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Studies of illness in the aged: The indeit of ADL: A standardized measure of biological and psychological function

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... In order to provide a standardized way to estimate the physical well-being of elderly and their need for assisted living; a specific set of activities, called activities of daily living (ADL's), was first proposed by [82]. The activities included in this proposal conforming the set of ADL's are: bathing, dressing, toileting, transferring, continence and feeding. ...
... ADL's represent a set of activities that the subject carries out as part of his normal daily schedule. The ADL's concept was first proposed in [82], in order to provide a standardized way to estimate the physical well-being of elderly and their need for assisted living. The activities included in this proposal conforming the set of ADL's are: bathing, dressing, toileting, transferring, continence, and feeding. ...
... The Katz index of ADL's was developed to address the functional status as a measurement of the ability of the elderly to perform ADL's independently [82,83]. The Katz index includes six items describing ADL's ordered by dificulty: (a) bathing; (b) dressing; (c) toileting; (d) transfer; (e) continence; and (f ) feeding. ...
Thesis
In recent years, the elderly population sector has increased faster than in the previous decades.In addition to that, elderly population suffers from age-related health issues and different chronicdiseases. Furthermore, various studies indicate that the vast majority of elderly people arewilling to live independently in their own homes as long as possible.In order to assess the abovementioned problem, personal sensor networks and body sensornetworks in smart environments represent an option regarding healthcare solutions for monitoringelderly people at home.However, despite their popularity, the abscence of a monitoring approch with regard toa dependency evaluation model such as the AGGIR (Autonomie Grontologie Groupes Iso-Ressources) grid variables has never been treated.Therefore, in this thesis work, with the aim of providing an analyis tool regarding themonitoring of ADL’s performed by the elderly/handicapped people within a home environmentby means of data recovered from sensors; a Domain Specific Language (DSL) relying on theAGGIR grid model is proposed.The main contributions of this research work are:• A state-of-the-art related to the proposed subject;• A Domain Specic Language (DSL) for assessing the AGGIR grid variables;• A framework for validating the proposed DSL.For the purpose of determining the ADL’s carried out by the elderly resident, as well asrecognising the AGGIR grid variables; the introduced DSL is based on both temporal andlocation operators.Moreover, with the goal to validate the abovementioned DSL, a framework architecture ispresented in order to meet the requirements for analyzing complex events. To this extent, theframework is conformed by: (i) the DSL as its main component, (ii) the integration of theproposed DSL to a smart-home simulator for performing evaluation and experimentation; (iii)a parser aimed to process the data recovered from the DSL in order to generate appropriateinstructions for the smart-home simulator.
... Total number of caregiver health conditions were ascertained via self-report using a 20-item checklist modified from the Chronic Conditions Checklist of the National Comorbidity Survey Replication (NCS-R; Kessler & Merikangas, 2004). Patient health information (i.e., primary diagnoses, hospice length of stay in days, impairment with activities of daily living (ADLs; Katz, Ford, Moskowitz, Jackson, & Jaffee, 1963) and Palliative Performance Scale scores (PPS; Anderson, Downing, Hill, Casorso, & Lerch, 1996)) were abstracted retrospectively from hospice medical records. The PPS is an indicator of patient prognosis that evaluates patient mobility, intake of food and fluids, and level of consciousness. ...
... Descriptive information about the caregiving experience during the month prior to patient admission to hospice care was ascertained via self-report and included months caregiving, number of hours spent caregiving, and a "yes" or "no" response to the availability of others to regularly assist with care. Caregivers also provided a "yes" or "no" response to regularly assisting with seven possible ADLs (Katz et al., 1963). A Cronbach's alpha of 0.80 was achieved in the current sample. ...
Article
Witnessing end-of-life suffering of loved ones is an underappreciated stressor that may affect caregiver bereavement. We interviewed 61 spousal caregivers of hospice patients who died within the past 6–18 months. Higher rumination about suffering and lower feelings of relief was related to poorer well-being. Rumination by caregivers about end-of-life suffering was an important predictor of depression and complicated grief. Most caregivers viewed the death as at least in part a relief. One important focus of grief support may be to help caregivers find productive ways to avoid rumination and use other forms of coping and to acknowledge feelings of relief.
... Activity of daily living (ADL) is highly dependent on cognitive function and behavior, requiring assessments that are capable of detecting changes in ADL as soon as changes in cognition and behavior are detected [5]. ADL is often divided into basic ADL (b-ADL), which includes activities such as personal hygiene, clothing, feeding and toileting [6] and instrumental ADL (i-ADL), which is commonly referred to as independent living abilities such as household activities, handling money, shopping and transportation [7,8]. i-ADL have a higher demand for cognitive function than b-ADL, and is important for living an independent life in the society [9]. ...
... Once we obtained ADL concepts, they were mapped to items in Katz's index (b-ADL) [6] and Lawton scale (i-ADL) [7,8], which are the most commonly used tools for assessing ADL. The items of ADL used in this study for each ADL category are-1) b-ADL: bathing, dressing, transferring, toileting, and feeding; 2) i-ADL: using transportation, shopping, preparing food, housekeeping, responsibility for own medications, and handling financing. ...
... The patients were followed up at 3 and 12 months after their fracture with a visit to a research nurse (RN) (PKP) or by a telephone interview. Data were also collected regarding the patients' living situation pre-fracture, KATZ ADL score [21] and the Charnley classification of walking ability [22]. Patients gave details about their medical history and a review of the medical records was carried out by the research RN to identify those patients with a history of depression and/ or use of anti-depressant medications. ...
... but it is not possible to draw any conclusions regarding gender differences as the groups were small. Those patients included with depressive symptoms had mild or moderate symptoms (HADS-D score 8-14, none had severe symptoms [15][16][17][18][19][20][21]. This was surprising as the literature tells us that depression is common among hip-fracture patients. ...
Article
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Background Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality. Aim We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture. Methods 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture. Results 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome. Conclusion In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
... The advancement of statistical methods and psychometric tests boosted the confidence of researchers in using subjective (patient-reported) health indicators. The Katz (1963) instrument measuring independence in activities of daily living (ADL) [46] gained wide acceptance. In addition, people's understanding about the function of health care systems, in particular in relation to health equity, was significantly improved by the work done by Nobel laureate, Kenneth Arrow, which summarized the special characteristics of the health care The preamble of the WHO constitution defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" and proposes that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". ...
... The advancement of statistical methods and psychometric tests boosted the confidence of researchers in using subjective (patient-reported) health indicators. The Katz (1963) instrument measuring independence in activities of daily living (ADL) [46] gained wide acceptance. In addition, people's understanding about the function of health care systems, in particular in relation to health equity, was significantly improved by the work done by Nobel laureate, Kenneth Arrow, which summarized the special characteristics of the health care The preamble of the WHO constitution defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" and proposes that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". ...
Article
Full-text available
Background: Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity. Methods: Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency. Results: A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions. Conclusion: The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.
... Activity of daily living (ADL) is highly dependent on cognitive function and behavior, requiring assessments that are capable of detecting changes in ADL as soon as changes in cognition and behavior are detected [5]. ADL is often divided into basic ADL (b-ADL), which includes activities such as personal hygiene, clothing, feeding and toileting [6] and instrumental ADL (i-ADL), which is commonly referred to as independent living abilities such as household activities, handling money, shopping and transportation [7,8]. i-ADL have a higher demand for cognitive function than b-ADL, and is important for living an independent life in the society [9]. ...
... Once we obtained ADL concepts, they were mapped to items in Katz's index (b-ADL) [6] and Lawton scale (i-ADL) [7,8], which are the most commonly used tools for assessing ADL. The items of ADL used in this study for each ADL category are-1) b-ADL: bathing, dressing, transferring, toileting, and feeding; 2) i-ADL: using transportation, shopping, preparing food, housekeeping, responsibility for own medications, and handling financing. ...
Article
Full-text available
The aging population has led to an increase in cognitive impairment resulting in significant costs to patients, their families, and society. A research endeavor on a large cohort to better understand the frequency and severity of cognitive impairment is urgent to respond to the health needs of this population. However, little is known about temporal trends of patient health functions (i.e., activity of daily living) and how these trends are associated with the onset of cognitive impairment in older adults. Moreover, the use of rich source of clinical narratives in electronic health records to facilitate cognitive impairment research (i.e., topic analysis) has not been well explored. A study indicated that clinicians often delay a diagnosis of cognitive impairment and miss appropriate treatment of underlying diseases and comorbid conditions which may cause safety issues for the patient and others. This study is to characterize and better understand early signals of older adult cognitive impairment by examining temporal trends of patient activity of daily living and analyzing topics of patient medical conditions described in clinical narratives using semantic topic models.
... Study participants were asked to rate each item on a three-point scale, ranging from 1 'no assistance needed' to 3 'full assistance needed' . A summed score (range 6-18) was calculated, with a higher score indicating higher dependence [23,24]. The IADL assesses ability to do cooking, laundry, walking for two kilometers without stopping, lifting up to 10 kg, repeated squatting and standing, using public transport alone, shopping, and socialising. ...
... Study participants were asked to rate their ability against each task on a three-point scale, ranging from 1 'no difficulty' to 3 'cannot do' . A summed score was calculated (range 8-24), with a higher score indicating a higher level of functional disability [23,24]. ...
Article
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Background This study aims to determine the change of inequality in functional disability of older populations in China over the period from 2008 to 2018 and decompose the contribution of the personal and environmental predictors to the change. Methods Data were drawn from two waves (2008 and 2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Functional disability was assessed by the basic activities of daily living (ADL) and the instrumental activities of daily living (IADL). Concentration index (CI) was calculated to measure the socioeconomic inequality in ADL and IADL. A two-level linear regression model was established to identify the individual and care environmental predictors and their contribution to the inequality of ADL and IADL, respectively. The Oaxaca-type decomposition technique was adopted to estimate the contribution of these predictors to changes of the inequality in ADL and IADL over the period from 2008 to 2018. Results Socioeconomic inequality in functional disability of older adults increased over the period from 2008 to 2018, with the CI for ADL changing from − 0.0085 to − 0.0137 and the CI for IADL changing from − 0.0164 to − 0.0276, respectively. Self-rated economic status was the single most powerful predictor of changes in the inequality, although the growing and dominant rating of older persons with fare economic status could offset the detrimental effects of other (rich or poor) ratings on the changes. The enlarged inequality was also attributable to the increasing importance of regular exercise and its distributional changes, as well as the accumulative long-term effect of farming in earlier life. They outweighed the counteracting effects of rural residency, living with chronic conditions and in an institution. Conclusions Socioeconomic inequality in functional disability of older populations in China increased over the period from 2008 to 2018. Re-distribution of wealth remains to be a powerful instrument for addressing the inequality issue, but alone it is not enough. The detrimental accumulative effect of farming will not disappear any time soon. While rural residents are catching up with their urban counterparts, new challenges such as physical inactivity are emerging.
... Functional capacity was assessed by Katz basic activities of daily living and Lawton-Brody instrumental activities of daily living scales. 19,20 Cognitive status was assessed by the Mini-Mental State Examination. 21 The severity of dementia was rated by using the clinical dementia rating (CDR), which contains 6 categories (memory, orientation, judgment and prob-lem solving, community affairs, home and hobbies, and personal care). ...
Article
Background: Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. Methods: This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. Results: Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively). Conclusion: Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.
... Pretested interview schedule in Nepali version were used to collect data. Questionnaire was consisted of socio-demographic characteristics; status of family and relation, social status relations; perceived physical health status of the respondents as well as Katz index of independence in activities of daily living scores of 6 items questions; (10) psychological status assessing by short form of geriatric depression scale of 15 items of total scores of 15 questions, (11) and 24 items of total scores of 120 quality of life of senior citizen questionnaire developed for World Health Organization. (12) During data collection privacy was maintained by taking interview in separate room and corners of the home setting. ...
Research
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Introduction: Globally, identifying factors associated with quality of life of senior citizens have become a public health concern. Quality of life (QoL) of senior citizen is affected by many factors associated with age related changes in physical in health status, psychological status and changing social role in family. Thus, this study aims to identify factors associated with QoL of senior citizens. Methodology: This study followed descriptive cross sectional research design. Four hundred sixty two senior citizens aged 70 and above, residing in Tarakeshwor Municipality, Kathmandu was included in a study by using non-probability purposive sampling technique. Data was collected from December 25 th 2017 to March 23 rd 2018 by team members of faculty research through individual interview method by using pretested structured interview guideline in Nepali version. Data was analyzed by using descriptive statistics and inferential statistics specifically Chi square and Pearson's correlation coefficient tests. Results: This study findings shows that most of the senior citizens were self-dependent on their activities of daily living. Likewise, most of them had good relation with spouses, children, and grand children, family as well as with friends and neighbours. Beside this majority of them had never experienced physical torture, insecurity; humiliation, neglect, sadness, stress where as more than two third experienced loneliness and boredom. Nearly half of them had some level of depression. On overall score of quality of life (QoL) revealed that More than four fifth of senior citizens had at fair level of QoL. Factors associated with low QoL of senior citizens were demographical factors such as increased age, female sex, living alone low, education and economic status. Also status of dependency on performing moderate household activities of daily living. Also findings revealed negative relationship between increased level of depression and QoL score. Conclusion: Overall quality of life was fair among these senior citizens. These identified factors as increased age, female sex, living alone, low education and economic status, dependency on performing moderate household activities of daily living and relationship between depression and QoL need to be highly considered while planning health program for senior citizens in Nepalese context from concern authorities.
... (c) Mini-mental state examination (MMSE) Arabic version [13]: A score of 24 or less was used as a cut-off point for cognitive impairment [14]. (d) Premorbid physical function assessment questionnaires were assessed using (1) the Katz index of independence in activities of daily living (ADL), which includes bathing, dressing, toileting, transferring, continence, and feeding [15], and (2) the instrumental activities of daily living (IADLs) [16], which includes using the telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for one's own medications, and ability to handle finances. ...
Article
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Background Despite decades of research evaluating different predictive strategies to identify persons at risk for falls, nutritional issues have received little attention. Malnutrition leads to weight loss associated with muscle weakness and consequently increases the risk of falls. Aims The current study assessed the association between nutritional state and fall risk scores in a geriatric in-patient unit in Ain Shams University Hospital, Cairo, Egypt. Methods A cross-sectional study was conducted to assess the nutritional state of 190 older inpatients using a short form of the Mini-Nutritional Assessment (MNA-SF), and the risk of falls was assessed using the Morse Fall Scale (MFS), Johns Hopkins fall risk assessment tool (JH-FRAT), Schmid Fall Risk Assessment Tool (Schmid-FRAT), Hendrich II Fall Risk Model (HII-FRM) and Functional Assessment Instrument (FAI). The generalised linear models (GLM) and odds ratio (OR) were calculated to test the nutritional status as a risk factor for falls. Results Malnutrition was significantly associated with high fall risk as assessed by MFS and HII-FRM (OR = 2.833, 95% CI 1.358–5.913, P = 0.006; OR = 3.477, 95% CI 1.822–6.636, P < 0.001), with the highest OR for JH-FRAT (OR = 5.455, 95% CI 1.548–19.214, P = 0.008). After adjusting for age, the adjusted Charlson Comorbidity Index (ACCI), number of fall risk-increasing drugs (FRIDs), risk of malnutrition or malnourished were significantly associated with high fall risk as assessed by MFS (OR = 2.761, 95% CI 1.306–5.836, P = 0.008), JH-FRAT (OR = 4.938, 95% CI 1.368–17.828, P = 0.015), and HII-FRM (OR = 3.486, 95% CI 1.783–6.815, P < 0.001). Conclusions This study demonstrated a significant association between malnutrition and fall risk assessment scores, especially JH-FRAT, in hospitalised older patients.
... All subjects gave written informed consent in accordance with the Declaration of Helsinki and they were duly informed about the goals of the research. In addition, we carried out personal interviews to collect demographic data and the following questionnaires were used to evaluate their mental health: STAI [24], Hamilton anxiety scale [25], Yesavage geriatric depression scale [26], MEC-35 [27], Ryff scale of psychological wellbeing [28], global deterioration scale [29], Katz index [30], PANAS [31]. After the interview, the EMA application was installed in their personal smartphone and they received an Empatica E4 device. ...
Conference Paper
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We present an intelligent wearable system to monitor and predict mood states of elderly people during their daily life activities. Our system is composed of a wristband to record different physiological activities together with a mobile app for ecological momentary assessment (EMA). Machine learning is used to train a classifier to automatically predict different mood states based on the smart band only. Our approach shows promising results on mood accuracy and provides results comparable with the state of the art in the specific detection of happiness and activeness.
... Kemampuan untuk makan mandiri masih dapat dilakukan walaupun terjadi penurunan fungsi kognitif secara progresif. 14 Ditinjau dari segi patofisiologi, frailty dan gangguan kognitif merupakan sesuatu yang kompleks dan multifaktorial. Beberapa jalur dan mediator diduga berperan dalam terjadinya gangguan kognitif pada lansia dengan frailty yaitu hormonal, inflamasi, nutrisi, vaskular, neuropatologi dan metabolik merupakan faktor yang diduga berkontribusi. ...
Article
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Latar Belakang: Gangguan kognitif merupakan salah satu masalah kesehatan lansia dan merupakan prediktor mayor kejadian demensia yang masih menjadi permasalahan kesehatan dan sosial. Penurunan fungsi intelektual merupakan masalah paling serius ketika proses penuaan yang akan mengakibatkan lansia sulit untuk hidup mandiri, dan meningkatkan risiko terjadinya demensia sehingga lansia akan mengalami gangguan perilaku dan penurunan kualitas hidup. Tujuan: Melihat faktor-faktor yang berhubungan dengan gangguan kognitif pada lansia di Panti Sosial Tresna Werdha Wana Seraya Denpasar, Bali. Metode: Studi ini menggunakan desain analitik potong lintang dengan metode pengambilan sampel adalah total sampling. Sebanyak 30 sampel terkumpul, dengan 10 sampel dengan fungsi kognitif normal dan 20 sampel memiliki gangguan kognitif. Sampel dilakukan wawancara untuk mengetahui karakteristik demografi. Variabel gangguan pendengaran dinilai dengan kuisioner Hearing Handicap Inventory for the Elderly-Screening, Frailty diukur dengan menggunakan Fried Frailty Index, tingkat kemandirian dinilai dengan Activity Daily Living Barthel dan fungsi kognitif dengan kuisioner Montreal Cognitive Assessment Indonesia. Analisis data menggunakan SPSS 17 dengan uji fisher’s exact. Hasil: Sejumlah 30 sampel lansia yang berusia 61-94 tahun mengikuti studi ini dengan median usia 73,73 tahun. Sebanyak 20 sampel didapatkan ada gangguan kognitif dan 10 sampel memiliki fungsi kognitif normal. Skor MoCA-INA berkisar antara 11 – 27 dengan rata-rata skor 19. Dari berbagai variabel yang dianalisis, gangguan pendengaran(p=0,000), tingkat kemandirian (p=0,005), frailty (p=0,017) berhubungan dengan gangguan kognitif secara bermakna. Simpulan: Terdapat 20 orang (67%) mengalami gangguan kognitif. Gangguan pendengaran, frailty, tingkat kemandirian merupakan variabel yang berhubungan dengan gangguan kognitif pada studi ini.
... The ADL score ranges from 0 to 6, indicating the number of basic activities in which the subject needs assistance. 17 The IADL score ranges from 0 to 100, indicating the percentage of activities in which the subject needs assistance, among those he/she usually performed independently. 18 20 which was completed by a suitable informant who has known the patient for at least 10 years. ...
Article
Background Delirium is a common and potentially preventable condition in older individuals admitted to acute and intensive care wards, associated with negative prognostic effects. Its clinical relevance is being increasingly recognised also in cardiology settings. The aim of the present study was to assess the prevalence, incidence, predictors and prognostic role of delirium in older individuals admitted to two cardiology intensive care units. Methods All patients aged over 65 years consecutively admitted to the two participating cardiology intensive care units were enrolled. Assessment on admission included acute physiological derangement (modified rapid emergency medicine score, REMS), chronic comorbidity, premorbid disability and dementia. The Confusion Assessment Method–Intensive Care Unit was applied daily for delirium detection. Results Of 497 patients (40% women, mean age 79 years), 18% had delirium over the entire cardiology intensive care unit course, half of whom more than 24 hours after admission (incident delirium). Advanced age, a main diagnosis of ST-segment elevation myocardial infarction or acute respiratory failure, modified REMS, comorbidity and dementia were independent predictors of delirium. Adjusting for patient’s features on admission, incident delirium was predicted by invasive procedures (insertion of peripheral arterial catheter, urinary catheter, central venous catheter, naso-gastric tube and intra-aortic balloon pump). In a logistic regression model, delirium was an independent predictor of inhospital mortality (odds ratio 3.18, 95% confidence interval 1.02, 9.93). Conclusions Eighteen per cent of older cardiology intensive care unit patients had delirium, with half of the cases being incident, thus potentially preventable. Invasive procedures were independently associated with incident delirium. Delirium was an independent predictor of inhospital mortality. Awareness of delirium should be increased in the cardiology intensive care unit setting and prevention studies are warranted.
... Secondary outcome measures included the Katz Index of Independence in Activities of Daily living [24] which examines functioning; the Generalised Anxiety Disorder 7 (GAD-7) [25]; and the Patient Assessment of Chronic Illness Care (PACIC) Scale where patients rate their satisfaction with their care [26]. ...
Article
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Objectives To determine the feasibility, implementation and outcomes of an Anticipatory Care Planning (ACP) intervention in primary care to assist older adults at risk of functional decline by developing a personalized support plan. Design Feasibility cluster randomized control trial. Setting and participants Eight primary care practices (four in Northern Ireland, United Kingdom and four in the Republic of Ireland) were randomly assigned to either intervention or control arm. Eligible patients were those identified in each practice as 70 years of age or older and assessed as at risk of functional decline. Study participants (intervention n = 34, control n = 31) and research staff were not blinded to group assignment. Anticipatory care intervention The intervention delivered by a registered nurse including: a) a home-based patient assessment; b) care planning on the basis of a holistic patient assessment, and c) documentation of a support plan. Outcome measures A conceptual framework (RE-AIM) guided the assessment on the potential impact of the ACP intervention on patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and reduction of potentially inappropriate prescribing. Data were collected at baseline and at 10 weeks and six months following delivery of the intervention. Results All pre-specified feasibility indicators were met. Patients were unanimous in the acceptance of the ACP intervention. Health care providers viewed the ACP intervention as feasible to implement in routine clinical practice with attending community supports. While there were no significant differences on the primary outcomes (EQ-5D-5L: -0.07 (-0.17, 0.04) p = .180; CES-D: 1.2 (-2.5, 4.8) p = .468) and most secondary measures, ancillary analysis on social support showed responsiveness to the intervention. Incremental cost analysis revealed a mean reduction in costs of €320 per patient (95% CI -31 to 25; p = 0.82) for intervention relative to the control. Conclusions We successfully tested the ACP intervention in primary care settings and have shown that it is feasible to implement. The ACP intervention deserves further testing in a definitive trial to determine whether its implementation would lead to better outcomes or reduced costs. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.
... The participants' cognitive status was evaluated using a version of the Mini Mental State Examination (originally developed by Folstein et al. in 1975) that was modified and updated for use in the Brazilian population in 2003 by Bruck et al. [11,12]. The Katz Index was applied to evaluate the participants' functional capacity [13,14]. ...
Article
Background Despite extensive studies of polypharmacy in older patients, no consensus regarding the definition of this practice exists in the literature. Several studies have defined polypharmacy as problematic when considering only the numbers of medications used by patients. Objective This study aimed to assess the prevalence of polypharmacy prescribing by comparing two different definitions (quantitative and qualitative) and evaluating factors associated with this practice in older patients. Setting Twenty-three basic health units. Method A cross-sectional study involving 386 older adults who received a prescription after a medical consultation. Multivariate analyses were conducted using a Poisson regression with robust variance. Main outcome measure The main outcome measures included patients with a prescription of five or more medications (quantitative polypharmacy) and those with a prescription of five or more medications including at least one drug considered potentially inappropriate for older adults (qualitative polypharmacy). Results The frequency of quantitative polypharmacy was 20.5%. The results of an adjusted analysis showed that the frequency of quantitative polypharmacy was associated with a higher number of self-reported morbidities and the prescription of potentially inappropriate drugs. The prevalence of qualitative polypharmacy was 10.4%, and after adjustment, this outcome remained significantly associated with the presence of three or more self-reported morbidities. Conclusions The presence of multiple comorbidities was identified as the main factor associated with the prescription of both quantitative and qualitative polypharmacy.
... • Disability burden using the Activities of Daily Living (ADL) index 35 . These deficits are identified by asking which activities the participant required help with: dressing, crossing a room, bathing, eating, getting in/out of bed, toileting. ...
Article
Background: All countries face growing demand for palliative care services. Projections of need are essential to plan care in an era of demographic change. We aim to estimate palliative care needs in Ireland from 2016 to 2046. Methods: Static modelling of secondary data. First, we estimate the numbers of people in Ireland who will die from a disease associated with palliative care need. We combine government statistics on cause of death (2007-2015) and projected mortality (2016-2046). Second, we combine these statistics with survey data to estimate numbers of people aged 50+ living and dying with diseases associated with palliative care need. Third, we use these projections and survey data to estimate disability burden, pain prevalence and health care utilisation among people aged 50+ living and dying with serious medical illness. Results: In 2016, the number of people dying annually from a disease indicating palliative care need was estimated as 22,806, and the number of people not in the last year of life aged 50+ with a relevant diagnosis was estimated as 290,185. Equivalent estimates for 2046 are 40,355 and 548,105, increases of 84% and 89% respectively. These groups account disproportionately for disability burden, pain prevalence and health care use among older people, meaning that population health burdens and health care use will increase significantly in the next three decades. Conclusion: The global population is ageing, although significant differences in intensity of ageing can be seen between countries. Prevalence of palliative care need in Ireland will nearly double over 30 years, reflecting Ireland’s relatively young population. People living with a serious disease outnumber those in the last year of life by approximately 12:1, necessitating implementation of integrated palliative care across the disease trajectory. Urgent steps on funding, workforce development and service provision are required to address these challenges.
... GA measures were used to describe the clinical characteristics of the sample. Activities of daily living [18] ...
Article
Objectives: The primary objective of the current study is to describe the prevalence and profile of cognitive domains affected in older adults with hematological malignancies evaluated for hematopoietic cell transplantation (HCT) using the Montreal Cognitive Assessment (MoCA) and neuropsychological tests. The secondary objective is to determine if a specific MoCA cut-off score would correlate with the identification of cognitive impairment detected by neuropsychological tests. This would facilitate interpretation of cognitive screening and referral of patients who would likely need further neuropsychological testing. Materials and methods: Fifty-one patients 60 years and older who were evaluated for HCT were assessed using a battery of standardized neuropsychological tests and MoCA. We analyzed Receiver Operating Characteristics (ROC) comparing MoCA scores and four different neuropsychological test criteria for cognitive impairment. Results: The prevalence of cognitive impairment detected by neuropsychological tests was 53 to 70.6% using the criteria for patients with cancer by the International Cancer Cognition Task Force (ICCTF). The following cognitive domains were most affected: language, learning and memory, visuospatial skills, and executive function. MoCA is an appropriate screening test for cognitive impairment. Using the ICCTF criteria, 86 to 100% of patients are correctly classified as having significant cognitive impairment on neuropsychological tests using a cut-off score of 20 or less. Conclusion: There is a high prevalence of cognitive impairment identified by neuropsychological tests in older patients with hematological malignancies evaluated for HCT. Identification of an appropriate MoCA cut-off score in this population is important to identify patients who would benefit from further assessment.
... Disability in activities of daily living (ADL) and mobility was determined using a standardized questionnaire. 16 ADL disability was defined as inability or limitation to dress and undress or take a bath or shower; mobility disability was defined as inability or limitation to walk 500 m or climb a flight of stairs. ...
Article
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Background: To assess the association of antidepressant (AD) medication use with prevalence and control of cardiovascular (CV) risk factors. Methods: Data of older adults from the population-based Italian Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey (OEC/HES) Study 2008-2012 were used. CV risk factors were measured using standardized procedures. Information on clinical features, lifestyles, and medications was collected using standardized questionnaires. Logistic regression models were elaborated to assess associations between AD use and prevalence and control of CV risk factors. Results: Around 2549 participants (age 71.4 ± 4.2 years, 51.3% men) were studied; 268 (10.5%) were AD users. Of these, 72.4% used selective serotonin reuptake inhibitors (SSRI). AD users had less favorable CV risk factor profile and were less likely to achieve control of blood pressure and total cholesterol. After multiple adjustment for potentially confounding variables, AD use was associated with greater likelihood of having diabetes (OR = 1.05, 95% CI = 1.02-1.10, P = 0.008), hypertension (OR = 1.10, 95% CI = 1.05-1.20, P = 0.003), and hypercholesterolemia (OR = 1.08, 95% CI = 1.04-1.14, P < 0.001). Among participants treated for hypertension and hypercholesterolemia, AD use was associated with poorer control of BP (OR = 1.07, 95% CI = 1.03-1.12, P = 0.001) and cholesterol (OR = 1.06, 95% CI = 1.01-1.12, P = 0.021). Results persisted virtually unchanged when analyses were restricted to participants on SSRI. Conclusions: AD use was associated with greater prevalence and poorer control of traditional risk factors for CV disease in a population-based sample of older adults. Such results highlight the need for surveillance of CV risk factors and promotion of healthy lifestyles in older adults with psychopathology and, in particular, in those under AD treatment.
... Sociodemographic data and carerelated data were obtained at baseline, including living situation, and number of prescriptions. Physical status was assessed by 'The Katz Index of Independence in Activities of Daily Living' (Katz-ADL [16]: ranging from 0-6, with a score of 0 indicating independence). The Charlson comorbidity index (CCI) was used to classify chronic comorbidity [17]. ...
Article
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Purpose Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Methods This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0–4 medications, polypharmacy 5–9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk—Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression. Results 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39–4.93) in patients with polypharmacy to 3.92 (95% CI 1.95–7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92–3.52) and 2.32 (95% CI 1.10–4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10–4.00) and OR 2.40 (95% CI 1.15–5.02). No significant association was found for readmission or self-reported fall. Conclusions Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty.
... ADL function was assessed using the Katz index of independence in ADL, which includes 6 ADLs (eating, transferring from bed to chair, walking, using the toilet, bathing, and dressing), each of which is scored with 0 or 1 depending on whether the participant is able to perform the activity with or without help, respectively. 18 Then, the 6 individual items are summed, resulting in a total 0 to 6 score. HAD was considered as a dichotomous variable attending to whether the patient had lost or not the ability to perform 1 or more ADLs independently, and was assessed at discharge and 3 months later. 1 Ambulatory capacity was assessed using the modified FAC, which classifies patients in 5 different categories attending to their level of dependence during walking; a score of 0 was assigned if the patient cannot walk, 1 if the patient requires continuous manual contact to support the body, 2 for light or intermittent manual contact to assist balance, 3 for independent but supervised ambulation, and 4 for independent ambulation on level surfaces or stairs. ...
Article
Objective: Hospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1 basic activities of daily living (ADLs) independently at discharge] is a frequent condition among older patients. The present study assessed whether a simple inpatient exercise program decreases HAD incidence in acutely hospitalized very old patients. Design: In this randomized controlled trial (Activity in Geriatric Acute Care) participants were assigned to a control or intervention group and were assessed at baseline, admission, discharge, and 3 months thereafter. Setting and participants: In total, 268 patients (mean age 88 years, range 75-102) admitted to an acute care for older patients unit of a public hospital were randomized to a control (n = 125) or intervention (exercise) group (n = 143). Methods: Both groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total duration of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory capacity, number of falls, rehospitalization, and death during a 3-month follow-up (secondary outcomes). Results: Median duration of hospitalization was 7 days (interquartile range 4 days). The intervention group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17-0.76, P = .007] and admission (OR 0.29; 95% CI 0.10-0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05). Conclusion and implications: A simple inpatient exercise program decreases risk of HAD in acutely hospitalized, very old patients.
... An incremental analysis will be undertaken to provide information on the marginal costs and effects of the ACP intervention relative to usual care through the calculation of incremental cost-effectiveness ratios and incremental net benefits. Uncertainty in the incremental analyses will be explored using cost-effectiveness acceptability curves 3. The Katz Index of Independence in Activities of Daily living [27] is a well-established measure of performance. It describes what the person actually does, rather than what they are capable of doing. ...
Article
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Background: The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for ACP. Methods/design: This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise: (a) information collection via patient assessment; (b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, (c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalised support plan. Discussion: This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as being at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland. Protocol version: Version 1, 17 September 2019. Trial registration: Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.
... Data collection includes demographic characteristics, lifestyle, mobility function, physical activity, chronic comorbidities, regular pharmacological treatments, nutritional status, frailty status, previous COVID-19 infection, previous anti-influenza, -pneumococcal, and -herpes zoster vaccinations. In particular, data regarding the Activities of Daily Living (ADL) [9], Instrumental Activities of Daily Living (IADL) [10], global cognitive performance with the Mini Mental State Examination (MMSE) [11], Frailty Syndrome (using the Anamnestic modified version) [12], Depression with the Geriatric Depression Scale (GDS) [13] and chronic comorbidities with Cumulative Illness Rating Scale (CIRS) scores [14], as well as routine laboratory analyses are under evaluation (Fig. 2a). We also collected data regarding mobility function (walk independently, walk with a cane, walk with a walker, move around in a wheelchair, is accompanied in a wheelchair, mostly bedridden however sometimes sits in a wheelchair, completely bedridden). ...
Article
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The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample.
... Further, ADL has been categorized into three categories as "severe ADL disability, " "moderate ADL disability, " and "No ADL disability. " Severe ADL ability is considered as those elderly who were not able to do in any of five activities, moderate ADL disability included those elderly who could not function in less than five activities, and no ADL disability included elderly who were able to perform in all five activities [26]. ...
Article
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Background The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India. Methods The study utilized the Longitudinal Ageing Study in India (LASI, 2017–18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly. Results Around 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR = 2.68, C.I. = 1.66–4.32) and severe IADL (RRR = 2.70, C.I. = 1.98–3.67) than no ADL and no IADL, respectively. Conclusion Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly.
... Severe ADL ability considered as those elderly who were not able to do in any of ve activities, moderate ADL disability included those elderly who could not function in less than ve activities, and no ADL disability includes elderly who were able to perform in all ve activities [23]. ...
Preprint
Full-text available
Background: The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzed determinants of ADL and IADL among elderly aged 60 and over living in India. Methods: The study utilized the Longitudinal Ageing Study in India (LASI, 2017-18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of sociodemographic parameters on ADL and IADL disability among the elderly. Results: Around 3 percent of the elderly reported severe ADL disability, and 6 percent elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR=2.68, C.I.=1.66-4.32) and severe IADL (RRR=2.70, C.I.=1.98-3.67) than no ADL and no IADL, respectively. Conclusion: Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centres in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically when they are based in group physical exercise and implemented through existing networks, are rewarding for the elderly.
... In addition, functionality and severity scales were applied including Functional Assessment Staging [FAST], the Global Deterioration Scale [GDS], Barthel (Mahoney & Barthel, 1965), Katz (Katz, 1963) and Lawton-Brody (Lawton & Brody, 1969). To evaluate memory complaints, the questionnaire was applied to the patient and family member, while for the emotional state evaluation, the abbreviated form Yesavage depression scale was used (Yesavage et al., 1982). ...
Article
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CADASIL is the most common hereditary cause of repeated ischemic strokes, and has also been identified as a model of pure vascular dementia. The objective of this study was to establish the cognitive performance of asymptomatic carriers with the mutations R1031C and R141C. This observational cross-sectional analytical study divided subjects into three groups: asymptomatic carriers of the R1031C mutation (n = 39), asymptomatic carries of the R141C mutation (n = 8) and non-carriers (n = 50). Statistically significant differences were found (p <0.05) between the group of the R1031C mutation and the non-carriers in constructional praxis, executive function and abstract reasoning. For the R141C mutation, scores below expected values in executive function and mental calculation were observed. It is concluded that asymptomatic carriers of the two mutations showed low performance in working memory, mental abstraction and processing speed, which could be associated with preclinical cognitive biomarkers preceding the presentation of the first vascular event.
... Recognition of these activities is the essential part of services developed for health care and assisted living purposes. Originally, Katz et al. [103] proposed a set of ADLs (such as dressing and feeding) to measure the biological and psychological function of people. ...
Thesis
The main goal of this thesis is to propose a complete framework for automatic discovery, modeling and recognition of human activities in videos. In order to model and recognize activities in long-term videos, we propose a framework that combines global and local perceptual information from the scene and accordingly constructs hierarchical activity models. In the first variation of the framework, a supervised classifier based on Fisher vector is trained and the predicted semantic labels are embedded in the constructed hierarchical models. In the second variation, to have a completely unsupervised framework, rather than embedding the semantic labels, the trained visual codebooks are stored in the models. Finally, we evaluate the proposed frameworks on two realistic Activities of Daily Living datasets recorded from patients in a hospital environment. Furthermore, to model fine motions of human body, we propose four different gesture recognition frameworks where each framework accepts one or combination of different data modalities as input. We evaluate the developed frameworks in the context of medical diagnostic test namely Praxis. Praxis test is a gesture-based diagnostic test, which has been accepted as a diagnostically indicative of cortical pathologies such as Alzheimer’s disease. We suggest a new challenge in gesture recognition, which is to obtain an objective opinion about correct and incorrect performances of very similar gestures. The experiments show effectiveness of our deep learning based approach in gesture recognition and performance assessment tasks.
... Physiological needs included: (1) Physical function. This was measured using Activities of Daily Living (ADL), including the Physical Self-maintenance Scale (PSMS) (Katz 1963) and the Instrumental Activities of Daily Living Scale (IADL) (Lawton and Brody 1969). The PSMS assesses six functions: feeding, dressing, bathing, toileting, grooming, and ambulation. ...
Article
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The growth of the aging population has been accompanied throughout a rapid increase in the number of disabled people and the demand for long-term care (LTC) services. Shandong Province has the largest number of older adults in China. It is necessary to explore their preferences in LTC models and the related factors. In a cross-sectional study conducted in August 2017, 6997 older adults aged 60 years and older were interviewed. Descriptive analysis, independent sample t tests, χ² tests, and multinomial logistic regression were used to show preferences and the related factors in LTC models (family care, home- and community-based care (HCBS), and institutional care) based on the Andersen Behavior Model. Family care (89.1%) was the first preference for older adults and 8.2% chose institutional care, but only 2.7% chose HCBS. The logistic regression results indicated that older people aged 60–64 years and those with a higher education level tended to choose HCBS or institutional care (P < 0.05); in the eastern region of Shandong Province, they tended to choose HCBS and institutional care over family care (P < 0.05). Older people with self-care limitations were more likely to choose HCBS (P < 0.05). Older adults with a stronger sense of loneliness were more likely to choose HCBS and institutional care (P < 0.05). The results can enable us to make tentative recommendations for older people, relevant decision-makers, and administrative bodies. Additionally, a more rigorous longitudinal design is necessary to investigate causality in regard to related factors and preference in LTC models.
... Several variables were used to test predictive validity: Age and sex (RAMQ files); education (CCHS questions) [18]; self-reported health status (SF-36) [21]; number of chronic diseases (Functional Comorbidity Index (FCI)) [22]; depression symptoms (Geriatric Depression Scale (GDS)) [23]; cognitive functioning (Montreal Cognitive Assessment (MoCA)) [24]; disability in basic and instrumental activities of daily living (ADL, IADL) Katz et al., [25] Lawton and Brody [26] scales; mortality in the three-year period following the first interview obtained from the Institut de la statistique du Québec. ...
Article
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Background Fried’s Phenotype Model of Frailty (PMF) postulates that frailty is a syndrome. Features of a syndrome are a heterogeneous population that can be split into at least two classes, those presenting and those not presenting the syndrome. Syndromes are characterized by a specific mixture of signs and symptoms which increase in prevalence, from less to more severe classes. So far, the null hypothesis of homogeneity – signs and symptoms of frailty cannot identify at least two classes – has been tested using Latent Class Analysis (LCA) on the five dichotomized components of PMF (unintentional weight loss, exhaustion, weakness, slowness, and low physical activity). The aim of this study is to investigate further the construct validity of frailty as a syndrome using the extension offered by Factor Mixture Models (FMM). Methods LCA on dichotomized scores and FMM on continuous scores were conducted to test homogeneity on the five PMF components in a sample of 1643 community-dwelling older adults living in Québec, Canada (FRéLE). Results With dichotomized LCA, three frailty classes were found: robust, prefrail and frail, and the hypothesis of homogeneity was rejected. However, in FMM, frailty was better represented as a continuous variable than as latent heterogeneous classes. Thus, the PMF measurement model of frailty did not meet the features of a syndrome in this study. Conclusion Using the FRéLE cohort, the PMF measurement model validity is questioned. Valid measurement of a syndrome depends on an understanding of its etiological factors and pathophysiological processes, and on a modelling of how the measured components are linked to these processes. Without these features, assessing frailty in a clinical setting may not improve patient health. Research on frailty should address these issues before promoting its use in clinical settings.
... A total of 182 surgical procedures for clival chordomas were performed p < 0.001; Table 1 forming normal activities or unable to function without assistance). 29 The presenting Katz Index did not differ between the two treatment eras (p = 0.182). An endoscopic endonasal transclival approach (EETA) was performed for the removal of 151 clival chordomas (83.0%). ...
Article
Objective: In the last 2 decades, the endoscopic endonasal approach in the treatment of clival chordomas has evolved to be a viable strategy to achieve maximal safe resection of this tumor. Here, the authors present a multicentric national study, intending to analyze the evolution of this approach over a 20-year time frame and its contribution in the treatment of clival chordomas. Methods: Clival chordoma cases surgically treated between 1999 and 2018 at 10 Italian neurosurgical departments were included in this retrospective study. Clinical, radiological, and surgical findings, adjuvant therapy, and outcomes were evaluated and compared according to classification in the treatment eras from 1999 to 2008 and from 2009 to 2018. Results: One hundred eighty-two surgical procedures were reviewed, with an increase in case load since 2009. The endoscopic endonasal transclival approach (EETA) was performed in 151 of 182 cases (83.0%) and other approaches were performed in 31 cases (17%). There was an increment in the use of EETA, neuronavigation, and Doppler ultrasound after 2008. The overall postoperative complication rate was 14.3% (26 of 182 cases) consisting of 9 CSF leaks (4.9%), 7 intracranial hemorrhages (3.8%), 5 cases of meningitis (2.7%), and 5 cerebral ischemic injuries (2.7%). Gross-total resection (GTR) was achieved in 93 of 182 cases (51.1%). Extent of resection (EOR) improved in the second era of the study. Signs and/or symptoms at presentation worsened in 27 cases (14.8%), and the Katz Index worsened in 10 cases (5.5%). Previous treatment, dural involvement, EETA, and intraoperative Doppler ultrasound correlated with GTR. Patients received adjuvant proton beam radiation in 115 of 182 cases (63.2%), which was administered more in the latter era. Five-year progression-free survival (PFS) and overall survival (OS) were 62.3% and 73.5%, respectively. GTR, EETA, proton beam therapy, and the chondroid subtype correlated with a better survival rate. The mean follow-up was 62 months. Conclusions: Through multicentric data collection, this study encompasses the largest series in the literature of clival chordomas surgically treated through an EETA. An increase in the use of this approach was found among Italian neurosurgical departments together with an improved extent of resection over time. The satisfactory rate of GTR was marked by low surgical morbidity and the preservation of patient quality of life. Surgical outcome was reinforced, in terms of PFS and OS, by the use of proton beam therapy, which was increasingly performed along the period of study.
... The interfaces visualised a set of fictitious activities in formats demonstrated to be the most effective and easily understood by participants of research studies within this area. The ADLs chosen for representation [87] remained the same in all UIs, involving the household rooms in which the majority of daily activities are conducted, namely, the bedroom, bathroom, sitting room and kitchen. ...
Article
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Activities of Daily Living systems (ADLs) and the User Interface (UI) design principles used to implement them empowers the elderly to continue living a normal daily routine. The daily monitoring of activities for most Assisted Living (AL) systems demands/necessitates accurate daily user interaction, and the design principles for these systems often focus on the UI usability for the elder, not the caregiver/family member. This paper reviews Ambient Assisted Living (AAL) and ADLs UI designs and evaluates the usability of ADLs visualisation tools for caregivers. Results indicate that the UI presenting information in a bar graph format was the preferred option for respondents, as 60% chose this summarisation method over the alternative line graph UI, which had 38% of respondents selecting this format for information representation. Therefore, when designing Ambient Assisted Living (AAL) UIs, it is recommended that short periods of time are best presented in a pie graph format in combination with a bar graph format for representing extended timeline information to caregivers about their loved ones.
... Secondary outcome measures included the Katz Index of Independence in Activities of Daily living [24] which examines functioning; the Generalised Anxiety Disorder 7 (GAD-7) [25]; and the Patient Assessment of Chronic Illness Care (PACIC) Scale where patients rate their satisfaction with their care [26]. ...
Article
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Background As the population of older adults’ increases, the complexity of care required to support those who choose to remain in the community has also increased. Anticipatory Care Planning (ACP) through earlier identification of healthcare needs is evidenced to improve quality of life, decrease the number of aggressive futile interventions, and even to prolong life. Aim To determine the feasibility of a cluster randomised trial to evaluate the implementation and outcomes of Anticipatory Care Planning (ACP) in primary care to assist older adults identified as at risk for functional decline by developing a personalised support plan. Method GP practices were randomised into control/intervention groups stratified by jurisdiction [Northern Ireland (UK) and the Republic of Ireland (RoI)], and by setting (urban and rural). Participants were included if they were a) aged ≥70 years, b) 2 or more chronic medical conditions, c) 4 or more prescribed medications. The Anticipatory Care Plan consisted of home visits where the study nurse discussed patients’ goals and plans. An action plan was put in place following consultation with patient’s GPs and study Pharmacist. Results Eight primary care practices participated; four in the UK and four in the RoI. Sample n = 64. Data was collected pertaining to patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and the use of potentially inappropriate medication. Conclusion Unique insights relating to the trans-jurisdictional delivery of healthcare services in the UK and RoI were observed which has implications on service delivery for older adults.
... In the CGA, the following frailty domains and instruments were examined: cognition, measured by the Mini-Mental State Examination (MMSE) [18]; strength, measured by the handgrip strength test [19]; (mal)nutrition, measured by the Malnutrition Universal Screening Tool (MUST) [20]; inactivity in basic activities of daily living, measured by the Katz index (Katz ADL) [21]; inactivity in instrumental activities of daily living, measured by the Lawton and Brody index [22]; and limitation of mobility using the Timed Up and Go Test (TUGT) [23] and 5 Meter Gait Speed Test (5MGST) [24]. A comprehensive explanation of the frailty domains and cutoff points can be found in Appendix A2. ...
Article
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Background: Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI. Methods: The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI. Results: 239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS ≥ 3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P = 0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P = 0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07-4.70, P = 0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05-0.50, P = 0.001) and renal dysfunction (OR 0.13, 95% CI 0.04-0.41, P = <0.001) at baseline was associated with improved HRQoL 1 year after TAVI. Conclusion: Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline.
... Physical function Measures for overall physical functioning include: Karnofsky score and ECOG scores [371]. Measures for dependence in daily activities include: Activities of Daily Living (ADL; basic activities) and Instrumental Activities of Daily Living (IADL; activities requiring higher cognition and judgement) [372][373][374]. ...
... CGA requires the evaluation of physical, cognitive, affective, social, financial, and environmental components. For that purpose; activities of daily living was assessed by basic and instrumental activities of daily living (Katz BADL and Lawton-Brody IADL) scales [14,15]. The Katz BADL measures six self-care tasks, including bathing, dressing, toileting, transferring to and from a chair, maintaining continence and feeding. ...
Article
OBJECTIVES: Frailty is a geriatric syndrome which develops as a result of cumulative decline in many physiological systems and results in an increased vulnerability and risk of adverse outcomes. The Clinical Frailty Scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people and evaluates items such as comorbidity, cognitive impairment and disability. We aimed to study the concurrent and construct validity and reliability of the 9 point CFS in Turkish Population. METHODS: This study was designed as a cross-sectional study. Participants, who were admitted to a geriatric medicine outpatient clinic, were included. Validity of 9 point CFS was tested by its correlation with the assessment and opinion of an experienced geriatric medicine specialist and Fried frailty phenotype. Test-retest and inter-rater reliability analyses were also performed. RESULTS: Median age of the 118 patients was 74.5 years (min: 65 max: 88) and 64.4 % were female. The concordance of CFS and experienced geriatric medicine specialist's opinion was excellent (Cohen's K: 0.80, p < 0.001).The concordance of CFS and Fried Frailty phenotype was moderate (Cohen's K: 0.514, p < 0.001).CFS inter-rater reliability and test-retest reliability was very strong (Cohen's K: 0.811, p < 0.001 and Cohen's K: 1.0, p < 0.001, respectively). CONCLUSIONS: CFS appears to be a quick, reliable and valid frailty screening tool for community-dwelling older adults in the Turkish population.
Article
Aged inmates comprise a growing segment of the incarcerated population world-wide, yet very little research has been devoted to examining the intergenerational experiences of this cohort and the research that has been conducted has been inconsistent in its findings of victimization and negative social relationships. In an attempt to help fill this gap, this study examined the intergenerational elements of the lives of older (male) inmates and investigated their social supports and the degree of age segregation characterizing their carceral experience. Qualitative data revealed ruptured connections among inmates and their children and apprehensive relationships with younger fellow inmates or the correctional staff. Nevertheless, the findings counter the contention that the intergenerational environment is detrimental to aged inmates and that age-segregated carceral units would be beneficial to them.
Article
In the present study, we explored the relationship between multimorbidity and frailty in a population of older individuals with cognitive disturbances attending a memory clinic. All subjects consecutively attending the Memory Clinic of the Department of Human Neuroscience, “Sapienza” University of Rome, between January 2017 and April 2018 for a first neurological evaluation were considered for the present analysis. Multimorbidity was defined as the simultaneous presence of two or more diseases in the same individual. A Frailty Index was computed by considering 44 age-related, multidimensional health deficits. Overall, 185 subjects were recruited in the study. A condition of multimorbidity was detected in 87.6% of the sample, whereas only the 44.6% of the study population was considered as frail. A poor agreement was observed between multimorbidity and frailty. The present findings confirm that counting diseases or health deficits may provide discordant information concerning the risk profile of older subjects.
Article
Purpose Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case‐control study was to assess the relation between medication use and falls among elderly in ALF. Methods A matched case‐control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall risk‐increasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed. Results The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. Conclusion The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.
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Rationale: Patients managed at a long-term acute-care hospital (LTACH) for weaning from prolonged mechanical ventilation are at risk for profound muscle weakness and disability. Objectives: To investigate effects of prolonged ventilation on survival, muscle function, and its impact on quality of life at 6 and 12 months after LTACH discharge. Methods: This was a prospective, longitudinal study conducted in 315 patients being weaned from prolonged ventilation at an LTACH. Measurements and Main Results: At discharge, 53.7% of patients were detached from the ventilator and 1-year survival was 66.9%. On enrollment, maximum inspiratory pressure (Pimax) was 41.3 (95% confidence interval, 39.4-43.2) cm H2O (53.1% predicted), whereas handgrip strength was 16.4 (95% confidence interval, 14.4-18.7) kPa (21.5% predicted). At discharge, Pimax did not change, whereas handgrip strength increased by 34.8% (P < 0.001). Between discharge and 6 months, handgrip strength increased 6.2 times more than did Pimax. Between discharge and 6 months, Katz activities-of-daily-living summary score improved by 64.4%; improvement in Katz summary score was related to improvement in handgrip strength (r = -0.51; P < 0.001). By 12 months, physical summary score and mental summary score of 36-item Short-Form Survey returned to preillness values. When asked, 84.7% of survivors indicated willingness to undergo mechanical ventilation again. Conclusions: Among patients receiving prolonged mechanical ventilation at an LTACH, 53.7% were detached from the ventilator at discharge and 1-year survival was 66.9%. Respiratory strength was well maintained, whereas peripheral strength was severely impaired throughout hospitalization. Six months after discharge, improvement in muscle function enabled patients to perform daily activities, and 84.7% indicated willingness to undergo mechanical ventilation again.
Article
Background Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many factors may contribute to sarcopenia as cancer and/or androgen deprivation therapy (ADT). Objectives The aims of this study are to describe the prevalence of sarcopenia in older prostate cancer patients before initiation of treatment with ADT and radiotherapy, and to evaluate the impact of ADT on the occurrence or aggravation of sarcopenia in this population. Design Longitudinal study. Participants and setting Sarcopenia was prospectively evaluated in 31 consecutive patients aged 70 to 88 years, referred in one hospital unit of south eastern France, for a comprehensive geriatric assessment (CGA) before cancer treatment initiation. Measurements and results CGA, measures of muscle strength and physical performances were performed at baseline (T0) and at the end of cancer treatment (T1). Appendicular skeletal muscle mass was measured by Dual-energy X-ray absorptiometry (DXA) at the end of treatment. At T0, 8 patients (among 31) had a probable sarcopenia according to European consensus, and 18 had altered physical performance. At T1, 15 patients (among 19) had abnormal one leg balance test. Finally, only one patient had a sarcopenia confirmed by DXA. Conclusion This preliminary study showed a high prevalence of muscle disorders before initiation of ADT in a population of elderly cancer prostate patients with intermediate frailty status, and an increased risk of falls at the end of ADT. This highlighted the importance of screening for sarcopenia before treatment initiation, to prevent the occurrence or aggravation of sarcopenia by possible adjustment of treatment, and implementation of appropriate exercise and nutrition interventions.
Article
Treatment decision‐making in older patients with cancer is difficult due to a paucity of data evaluating chemotherapy tolerability in this population. We investigated the feasibility of chemotherapy in the oldest old and performed a singl‐centre retrospective analysis of patients aged ≥80 years initiating chemotherapy for one of five common solid malignancies or non‐Hodgkin lymphoma between 2010 and 2016. Treatment plan and course were extracted from medical files. Primary outcome was whether chemotherapy was completed according to plan, defined as a calculated relative dose intensity (RDI) ≥85%. A total of 104 patients receiving 129 chemotherapy lines were included. Median age at diagnosis was 82 years (range 80–94 years). Most patients (64%) received palliative intent chemotherapy. Primary and secondary chemotherapy adaptations were implemented in 63% and 65% of the cases, and hospitalisation occurred in a quarter. 52% of all cases completed chemotherapy according to plan. Almost half of the chemotherapy regimens started in the oldest old were not completed according to plan, despite frequently implemented upfront adaptations. The decision to start chemotherapy in these patients should be carefully considered. To improve decision‐making in current practice, there is a need for the implementation of validated tools assessing chemotherapy feasibility in these patients.
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Background Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings. The aim of this study was to identify dietary, nutritional, physical and cognitive factors associated with poor socioeconomic status (SES) among older adults according to urban and rural settings in Malaysia. Methods An analysis was conducted among 2237 older adults who participated in a longitudinal study on aging (LRGS TUA). This study involved four states in Malaysia, with 49.4% from urban areas. Respondents were divided into three categories of SES based on percentile, stratified according to urban and rural settings. SES was measured using household income. Results The prevalence of low SES was higher among older adults in the rural area (50.6%) as compared to the urban area (49.4%). Factors associated with low SES among older adults in an urban setting were low dietary fibre intake (Adj OR:0.91),longer time for the Timed up and Go Test (Adj OR:1.09), greater disability (Adj OR:1.02), less frequent practice of caloric restriction (Adj OR:1.65), lower cognitive processing speed score (Adj OR:0.94) and lower protein intake (Adj OR:0.94). Whilst, among respondents from rural area, the factors associated with low SES were lack of dietary fibre intake (Adj OR:0.79), lower calf circumference (Adj OR: 0.91), lesser fresh fruits intake (Adj OR:0.91), greater disability (Adj OR:1.02) and having lower score in instrumental activities of daily living (Adj OR: 0.92). Conclusion Lower SES ismore prevalent in rural areas. Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings. Factors associated with low SES identifiedin both the urban and rural areas in our study may be useful inplanning strategies to combat low SES and its related problems among older adults.
Article
Background: Few studies have investigated the global burden of the sequelae and the health-related quality of life (HR-QoL) for epidermal necrolysis (EN) survivors. Objectives: To investigate the long-term HR-QoL of EN survivors using validated instruments. Methods: Monocenter study enrolling patients admitted for EN between 2010 and 2017. HR-QoL was assessed during a phone interview by using the SF-36 questionnaire, Hospital Anxiety and Depression (HAD) scale, Impact of Event Scale-Revised (IES-R), and general QoL outcomes, including EN-specific sequelae. The primary outcome measure was the physical component summary (PCS) score of the SF-36. Results: In total, 57 EN survivors (19 [33%] with ICU admission) were phone-interviewed at a median of 3·6 [1·9-6·1] years after hospital discharge. The median PCS score was 0·44 standard deviations below that of the age-sex-matched reference population. The median PCS score was significantly lower for EN survivors admitted versus not admitted to the ICU (43·7 [28·7-49·3] vs 51·2 [39·4-56·5]; p=0·042). The overall proportion of EN patients with HAD-anxiety score ≥ 8 or HAD-depression score ≥ 5 was 54% and 21%. Physical and mental outcomes did not differ between EN patients admitted to the ICU and septic shock survivors. Reported EN-specific sequelae were cutaneous (77%), ocular (70%), psychological (60%), dental/oral (49%), genital (30%) and respiratory (18%), with median intensity on a visual analog scale of 5 and 6/10. Conclusions: Our study confirms the major burden and long-term impact of EN on QoL of survivors and emphasizes the need for prolonged close follow-up after the acute phase of EN. This article is protected by copyright. All rights reserved.
Conference Paper
Since the abrupt change of daily routines can be an early symptom of cognitive impairment, it is important to measure and track the variability of daily routines of the elderly living alone in terms of their healthcare. This study is motivated by the idea that the degree of image complexity manifested in a person's day-to-day schedule chart is related to the degree of routine variability of his/her daily activities. To test this idea, synthetic data on daily activity logs containing varying degrees of routine variability was created, and a schedule bar chart image was generated based on the synthetic data. Then this study examines whether and to what extent the routine variability inherent in the dataset can be measured by existing image complexity metrics, which have been used to a pattern tendency of an image. The results indicate that the outcomes from three metrics, including Shannon Entropy, GLCM-Entropy, and GLCM-Energy, are well-associated with the degree of routine variability manifested in different aspects of daily activity schedules (i.e., start-time, duration, non-routine-contributing activities, and sequence of routine-contributing activities).
Article
Objective: To identify the socioeconomic factors leading to disparities in participation in leisure activities over the life course among Chinese oldest-old people. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a sample of adults aged 80 years or older in the period 1998-2012, featuring 38 312 individuals (58 945 observations). Results: The younger birth cohorts were found to have significantly higher levels of participation in leisure activities, with a non-linear decrease in age observed for oldest-old men and women. Higher participation levels were significantly related to higher education levels, economic independence and non-manual occupations before retirement among the Chinese oldest-old. Conclusions: Leisure activity participation has increased substantially in recent cohorts of Chinese oldest-olds. Those with lower socioeconomic status may represent a disadvantaged population in terms of participation in leisure activities over their life course.
Book
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El libro Terapia Ocupacional en Geriatría y Gerontología presenta los fundamentos y aplicaciones practicas de la terapia ocupacional para optimizar el desempeño ocupacional de las personas mayores. Se aborda también el desarrollo de Terapia Ocupacional en los tres niveles asistenciales geriátricos (atención primaria, atención especializada y servicios sociales socio comunitarios).
Article
Objectives: To determine the factors associated with the potentially inappropriate transfer of nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization costs before and after transfer of individuals addressed inappropriately vs those addressed appropriately. Design: Multicenter, observational, case-control study. Setting and participants: 17 hospitals in France, 1037 NH residents. Measures: All NH residents transferred to the 17 public hospitals' EDs in southern France were systematically included for 1 week per season. An expert panel composed of family physicians, emergency physicians, geriatricians, and pharmacists defined whether the transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics and contextual factors were entered into a mixed logistic regression to determine factors associated independently with potentially inappropriate transfers. Hospital costs were collected in the national health insurance claims database for the 6 months before and after the transfer. Results: A total of 1037 NH residents (mean age 87.2 ± 7.1, 68% female) were transferred to the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment, anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood of potentially inappropriate transfers. The existence of an Alzheimer's disease special care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives (OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit) (OR 0.47, 95% CI 0.34-0.66) were significantly associated with a lower probability of potentially inappropriate transfer. Although the 6-month hospitalization costs prior to transfer were higher among potentially inappropriate transfers compared with appropriate transfers (€6694 and €4894, respectively), transfer appropriateness was not significantly associated with hospital costs. Conclusions and implications: Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness was conditioned by NH staff training, access to specialists' medical advice, and calling the SAMU before making transfer decisions. Trial registration: clinicaltrials.gov, NCT02677272.
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Aim Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. Chronic inflammatory conditions and increased oxidative stress are in the pathogenesis of sarcopenia. Our aim was to evaluate the relationship between sarcopenia and thiol–disulfide homeostasis and ischemia-modified albumin levels as an oxidative stress marker. Methods Patients aged ≥65 years were recruited in this study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criterion. Total thiol, native thiol, disulfide and ischemia-modified albumin levels were measures according to clinical and laboratory features. Patients were divided into two groups according to their sarcopenia presence; thiol–disulfide homeostasis and ischemia-modified albumin levels were evaluated between these groups. Results Overall, 94 patients were analyzed. The mean age was 75.0 ± 6.71 years. A total of 39% of the patients were diagnosed as probable sarcopenia, 3.2% had sarcopenia, 6.4% had severe sarcopenia and 51.1% were diagnosed as normal. The levels of native thiol, total thiol, disulfide level and disulfide–native thiol, native thiol–total thiol and disulfide–total thiol ratios were similar in patients with sarcopenia when compared with the control group. In addition, there were no differences between albumin and ischemia-modified albumin levels. In univariate regression analysis, handgrip strength was found to be an independent predictor of native thiol and total thiol, and disulfide levels. Conclusion This is the first study in the literature that evaluates the thiol–disulfide homeostasis and ischemia-modified albumin levels in sarcopenic older patients. Long-term studies are warranted to confirm the relationship between oxidative stress markers and sarcopenia. Geriatr Gerontol Int 2021; ••: ••–••.
Article
Outcomes after critical illness remain poorly understood. Conceptual models developed by other disciplines can serve as a framework by which to increase knowledge about outcomes after critical illness. This article reviews 3 models to understand the distinct and interrelated content of outcome domains, to review the components of functional status, and to describe how injuries and illnesses relate to disabilities and impairments afterward.
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