
12
|
Adelman EE, Lisabeth LD, Smith MA, Baek J, Case EC, Sánchez BN, Burke JF, Skolarus LE, Zahuranec DB, Meurer WJ, Brown DL, Kerber KA, Levine DA, Garcia NM, Campbell MS, Morgenstern LB. Stroke Performance Measures Do Not Predict Functional Outcome. Neurohospitalist 2016. [PMID: 28634500 DOI: 10.1177/1941874416675797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Poststroke functional outcome is critical to stroke survivors. We sought to determine whether adherence to current stroke performance measures is associated with better functional outcome 90 days after an ischemic stroke. METHODS Utilizing the Brain Attack Surveillance in Corpus Christi cohort, we examined adherence to 7 ischemic stroke performance measures from February 2009 to June 2012. Adherence to the measures was analyzed in aggregate using a binary defect-free score and an opportunity score, representing the proportion of eligible measures met. The opportunity score ranges from 0 to 1, with values closer to 1 implying better adherence. Functional outcome, defined by an activities of daily living and instrumental activities of daily living (ADL/IADL) score (range 1-4, higher scores worse), was ascertained at 90 days poststroke. Tobit regression models were fitted to examine the associations between the performance measures and functional outcome, adjusting for demographic and clinical characteristics, including stroke severity. RESULTS There were 565 patients with ischemic stroke included in the analysis. The median ADL/IADL score was 2.32 (interquartile range [IQR]: 1.41-3.41). The median opportunity score was 1 (IQR: 0.8-1), and 58.4% of the patients received defect-free care. After adjustment, the opportunity score (P = .67) and defect-free care (P = .92) were not associated with functional outcome. CONCLUSION In this population, adherence to a composite of current stroke performance measures was not associated with poststroke functional outcome after adjustment for other factors. Performance measures that are associated with improved functional outcome should be developed and incorporated into stroke quality measures.
Collapse
Affiliation(s)
- Eric E Adelman
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Lynda D Lisabeth
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Melinda A Smith
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jonggyu Baek
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erin C Case
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - James F Burke
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA
| | - Lesli E Skolarus
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Darin B Zahuranec
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - William J Meurer
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Devin L Brown
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin A Kerber
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Deborah A Levine
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nelda M Garcia
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Lewis B Morgenstern
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Helvik AS, Høgseth LD, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Selbæk G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. BMC Geriatr 2015; 15:47. [PMID: 25888187 PMCID: PMC4406178 DOI: 10.1186/s12877-015-0047-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/31/2015] [Indexed: 12/01/2022] Open
Abstract
Background There have been few studies of how personal and instrumental activities of daily living (P-ADL and I-ADL) develop over time in older people receiving domiciliary care. This study aimed at assessing variables associated with the development of P-ADL and I-ADL functioning over a 36-month follow-up period, with a particular focus on cognitive functioning. Method In all, 1001 older people (≥70 years) receiving domiciliary care were included in a longitudinal study with three assessments of P-ADL and I-ADL functioning during 36 months. P-ADL and I-ADL were assessed using the Lawton and Brody’s Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale, respectively. Mini Mental State Examination (MMSE), diagnosis of dementia and MCI, neuropsychiatric symptoms and use of psychotropic medication were also evaluated during the three assessments. Baseline demographic and general medical health information and information of being a nursing home resident at follow-up were recorded. Linear mixed models were estimated. Results There was a significant decline in P-ADL and I-ADL functioning throughout the follow-up. A lower MMSE sum-score, diagnosed MCI and dementia, a higher level of neuropsychiatric symptoms and the use of antipsychotics and antidepressants recorded at each assessment were associated with a decline in both P-ADL and I-ADL functioning. Furthermore, a decline in P-ADL and I-ADL functioning at follow-ups was associated with being male, a higher baseline age and in poorer medical health as well as residing in a nursing home at follow-up. Conclusion P-ADL and I-ADL functioning in older people worsened over time. The worsening was associated with lower MMSE sum-score, diagnosed MCI and dementia, poorer medical health, neuropsychiatric symptoms, use of psychotropic medication and being transferred to nursing home care. Clinicians should pay close attention to the assessment and treatment of these factors to help older people maintain their level of functioning for as long as possible.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, NO7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Lisbeth D Høgseth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Jūratė Šaltytė-Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway. .,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Faculty of Health, Care and Nursing, Gjøvik University College, Gjøvik, Norway.
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Akershus University Hospital, Lørenskog, Norway.
| |
Collapse
|
14
|
Home modification by older adults and their informal caregivers. Arch Gerontol Geriatr 2014; 59:648-56. [DOI: 10.1016/j.archger.2014.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
|
15
|
Lisabeth LD, Sánchez BN, Baek J, Skolarus LE, Smith MA, Garcia N, Brown DL, Morgenstern LB. Neurological, functional, and cognitive stroke outcomes in Mexican Americans. Stroke 2014; 45:1096-101. [PMID: 24627112 DOI: 10.1161/strokeaha.113.003912] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Our objective was to compare neurological, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites using data from a population-based study. METHODS Ischemic strokes (2008-2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days poststroke) and medical records. Ethnic differences in neurological (National Institutes of Health Stroke Scale: range, 0-44; higher scores worse), functional (activities of daily living/instrumental activities of daily living score: range, 1-4; higher scores worse), and cognitive (Modified Mini-Mental State Examination: range, 0-100; lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. RESULTS A total of 513, 510, and 415 subjects had complete data for neurological, functional, and cognitive outcomes and covariates, respectively. Median age was 66 (interquartile range, 57-78); 64% were MAs. In MAs, median National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living, and Modified Mini-Mental State Examination score were 3 (interquartile range, 1-6), 2.5 (interquartile range, 1.6-3.5), and 88 (interquartile range, 76-94), respectively. MAs scored 48% worse (95% CI, 23%-78%) on National Institutes of Health Stroke Scale, 0.36 points worse (95% CI, 0.16-0.57) on activities of daily living/instrumental activities of daily living score, and 3.39 points worse (95% CI, 0.35-6.43) on Modified Mini-Mental State Examination than non-Hispanic whites after multivariable adjustment. CONCLUSIONS MAs scored worse than non-Hispanic whites on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.
Collapse
Affiliation(s)
- Lynda D Lisabeth
- From the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S., J.B.), University of Michigan School of Public Health, Ann Arbor; and Stroke Program, University of Michigan Health System, Ann Arbor (L.D.L., L.E.S., M.A.S., N.G., D.L.B., L.B.M.)
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Individual correlates of autonomy in activities of daily living of institutionalized elderly individuals: an exploratory study in a holistic perspective. Holist Nurs Pract 2014; 27:284-91. [PMID: 23925349 DOI: 10.1097/hnp.0b013e31829b9483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed at identifying the individual correlates of autonomy in activities of daily living (ADL) of 40 institutionalized elderly individuals. Results showed that balance skill and perception of physical functioning were significantly associated with ADL. Interventions on the physical functioning, both perceived and real, might have positive influence on the autonomy of institutionalized elderly individuals.
Collapse
|
17
|
Bedaf S, Gelderblom GJ, Syrdal DS, Lehmann H, Michel H, Hewson D, Amirabdollahian F, Dautenhahn K, de Witte L. Which activities threaten independent living of elderly when becoming problematic: inspiration for meaningful service robot functionality. Disabil Rehabil Assist Technol 2013; 9:445-52. [DOI: 10.3109/17483107.2013.840861] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Effects of hippotherapy on mobility, strength and balance in elderly. Arch Gerontol Geriatr 2013; 56:478-81. [DOI: 10.1016/j.archger.2012.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/05/2012] [Accepted: 12/07/2012] [Indexed: 11/17/2022]
|