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Objective: To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: In this study, 85 patients with MCI and 93 with AD, stratified by age (≤ 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed. Results: Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients. Conclusion: The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.
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... The data were collected by using an interview schedule comprised of (a) Sociodemographic profile of patient, (b) Clinical profile of patient, (c) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, 6 (d) Visual analog pain scale 7 and general activity of daily living (GADL) scale. 8 Western Ontario and McMaster Universities Osteoarthritis Index scale and visual analog pain scale were freely available for the use of researchers. Permission to use the GADL scale was obtained from the authors. ...
... Internal consistency of the scale is 0.849. 8 As per the visual analog pain scale, participants rank their response from 0 to 10. It was divided into 5 categories (1) 0-no pain, (2) 1-3-mild pain, (3) 4-6-moderate to severe, (4) 7-9-very severe, and (5) 10-worst pain. ...
... 5 There are two groups of ADLs: basic ADLs (BADLs) and instrumental ADLs (IADLs). BADLs refer to the fundamental skills needed to manage basic physical needs (e.g., bathing, dressing, toileting, transferring, and feeding), 6,7 while IADLs refer to more complex activities related to independent living in the community (e.g., using the telephone, handling finance and managing medications). 6,8 Impairment in ADLs is one of the most common reasons for increased dependency among people with dementia which leads to increased nursing care needs, 9,10 poor quality of life, 9 and institutionalization. 11 As the majority of people with dementia tend to live in the community, 12 family caregivers are needed to support their ADL needs. ...
... BADLs refer to the fundamental skills needed to manage basic physical needs (e.g., bathing, dressing, toileting, transferring, and feeding), 6,7 while IADLs refer to more complex activities related to independent living in the community (e.g., using the telephone, handling finance and managing medications). 6,8 Impairment in ADLs is one of the most common reasons for increased dependency among people with dementia which leads to increased nursing care needs, 9,10 poor quality of life, 9 and institutionalization. 11 As the majority of people with dementia tend to live in the community, 12 family caregivers are needed to support their ADL needs. Due to the deterioration of ADLs in people with dementia, providing functional care is very complex, and usually, family caregivers need specialized knowledge and skills to assist or provide this care. ...
Article
The co-design of a mobile health (mHealth) application for family caregivers of people with dementia to address functional disability care needs is presented. Participants included family caregivers of people with dementia, aged care nurses, physicians, occupational therapists, and information technology (IT) experts. The co-design process involved two phases: (1) needs assessment phase (an online survey and in-depth interviews with family caregivers and expert consultation); and (2) development of an mHealth application (content and prototype development). Data triangulation from phase one informed the content of the application. Data triangulation resulted in three content modules: “an overview of dementia and care,” “management of daily living activities,” and “caregivers’ health and well-being.” The content was based on contemporary literature, and care guidelines with input from family caregivers and dementia care experts. IT engineers developed the mHealth application. In this study, an Android-based mHealth application was designed to address the functional care needs of family caregivers and the co-design process ensured the incorporation of end-users’ real-world experiences and the opinions and expertise of key stakeholders in the development of the application prototype.It is to be noted that before releasing the application into the app store, testing its feasibility and effectiveness is essential. KEYWORDS: Dementia, family caregivers, functional disability, mHealth application
... The standard questionnaire for General Activity Daily Living (GADL) was used to evaluate functional ADL for each participant by face-to-face interview. In short, the GADL shows a hierarchical structure with three components of more specific activities as demonstrated in the previous study [31]. In summary, the first component is BADL or self-care ADL, including changing clothes, using the toilet, bathing or showering, getting into/out of bed or a chair, and eating. ...
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Background/aims: Many motor impairments are present in older adults with cognitive decline. One of them is the impairment of hand dexterity and bimanual coordination that result in poor functional ability in the activities of daily living (ADL). This study investigated the effects of hand dexterity and bimanual coordination declination on the sub-domains of ADL in older adults with mild cognitive impairment (MCI). Methods: Thirty-one senior individuals with MCI were recruited in this study. The Purdue Pegboard Test was used to measure hand dexterity, and bimanual coordination was assessed by the continuous circle-drawing task. Their ADL were assessed with the General Activity Daily Living questionnaire. Results: The correlations analysis showed an association between the dominant hand and bimanual dexterity with the domestic domain of ADL and all conditions of hand dexterity with the complex domain of ADL. Moreover, the multiple regression analysis showed that the predictor of the greatest effect for domestic and complex domains was dominant hand dexterity. Discussion/conclusion: These results revealed that dominant hand dexterity strongly affected domestic and complex ADL in older adults with MCI. There were age-related changes regarding lateral asymmetrical motor reduction, especially in cognitive tasks. However, complex tasks involving cognitive function may need dominant, nondominant and bimanual hand dexterity.
... It was assessed using the modified version of the Katz (Branch et al. 1984) and defined as a limitation in one or more of the following: eating, dressing, grooming, bathing, using the toilet, and walking across a small room. The reliability and validity of this scale have been proven in older adults (de Paula 2014;Brorsson and Asberg 1984). ...
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Objective Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. Design A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94–2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility – disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. Results Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09–1.68] and mobility (OR = 1.34, 95% CI = 1.18–1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value < .010). Conclusions Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up.
... We detailed these procedures in a previous study conducted with this sample (de Paula et al., 2013). This study focused on the following instruments: the Mini-Mental State Examination (MMSE; Brucki et al., 2003) and the CDR (Maia et al., 2006), which evaluates general cognition, the 15 items version of the Geriatric Depression Scale GDS-15 (GDS-15; Paradela et al., 2005) for depressive symptoms, the General Activities of Daily Living Scale (GADL; de Paula et al., 2014) for the assessment of daily life activity, which assesses self-care, domestic activities, and complex activities. Moreover, the RAVLT (de Paula & Malloy-Diniz, 2018) was applied to evaluate verbal episodic memory. ...
... Specific questionnaires and/or checklists were developed to assess ADLs. Some of them only assess BADLs [3][4][5][6][7]; others focus on IADLs [8][9][10], and others provide a composite score of BADLs and IADLs [11,12] or two separate indexes [13]. ...
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Background Activities of daily living (ADL) are fundamental skills required to independently care for oneself and are categorized in basic (BADLs) and instrumental (IADLs) activities of daily living. ADL evaluation is of paramount importance in clinical practice to discriminate between healthy individuals (HC) and patients with mild cognitive impairment (MCI) or Alzheimer’s disease (AD). However, it is unclear whether and to what extent BADL and IADL deficits occur in MCI, when compared with AD. Therefore, the present study aimed at comparing performance on both BADLs and IADLs in HC, MCI, and AD.Methods Three electronic databases were consulted for studies comparing total BADLs/IADLs, and single BADLs/IADLs in AD, MCI, and HC (comparisons: AD versus MCI, AD versus HC, MCI versus HC). Ninety-six studies were included in the meta-analysis with random effect models (Hedges’ g). Meta-regression was performed to evaluate the effect of clinical variables on ESs.ResultsAD group had more difficulties in BADLs and IADLs than HC and MCI groups; people with MCI showed more difficulties in both IADLs and BADLs than HC. The meta-regression analysis revealed that the percentage of males in the samples was a significant predictor of the ES in the meta-analysis comparing total BADL scores between MCI and HC; in the comparison between AD and HC, age at evaluation predicted the ES on some single IADLs: preparing food, handling medication, and finances.Conclusions In MCI, it should be considered not only a decline of IADLs but also subtle decline of BADL abilities.
... The IADL tool with eight items was tested by factor analysis for validity by the Kaiser-Meyer-Olkin (KMO) measure (Paula et al., 2014), with IADL value 0.781 at p < 0.001. The result of factor analysis, all factor loadings were statistically significant at p < 0.001, ranging from 0.84 to 0.96 (Table 3). ...
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Purpose Normal aging changes, acute and chronic illness, and the long stay in the hospital made the decline in elderly physical and mental abilities in non-instrumental and Instrumental Activities Daily Livings (IADL). This paper aims to determine the validity and reliability of Lawton IADL in the Iranian elderly community relevancy to physical, mental and cognitive measurements. Design/methodology/approach A cross-sectional study with 422 participants, age 60 years old and over selected by face-to-face interviewing from the geriatric clinic, Tehran medical university from January to June 2019. Findings Of 422 participants referring to outpatient clinics the majority were male (62.8%); with an average of 66.9 ± 5.95 years old. Reliability was significantly high (Cronbach’s alpha = 0.96, p < 0.001). There was a significant relationship between IADL with Short-Form Health Survey36-Mental Component Score (SF36-MCS), with p < 0.01. Reliability was significantly high (Cronbach’s alpha = 0.96, p < 0.001). In the factor analysis with eigenvalues more than one, two components were found; that the first factor named as observational daily activities, whereas the second factor named “advanced daily activities”. Research limitations/implications The limitation of this study was the low number of similar studies to compare the results and the stronger discussion. Originality/value Determining IADL's dependency in the community elderly is important to maintain their self-care manages. More studies are needed to manifest the relationship between mental health and IADL's independence. Therefore, validation in different settings is important in planning for the geriatrics team.
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This study aimed to map and categorize the psychosocial assessment instruments, with available psychometric evidence, for elderly Brazilians. Through a scoping review, 5.258 studies were identified and after applying the eligibility criteria, 237 studies were included for analytical synthesis. Part of the extracted data was presented in four blocks: Review identifiers (information about the studies); Population (information about the participants); Psychosocial Instruments (organized by categories); Psychometric properties (type of evidence). 192 instruments were highlighted, which were organized into five subcategories, being “Anxiety, Depression and Stress”, “Physical Activity, Ability to Work and Mobility”, “Intelligence and Cognition”, “Health, Well-Being and Quality of Life” and “Geriatric’s Syndromes and Violence”. This study does not exhaust the alternatives of instruments available to elderly Brazilians, but allows a broader view, gathering in a single source, evidence that can generate reflection and add to the research and practice of all those interested in the theme.
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Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.
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Objective: Human T-cell leukemia virus type-I (HTLV-1) infection courses with a myelopathy, the Tropical Spastic Paraparesis (HAM/TSP). Method: In a case-control study, we compared the neuropsychological profile and functional characteristics in two case HTLV-1 infected groups, (asymptomatic and with HAM/TSP) with a control group negative for HTLV-1. Subjects were paired for age, sex and educational features. Results: The case group differed from control group in neuropsychological measures such as in episodic memory recall, executive functions and fine motor dexterity measure. Individuals with HAM/TSP have more depressive symptoms and worst performance in Activities of Daily Living (ADL) presenting a less functionality. In multivariate models, the fine motor performance, the executive functioning, the recognition memory and the depressive symptoms explained part of the variance in functionality. Conclusion: Those findings may contribute to understand of everyday life impairments and limitations of HTLV1 infected population and to organize the rehabilitation. Once more, based in neuropsychological and functional data, we can reafirm that HTLV1 is never a benign condition but sometimes it is only in a stage coursing with less symptoms.
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Objective: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). Methods: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. Results: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. Conclusion: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.
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O projeto SABE (Saúde, bem-estar e envelhecimento) foi coordenado pela Organização Pan-Americana de Saúde com o objetivo de coletar informações sobre as condições de vida dos idosos (60 anos e mais) residentes em áreas urbanas de metrópoles de sete países da América Latina e Caribe - entre elas, o Município de São Paulo - e avaliar diferenciais de coorte, gênero e socioeconômicos com relação ao estado de saúde, acesso e utilização de cuidados de saúde. Por meio de questionário e processo amostral padronizados foram entrevistadas 2.143 pessoas. Encontrou-se que as mulheres são maioria, os imigrantes eram 8,7%, 62,6% viveram por cinco anos ou mais na área rural até os quinze anos de vida. Dos idosos, 13,2% viviam sós, sendo que esse valor aumentou com a idade e no sexo feminino. Em relação ao estado mental, encontrou-se, pelo Mini Exame do Estado Mental (MEEM), 6,9% de deterioração cognitiva e 18,1% de depressão, segundo a Escala de Depressão Geriátrica. As auto-avaliações de saúde mostram que 53,8% dos entrevistados consideraram a sua saúde regular ou má. Dentre as doenças mais freqüentes estavam a hipertensão (53,3%); artrite/artrose/reumatismo, 31,7%; e diabetes, 17,9%. A grande maioria dos idosos não apresentou dificuldades nas atividades básicas de vida diária (80,7%), e entre aqueles que apresentaram, a maioria tinha dificuldades em uma ou duas atividades. Foram apresentados dados dos arranjos domiciliares encontrados, do acesso e utilização de serviços de saúde, e relativos à renda e condição de trabalho. Conclui-se que as condições de saúde são preocupantes, assim como a insuficiência do sistema de seguridade social.
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Objective: To compare functional performance among institutionalized elderly people with cognitive impairment, by means of applying the Mini-Mental State Examination (MMSE), a mobility test and the Katz Index. Method: Twenty-eight subjects participated in this study (82 ± 9.06 years). Mobility was assessed using the "Timed Up and Go" (TUG) test, and daily living activities (DLA) via the Katz Index. Results: There was no statistically significant correlation between mobility assessed by TUG and performance in the MMSE (Pearson's r = 0.234; p = 0.232). A positive association was detected between the elderly people's performance in the TUG test and their achievement in bathing, dressing and transferal tasks measured by the Katz Index (p = 0.039; p = 0.000; p = 0.001, respectively; ANOVA). There was no significant association between cognitive impairment detected by MMSE and the elderly people's performance in the five activities of the Katz Index (bathing: p= 0.774; dressing: p = 0.567; hygiene: p = 0.857; transferal: p = 0.824; continence: p= 0.947; ANOVA). Increasing age did not demonstrate any significant correlation with performance in any of the tests (TUG: p = 0.466, r = 0.144; MMSE: p = 0.841, Pearson's r = 0.040). Conclusion: The cognitive impairment of these elderly people, detected via the MMSE, did not have any association with their performance in the mobility and DLA tests. However, there was a significant association between their performance in the mobility test and their achievement in bathing, dressing and transferal activities.
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Com o crescente aumento do número de idosos, cresce, também, a necessidade de utilização de instrumentos de avaliação funcional. Tal utilização, no entanto, deve ser comparável entre os diversos estudos e diferentes realidades. O Índex de Independência nas Atividades de Vida Diária (AVD), desenvolvido por Sidney Katz, é um dos instrumentos mais antigos e também dos mais citados na literatura nacional e internacional. Diferentes publicações têm mostrado, no entanto, versões modificadas do referido instrumento, dificultando aos leitores sua correta utilização. Este estudo teve por objetivo traçar o histórico do desenvolvimento, evolução e correta utilização do Índex de Independência nas Atividades de Vida Diária de Katz, bem como as modificações e adaptações desenvolvidas, com a anuência do autor, no transcorrer do tempo, de forma a contribuir para a uniformização das informações das pesquisas relacionadas à avaliação funcional em gerontologia.
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This study involved the development and per- formance assessment of a cultural adaptation of the Katz scale of independence in activities of daily living, translated into Portuguese in Bra- zil. Two translations and two back-translations of the items were analyzed by experts in order to decide on the final version. Operational equiv- alence was assessed in a pilot study. The reli- ability and internal consistency of the adapted version were assessed by retesting 156 patients on the same day or 7 days after the first inter- view. Cultural equivalence was achieved after resolving subtle differences in some items. The final version was considered easy to understand and use. Chance-corrected agreement (weighted kappa) was 0.91. Cronbach's alpha ranged from 0.80 to 0.92. Conclusions: a Portuguese version of the Katz scale of independence in activities of daily living, thoroughly developed and test- ed, proved equivalent to the original version in English. The items were internally consistent and the rates were reliable.
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On the title page, the authors' affiliations need to be reversed. The first author is affiliated to the Gerontology Department at the School of Arts, Sciences and Humanities (EACH), University of São Paulo, and the remaining authors are affiliated to the Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo.