Activities Of Daily Living Decline Research Articles

A Lower CD4+/CD8+ Ratio Predicts Activities of Daily Living Decline Among Older Adults with HIV.

Aging of people with human immunodeficiency virus (HIV) is a worldwide reality, and age-related conditions, including disability, have also increased. Efforts are being made to search for more specific markers of immune system malfunction, which serve as good predictors of adverse health-related outcomes. Therefore, this study aimed to determine the relationship between the CD4+/CD8+ ratio and functional decline in activities of daily living (ADL). Participants in this longitudinal study underwent a standardized comprehensive geriatric assessment by trained staff, using validated tools. Functional decline in ADL was established by the delta resulting from the subtraction of the score on the Barthel index at T1 minus the score at T0 (baseline). Multivariate linear regression analyses were used to determine the independent relationship between the CD4+/CD8+ ratio and ADL decline. Mean age was 57.9 (standard deviation 6.6; range 50-84 years), and 82.7% were men. Eleven of the 209 participants had disability for ADL at baseline. Multivariate linear regression analysis showed an inverse relationship between the log of CD4+/CD8+ ratio at baseline and the delta of Barthel index even after adjustment for multiple confounders (β = -1.68, 95% confidence interval -3.02 to -0.33; p = .01). A CD4+/CD8+ ratio of <1 predicts the development of functional decline in ADL. This ratio can be a useful marker to identify people at risk of disability and should be considered for the tailored management of older adults with HIV.

Higher dietary diversity and better healthy aging: A 4-year study of community-dwelling middle-aged and older adults from the Taiwan Longitudinal Study of Aging.

To investigate the relationship between dietary diversity and healthy aging (in terms of mobility performance, physical functions, cognitive functions, and depressive symptoms) among community-dwelling middle-aged and older adults by using a nationally representative population-based cohort study. Data from 3213 study participants in the Taiwan Longitudinal Study on Aging (TLSA) were retrieved for analysis, and all participants were divided into five groups according to the quintile of dietary variety scores (DVSs). In the 4-year follow-up study, multivariate logistic regression models were applied to investigate the associations between DVS subgroups and declines in mobility performance, physical function (activities of daily living (ADLs) and instrumental activities of daily living (IADLs)), cognitive function and depressive symptoms. In this study, the DVS quintile identified people who were significantly vulnerable in diet quality. Among those in the lowest DVS quintile, the proportions consuming seafood, eggs, and beans/legumes per week were 0.3%, 7.8% and 12.6%, respectively, while among those in the highest DVS quintile, the proportions were 40.2%, 83.1%, and 82.7%, respectively. "Inverse" dose-response associations were observed between the DVS and the risks of decline in mobility performance, physical function (ADLs and IADLs), cognitive function, and depressive symptoms. These risks decreased with the higher DVS quintile group as compared to the lowest DVS quintile group. Even after adjustments for demographics, health behaviors (e.g., physical activity) and comorbidities, participants in the highest DVS quintile group were still associated with the lowest risk of decline in ADLs (adjusted odds ratio (aOR) 0.59 [95% confidence interval (CI) 0.37-0.94], p<0.05) and IADLs (aOR 0.53 [0.39-0.73], p<0.01). However, no such association was observed in the risk of worsened mobility performance, cognitive function and depressive symptoms. In conclusion, higher dietary diversity has protective effects in declines in multidimensional outcomes associated with healthy aging, particularly physical functions (ADL and IADL), among community-dwelling middle-aged and older adults. Intervention studies are needed to confirm the causal relationships between dietary diversity and healthy aging.

Association between cognitive decline and activities of daily living decline in patients undergoing long-term oxygen therapy: a prospective observational pilot study

Purpose Patients undergoing long-term oxygen therapy (LTOT) are predisposed to progressive cognitive decline; however, the association between cognitive decline progression and activities of daily living (ADL) decline has not been described. We aimed to describe the association between cognitive decline progression and ADL decline in patients undergoing LTOT. Materials and methods In this prospective observational pilot study, data were collected at baseline and 1-year following the ambulatory recruitment of patients in the Department of Respiratory Medicine at the National Hospital Organization Nishiniigata Chuo Hospital. We recruited 96 patients with chronic respiratory disease undergoing LTOT, and 55 patients who completed a 1-year follow-up were finally included. Results Multivariate logistic regression analysis revealed that Montreal Cognitive Assessment score reduction (a measure of cognitive decline) was associated with Barthel index score reduction (a measure of ADL) at 1-year follow-up (odds ratio: 3.98; 95% confidence interval: 1.16 − 13.69; p = 0.02). Conclusion A progression of cognitive decline in patients undergoing LTOT may affect ADL decline. An early detection of cognitive decline in patients undergoing LTOT is essential for ADL maintenance in rehabilitation practice. IMPLICATIONS FOR REHABILITATION Patients undergoing long-term oxygen therapy (LTOT) present with progressive cognitive decline. Cognitive decline progression is associated with a decline in activities of daily living in patients undergoing LTOT. A periodic cognitive assessment is important in rehabilitation practice for the early detection of progressive cognitive decline in patients undergoing LTOT.

Impact of frailty on risk of long-term functional decline following vascular surgery

ObjectiveFrailty is a clinical syndrome associated with slow recovery after vascular surgery. However, the degree and length of functional impairment frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail and non-frail patients undergoing a spectrum of different vascular surgery procedures. MethodsPatients consented to undergo elective minor and major vascular surgery procedures at an academic medical center between May 2018 and March 2019 were prospectively identified. Prior to surgery, all patients underwent provider assessment of frailty using the validated Clinical Frailty Scale (CFS), as well as baseline assessment of functional status using the Katz Activities of Daily Living (ADL) index and the Lawton Instrumental Activities of Daily Living (iADL) index. These same instruments were used to evaluate each patient’s functional status at 2-weeks, 1-month, 1-year, and 2-year time points following surgery. Changes in iADL and ADL scores among frail (CFS ≥5) and non-frail patients were compared using paired Wilcoxon signed-rank tests and logistic regression models. ResultsA total of 126 patients were assessed before and after minor (55%) and major (45%) vascular procedures, of which 43 patients (34%) were determined to be frail prior to surgery. Frail patients were older and more likely than non-frail patients to have medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, or diabetes (all P < .05). When compared with the non-frail cohort, frail patients had significantly lower ADL and iADL scores before surgery and experienced a greater decline in ability to independently complete ADL and iADL activities after surgery that was sustained at 2 years (P < .05 and P < .001, respectively). After risk-adjustment, frailty was associated with an increased likelihood of decline in ADLs (odds ratio, 5.4; 95% confidence interval, 1.9-15.4; P < .05) and iADLs (odds ratio, 6.3; 95% confidence interval, 2.6-15.1; P < .001) at 2 years following surgery. ConclusionsFrail patients experience a significant decline in ability to perform ADL and iADLs that persists 2 years following vascular surgery. These data highlight the degree of functional decline occurring immediately following surgery, as well as risk for long-term, sustained impairment that should be shared with frail patients before undergoing a procedure.

Relationship between psychiatric symptoms and activities of daily living in patients undergoing hemodialysis

BackgroundAccurately identifying the factors contributing to decline in activities of daily living (ADL) is important for preventing such decline in patients undergoing hemodialysis (HD). We studied the prevalence and number of overlapping psychiatric symptoms (depressive symptoms, apathy, and sleep disturbance) in patients undergoing HD and examined the relationship between psychiatric symptoms and ADL.MethodsThe study utilized a cross-sectional research design. The sample included 203 outpatients (median age: 69 years) undergoing stable HD treatment three times a week. Patient characteristics, including age, sex, body composition, dialysis vintage, primary kidney disease, comorbidity, and nutritional status, were collected from patients’ medical records. Functional status was assessed based on the self-reported questionnaire that combined five basic and eight instrumental ADL items. Usual walking speed was used as an index of physical function. Additionally, the short version of the Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Further, apathy and sleep disturbance were assessed using the Motivation Score and the Athens Insomnia Scale, respectively.ResultsOverall, 59 (29.1%) patients demonstrated depressive symptoms, 100 (49.3%) reported apathy, 83 (40.9%) had sleep disturbance, 31 (15.3%) had three overlapping psychiatric symptoms, 43 (21.2%) had two overlapping psychiatric symptoms, 63 (31.0%) had only one symptom, and 66 (32.5%) had no psychiatric symptoms. Multiple logistic regression analysis showed that having two or three overlapping psychiatric symptoms was independently and significantly associated with ADL (functional status of 13 points for the ADL maintenance group, and of < 13 points for the ADL decline group, respectively), even after adjusting for patient characteristics and walking speed (odds ratio: 2.74, 95% confidence interval: 1.12–6.69, reference; no psychiatric symptoms).ConclusionThe present study clarified that the overlapping symptoms, including depressive symptoms, apathy, and sleep disturbance, were independently associated with ADL decline in patients undergoing HD. It is useful to examine not only depressive symptoms but also other symptoms such as apathy and sleep disturbance to elucidate factors associated with deteriorated ADL in chronic patients. Our findings provide a strong basis for targeted interventions to prevent functional dependence in the HD population.

The Influence of Exercise, Nutritional Status, and Disease on the Functional Ability to Undertake Activities of Daily Living and Instrumental Activities of Daily Living in Old Taiwanese People

This study aimed to examine the influence of changes in exercise status, nutritional status, and a number of comorbidities on functional ability in Taiwanese community-dwelling older adults. Data were obtained from the Taiwan Longitudinal Study of Aging. The results revealed that current exercise and consistent exercise were negatively associated with subsequent 4- and 8-year activities of daily living (ADL) and instrumental ADL (IADL) decline (all p &lt; 0.05). The Mini-Nutritional Assessment (MNA) score was negatively associated with subsequent 8-year IADL decline (all p &lt; 0.05), while the number of diseases was positively associated with subsequent 4- and 8-year IADL decline (all p &lt; 0.05). Current exercise and consistent exercises are beneficial for adults aged ≥65 years to maintain their functional ability in ADL and IADL and to prevent declines in functional ability. Consistency of exercise, MNA score, and the number of chronic diseases are good predictors of IADL decline.

Early initiation of tolvaptan is associated with early discharge in patients with heart failure regardless of age

BackgroundElderly patients with heart failure (HF) have been observed to decrease activities of daily living (ADL) during hospitalization. Prevention of ADL decline from shortening of hospital stays is especially important in the elderly, because decreasing ADL is associated with poor prognosis. We investigated the relationship between the early initiation of tolvaptan (TLV) after hospitalization and the length of hospital stay in patients with HF aged younger than 80 years and aged 80 years and older.MethodsWe analyzed 146 patients younger than 80 years (< 80) and 101 patients aged 80 years and older (≥ 80) who were hospitalized with HF from February 2011 to June 2016 and had initiated TLV. The relationship between the time until commencement of TLV and the length of hospital stay was assessed. Additionally, a comparison made between the TLV early start group (within the median) and the delayed start group (over the median) for both groups. Multivariate analysis was also performed on factors that required hospital stays below the median.ResultsA significant correlation was observed between time to TLV initiation and the length of hospital stay (< 80: r = 0.382, P < 0.001; ≥ 80: r = 0.395, P < 0.001). The length of hospital stay in the early group was significantly longer than that in the delayed group for both groups (< 80: early 21.0 ± 13.0 days and 33.0 ± 22.7 days, respectively, P < 0.001; ≥ 80: early 21.3 ± 12.5 days and 32.9 ± 17.9 days, respectively, P < 0.001). Conversely, no statistically significant difference found in the length of hospital stay after initiation of TLV. Moreover, no increase in adverse events in the elderly observed. A multivariate analysis revealed that a predictive factor for short-term hospitalization was early administration of TLV regardless of age.ConclusionsThe early initiation of TLV after hospitalization was associated with a shorter length of hospital stay in patients with HF regardless of age.

Muscle changes on muscle ultrasound and adverse outcomes in acute hospitalized older adults

ObjectivesMuscle ultrasound is a non-invasive technique that enables identification of the quantity and quality of muscle tissue. It has been used not only for diagnosis of sarcopenia but also for prediction of outcomes in clinical practice. There is now increasing awareness that muscle changes detected during acute hospitalization indicate acute sarcopenia leading to worse outcomes. However, to our knowledge, few studies have investigated this in hospitalized older adults. The aim of this study was to determine whether muscle changes on muscle ultrasound can predict poor outcomes in acute hospitalized older adults. MethodsThis prospective, observational cohort study involved 145 acute hospitalized older adults. Bilateral anterior thigh thickness (BATT), echo intensity (EI), and corrected EI of the quadriceps were assessed on admission and 7 d later. The primary outcome was mortality, and the secondary outcomes were hospital-associated complications and decline in activities of daily living (ADLs) at 3 mo after discharge. ResultsChanges in BATT, EI, and corrected EI at 7 d after admission were found in 0.2%, 0.0%, and 0.2% of cases, respectively. The respective rates for mortality, hospital-associated complications, and ADL decline were 8.7%, 52.8%, and 43%, respectively. Multivariable logistic regression analysis showed that the BATT value at admission tended to be associated with mortality. Changes in BATT, EI, and collected EI were not associated with adverse outcomes. ConclusionsAcute muscle changes on muscle ultrasound were not associated with mortality, ADL decline, or hospital-associated complications in acute hospitalized older adults. More research in various settings is needed to clarify the value of muscle ultrasound in clinical practice.

Discharge disposition and 1-year readmission in acute-phase hospitalized patients with heart failure: a retrospective observational multi-center study.

Patients hospitalized for acute heart failure (HF) tend to experience declines in physical function and activities of daily living (ADL) due to bed rest and restricted mobilization. This could result in some patients being transferred to rehabilitation hospitals. This study aims to examine the relationship between discharge disposition and 1-year readmission and mortality rates in HF patients. Nine hundred fifty six consecutive HF patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into two groups: home (returned home) or transfer (transferred to rehabilitative or long-term care hospital units due to decline in physical function and/or ADL) groups. The primary and secondary outcomes were 1-year readmission and mortality rates after discharge, respectively. Of the 956 patients, 8.6% (n = 82) were transferred to rehabilitative or long-term care hospital units. Over a 1-year follow-up period, all-cause and HF readmission rates were 50.1% (n = 479) and 27.2% (n = 260), respectively. The transfer group had significantly lower readmission rates compared to home group after adjusting for the pre-existing risk factors (hazard ratio for all-cause and HF readmission: 0.600 and 0.552, 95% CI 0.401-0.897 and 0.314-0.969; P = 0.013 and P = 0.038, respectively). There was no significant relationship between discharge disposition and all-cause mortality rate. Low ADL defined as Barthel index < 60 points was identified as a predictor of all-cause and HF readmission among the home group (odds ratio for all-cause and HF readmission rates: 2.156 and 1.847, 95% CI 1.026-4.531 and 1.036-2.931; P = 0.043 and P = 0.037, respectively). This multi-center study demonstrated that HF patients transferred to rehabilitative or long-term care hospital units after an acute hospitalization had a significantly decreased 1-year all-cause and HF readmission rates compared to patients who returned to their home. These findings may help in selecting a discharge disposition for older HF patients with ADL decline.

Prevalence and Social Risk Factors of Functional Limitations Among Slum-Dwelling Older Adults: Findings From the Nairobi Urban Health and Demographic Surveillance System.

Objective: In this study, we investigate the patterns and the risk factors of functional limitations in a sample of 1323 slum-dwelling older adults in Kenya who participated in the Nairobi Urban Health and Demographic Surveillance Systems. Methods: We conducted crude and adjusted logistic regression analyses to evaluate the associations. Results: The prevalence of activities of daily living (ADL) and instrumental ADL (IADL) limitations were approximately 5% and 8%, respectively; some 4.5% reported both limitations. Estimates varied significantly between sexes and age (p < .001). After adjustments, age, female, and Garre ethnic group were associated with ADL and IADL limitations. ADL decline was determined by co-residence (aOR = 0.93, 95% CI = 0.34–0.95), household size (aOR = 1.19, 95% CI = 1.04–1.37) and educational level (aOR = 0.45, 95% CI = 0.05–0.72). Conclusions: Older slum-dwellers in Nairobi experience functional impairments with marked age and sex differences. These findings may encourage salient policy planning and public health interventions to promote healthy aging in informal settlements.

What is the optimal nutritional assessment tool for predicting decline in the activity of daily living among older patients with heart failure?

The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.

Impact of the COVID-19 Pandemic on Elderly Patients with Spinal Disorders.

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, home-quarantine has been necessary, resulting in lifestyle changes that might negatively affect patients with spinal disorders, including a reduction in their quality of life (QoL) and activities of daily living (ADLs). However, studies on this impact are lacking. This study aimed to investigate the age-related changes in QoL and ADLs in patients with spinal disorders, and also identify factors associated with decline in ADLs. This multicenter cross-sectional study included patients who visited four private spine clinics for any symptoms. The study participants either had a clinic reservation, were first-time clinic visitors, or had a return visit to the clinic. The participants completed several questionnaires at two points: pre-pandemic and post-second wave. Changes in patient symptoms, exercise habits, ADLs, and health-related QoL were assessed. A logistic regression model was used to calculate the odds ratio (OR) of each variable for decline in ADLs. We included 606 patients; among them, 281 and 325 patients were aged <65 and ≥65 years, respectively. Regarding exercise habits, 46% and 48% of the patients in the <65 and ≥65-year age groups, respectively, did not change their exercise habits. In contrast, 40% and 32% of the patients in the <65 and ≥65-year age groups, respectively, decreased their exercise habits. In the multivariate analysis, the adjusted ORs for sex (female), decreased exercise habit, and age >65 years were 1.7 (1.1–2.9), 2.4 (1.4–3.9), and 2.7 (1.6–4.4), respectively. In conclusion, there was a decline in the ADLs and QoL after the COVID-19 outbreak in patients with spinal disorders. Aging, reduction of exercise habits, and female sex were independent factors related to decline in ADLs.

Challenges to Understanding the Role of Cognition in the Assessment of Activities of Daily Living in Patients with Spinal Cord Injury: A Narrative Literature Review

<h3>Research Objectives</h3> When working in acute rehabilitation settings with physically compromised populations, including patients with spinal cord injury (SCI), assessing one's ability to manage basic and instrumental activities of daily living (ADLs) is a crucial component of treatment and discharge planning. Neurocognitive diagnoses, in particular, are predicated on the extent to which one's cognitive deficits negatively impact ADLs. However, parsing apart the relative contribution of cognitive versus physical changes on ADLs can be particularly challenging in patients with SCI as decline in ADLs may be attributable to motor limitations, cognitive decline, or both. This narrative review sought to investigate the existing literature regarding cognitive assessment and the role of cognition in functional assessment in SCI <h3>Design</h3> Narrative literature review. <h3>Setting</h3> N/A. <h3>Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Robust empirical data suggest substantial cognitive impairment in individuals with SCI. However, there is a lack of standardized cognitive assessments designed for use specifically with this population. Further, few studies have been published assessing the role of cognition in functional assessment of patients post-SCI, and those reviewed suggest that current functional measures with cognitive components have limited ecological validity. This can ultimately result in a lack of convergence among one's cognitive status, motor limitations, and ability to function independently post-discharge. <h3>Conclusions</h3> While many of the existing measures of functional assessment in SCI speak to the general capacity of physical recovery and level of physical functioning post-injury, few address ability to resume daily activities following discharge from a cognitive perspective. This lack of inclusion of cognition in functional assessment presents challenges for rehabilitation psychologists and neuropsychologists in making accurate diagnoses and treatment plans while working with patients with new onset cognitive difficulties, particularly within the context of physical disability such as SCI. <h3>Author(s) Disclosures</h3> None.

Plasma Neurofilament Light and Future Declines in Cognition and Function in Alzheimer’s Disease in the FIT-AD Trial

Background:Utilities of blood-based biomarkers in Alzheimer’s disease (AD) clinical trials remain unknown.Objective:To evaluate the ability of plasma neurofilament light chain (NfL) to predict future declines in cognition and activities of daily living (ADL) outcomes in 26 older adults with mild-to-moderate AD dementia from the FIT-AD Trial.Methods:Plasma NfL was measured at baseline and 3 and 6 months. Cognition and ADL were assessed using the AD Assessment Scale-Cognition (ADAS-Cog) and AD Uniform Dataset Instruments and Disability Assessment for Dementia (DAD), respectively, at baseline, 3, 6, 9, and 12 months. Linear mixed effects models were used to examine the associations between baseline or change in plasma NfL and changes in outcomes.Results:Higher baseline plasma NfL was associated with greater rate of decline in ADAS-Cog from baseline to 6 months (standardized estimate of 0.00462, p = 0.02853) and in ADL from baseline to 12 months (standardized estimate of –0.00284, p = 0.03338). Greater increase in plasma NfL in short term from baseline to 3 months was associated with greater rate of decline in memory and ADL from 3 to 6 months (standardized estimate of –0.04638 [0.003], p = 0.01635; standardized estimate of –0.03818, p = 0.0435) and greater rate of decline in ADL from 3 to 12 month (standardized estimate of –0.01492, p = 0.01082).Conclusion:This study demonstrated that plasma NfL might have the potential to predict cognitive and function decline up to 12 months. However, future studies with bigger sample sizes need to confirm the findings.

Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery.

This study aimed to investigate the trajectory of functional recovery of activities of daily living (ADL) from the time of admission up to hospital discharge, and explored which preoperative and postoperative variables were independently associated with functional decline in ADL at discharge of patients after cardiovascular surgery. In this observational study, we evaluated ADL preoperatively and at discharge using the Functional Independence Measure (FIM) in patients after cardiovascular surgery. Functional decline in ADL was defined as scoring 1-5 on any one of the FIM items at discharge. Multiple logistic regression was performed to predict the functional decline in ADL at discharge. We found that 18.8% of elective cardiovascular surgery patients suffered from decreased ADL at discharge. The Mini-Mental State Examination (odds ratio (OR): 0.573, 95% confidence interval (CI): 0.420-0.783), gait speed (OR: 0.032, 95% CI: 0.003-0.304) and initiation of walking around the bed (OR: 1.277, 95% CI: 1.103-1.480) were independently associated with decreased ADL at discharge. A functional decline in ADL at discharge can be predicted using preoperative measures of cognitive function, preoperative gait speed and postoperative day of initiation of walking. These results show that preoperative cognitive screening and gait speed assessments can be used to identify patients who might require careful postoperative planning, and for whom early postoperative rehabilitation is needed to prevent serious functional ADL deficits.

Trajectories of functional status among older adults receiving treatment for gastrointestinal (GI) malignancies: A report from the CARE study.

12045 Background: Preservation of functional independence while undergoing treatment is of utmost importance to older adults with cancer, in addition to being associated with healthcare utilization and survival. Yet, such data are not readily available from published clinical trials. We sought to examine functional status trajectories and risk factors associated with functional decline among older adults receiving treatment for GI malignancies. Methods: This study included older adults (≥60y) treated at the UAB GI oncology clinic and enrolled in a prospective Cancer and Aging Resilience Evaluation (CARE) registry. All patients completed a geriatric assessment (GA) that included an assessment of activities of daily living (ADL) and instrumental activities of daily living (IADL). Participants were approached for a repeat assessment three months after baseline GA. Change in functional status was classified as one or more points decline or improvement in IADL and/or ADL from baseline to follow up. We measured the proportion with functional decline or improvement and constructed 95% confidence interval (95%CI) using binomial exact methods. We built multivariable logistic regression models to study the impact of baseline predictors on functional decline. Putative risk factors included age, sex, race/ethnicity, cancer type &amp; stage, baseline CARE frailty index, fatigue, pain, malnutrition and CT-based muscle mass indices (Skeletal Muscle Index [SMI] and Skeletal Muscle Density [SMD]) at the time of diagnosis. Results: This study included 184 patients. The median age at first visit was 68y (IQR 64-74); 55% were males, 71% white. Primary cancer diagnoses included colorectal cancer (29%), pancreatic cancer (28%) and other GI cancers (43%); 73% presented with advanced stage disease (III/IV). Most patients were receiving first line therapy (91%), with systemic chemotherapy (95%). The median duration between the baseline and follow up assessment was 109 days (IQR 84-154 days). Overall, 38% (95%CI, 30-45%) experienced a functional decline, whereas functional improvement was seen in 22% (95%CI, 16-29%). In a multivariable analysis, baseline frailty (odds ratio [OR] = 2.37; 95%CI, 1.05-5.38; p =0.03) was associated with significantly increased odds of functional decline; a trend towards increased odds was seen for pancreatic cancer (OR = 2.23; 95%CI, 0.90-5.53; p= 0.08; reference group: colorectal cancer). Conclusions: One in three older adults with GI malignancies experienced functional decline while a quarter experienced functional improvement in the first 3 months following treatment. Baseline frailty was associated with higher odds of functional decline. Early identification of such patients may allow targeted interventions to preserve functional independence and optimize quality of life of older adults with cancer.

Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults

Identification of high-risk patients that may experience functional decline following surgery poses a challenge to healthcare providers. The Vulnerable Elders Survey (VES-13) is a patient-reported tool designed to identify risk for health deterioration based on age, self-rated health, physical function, and functional disabilities. This study was designed to determine whether VES-13 could predict long-term functional decline among patients undergoing vascular surgery procedures. Vascular surgery patients at an academic hospital were administered VES-13 between May 2018 and March 2019, and those scoring ≥3-points were classified as vulnerable. Each patient's functional status was assessed using the Katz Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (iADL) indices preoperatively and at 2-week, 1-month, and 1-year postoperative time points. Logistic regression models were used to identify independent predictors of functional decline. 126 patients (59% male) were assessed before and after minor (56%) and major (44%) vascular procedures, with 55 (43%) meeting criteria for vulnerability. Vulnerable patients were older, had lower baseline functional status, and were more likely than non-vulnerable patients to experience declines in ADLs and iADLs at all time-points (P < 0.05 for all time points). These findings were confirmed in risk-adjusted regression models where vulnerability was associated with an increased likelihood of decline in ADLs (OR:3.3; 95%CI:1.0-10.6; P < 0.05) and iADLs (OR:2.6; 95%CI:1.0-6.6; P = 0.05) at 1-year following surgery. The patient-reported VES-13 survey identifies vulnerable patients who are at risk for long-term functional decline following vascular surgery. This quick preoperative screening tool can allow surgeons to prepare older patients and caretakers for postoperative functional limitations.

Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

BackgroundImpairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.MethodsIn total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.ResultsAdvanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7).ConclusionIn addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

The investigation of the level of activities of daily living by Katz index and related factors in elderly inpatients at department of cardiology of Thong Nhat hospital

Background: Assessment of the level of Activities of Daily Living (ADL) in heart failure elderly inpatients is important factors in comprehensive geriatric caring. Objectives: Investigating the level of activities of daily living in elderly inpatients at Department of Cardiology of Thong Nhat Hospital and age, gender and heart failure (HF) by Katz index. Method: A cross-sectional study on 202 elderly inpatients (≥60 years old) treated at Department of Cardiology of Thong Nhat Hospital was assessed ADL by Katz index from 05/2020 to 05/2021. Results: In general population, the proportions of independence, partial dependence, and complete dependence are 64.4%, 16.8%, and 18.8%, respectively. The dependency proportions (complete and partial) in 60-69 group, 70-79 group, ≥80 were 30.2%, 48.1% và 32.3% (p=0.003), correspondingly. Female patients had a higher rate than male patients (45.5% compared to 28.0%) (p=0.035). Patients with HF had a dependency rate of 55.1%, 27.8% higher than the group without HF (p=0.001). Conclusions: The in dependence of ADL rate in elderly inpatients at Department of Cardiology, Thong Nhat Hospital is high. Patients in age group 70-79, female, with heart failure have a higher decline in ADL than the other group.

Impact of cardiac surgery-associated acute kidney injury on activities of daily living at discharge in elderly cardiac surgery patients.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a critical complication associated with mortality and morbidity. This study aimed to clarify the impact of CSA-AKI on activities of daily living (ADL) at discharge in elderly cardiac surgery patients. We included 122 cardiac patients who underwent coronary artery bypass surgery, valve surgery, or combined surgery by mid-line incision followed by postoperative cardiac rehabilitation (CR) from March 2015 to May 2020. CSA-AKI was based on KDIGO criteria. The index of ADL was the Functional Independence Measure (FIM). We compared background factors, clinical parameters, activity level before hospitalization, CR progress, and FIM in patients with or without CSA-AKI. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with p < 0.01 in bivariate correlation as independent variables. Ultimately, 122 patients were divided into the non-CSA-AKI group (n = 84) and CSA-AKI group (n = 38). CR progression in the CSA-AKI group was significantly slower and FIM was lower than that in the non-CSA-AKI group. Moreover, even after adjustment for confounding factors, CSA-AKI (β = -0.18), start day of walking (β = -0.34), postoperative atrial fibrillation (β = -0.15), and activity level before hospitalization (β = -0.37) were predictive factors of ADL decline at discharge (adjusted R2 = 0.52). CSA-AKI of elderly cardiac surgery patients was a predictive factor of ADL decline at discharge.