Activities Of Daily Living Deficits Research Articles

The Effect of Apathy and Depressive Syndromes on Functional Outcomes in Alzheimer's Disease.

Alzheimer's disease (AD) is the most common cause of dementia. Its initially characterized by progressive short-term memory loss followed by cross-domain cognitive decline in later stages resulting in significant functional deficits and loss of activities of daily living (ADLs) independence. Apathy and depression are frequent neuropsychiatric sequelae in AD, but their contribution to functional deficits is poorly understood. We aimed to quantitatively investigate if apathy and depressive symptoms predict ADLs in AD. We also wanted to fractionate apathy dimensions by factor-analyzing the apathy evaluation scale (AES) and then investigate the dimensions' relation to ADLs. We recruited a sample of 115 patients with probable or possible AD and assessed them for depression, apathy, and ADLs alongside other measures. We hypothesized that apathy and depressive symptoms would predict ADLs and that AES items will load into cognitive, behavioral, and affective factors that would differentially relate to ADLs. Our results indicated that apathy symptoms predict ADLs deficits. The AES items resolved into a three-factor solution but the manner of clustering diverged from that proposed by AES authors. When these factors were regressed simultaneously, only behavioral apathy predicted global ADLs. Distinguishing basic from instrumental ADLs showed that behavioral and cognitive apathy symptoms associate with ADLs deficits while affective symptoms do not. Our results highlight the influence of apathy on ADLs in AD. This has important implications for patient care considering the high prevalence of apathy in AD and other dementing illnesses.

Factors associated with informal, and professional care, and unmet care needs in persons with deficits in activities of daily living in Austria. Results of two repetitive population-based surveys in people aged ≥65 years.

Introduction: Europe’s population is growing older, a trend that is projected to continue. Increased life expectancy means, older individuals are at risk of falls, hip fractures, long-term health conditions, re-hospitalization, which leads to the possibility of increased time spent in poor health. Hence, it is paramount to identify the diverse factors influencing the ageing process and subsequent limitation in Activities of Daily Living (ADLs)—eating and drinking independently, getting up and sitting down, dressing and undressing, using the toilet, and bathing or showering. Evidence shows worsening disability and developing new difficulty in ADLs has become more common with age, and leads to reduced quality of life, loss of independence and increased dependency and the increased need for care.
 Methods: Data was obtained from the Austrian Health Interview Surveys. 2931 and 2922 study participants aged ≥65 from 2014 and 2019, respectively, were included in the analysis. Three binary logistic regression was conducted with informal care, professional care and unmet care needs as dependent variable, and socio-demographic, health-related, and lifestyle-related parameters as independent variables, and the latter were mutually adjusted for each other.
 Results: In 2014, 12.8% of men and 17.9% of women, respectively, had difficulty in at least one ADL domain, compared to 19.2% and 25.7%, in 2019 (p<0.001). Of men and women with ADL deficits, 50.2% and 50.0% sought help from family members or friends, 14.1% and 27.5% received help from professional caregivers, and 17.4% and 30.4% said they would need more help than they actually get. The probability of both informal and professional care with ADL deficits increased significantly from 2014 to 2019 (OR; 95% CI: 1.88; 1.47-2.41; 2.42; 1.76 -3.33), however, there was no change in unmet care needs (1.06; 0.81-1.39). Male sex was associated with professional care (1.67; 1.16-2.40) and unmet care needs (2.04; 1.48-2.82). Higher age was associated with all three measures of care (2.54; 1.96-3.30; 2.77; 2.00-3.85; 2.09; 1.56-2.79). Lower education was associated with informal care (2.90; 1.57-5.35 for primary education; 2.53; 1.38-4.64 for secondary education). Being born in other European states (EU or EFTA) was associated with a higher chance for professional care (3.11; 1.93-5.02) and unmet care needs (1.90; 1.22-2.95). Living in a big city was negatively associated with informal care (0.60; 0.44-0.83). Not living in a relationship was negatively associated with informal (0.55; 0.42-0.73) and positively with professional care (2.18; 1.56-3.06). Having at least one chronic disease was associated with informal care (2.16; 1.56-3.00) and unmet care needs (2.56; 1.69-3.88). Lack of physical activity was associated with all three care parameters (2.90; 1.32-4.28; 11.87; 2.03-69.45; 2.09; 1.02-4.29). Being underweight was associated with a higher chance for informal care (3.33; 1.11-10.01), and obesity with unmet care needs (1.49; 1.05-2.13).
 Conclusions: Socio-economic, health and lifestyle-related factors are significantly associated with formal and professional and unmet care needs in older people with ADL deficits. To deliver a sustainable integrated care for older people in Europe, the importance of physical health, social, cultural, and emotional needs must be recognized and supported in all levels of care.

Differential use of postoperative psychosocial and physical services among older adults with head and neck cancer

IntroductionOlder adults undergoing head and neck cancer (HNC) surgery often have significant functional and mental health impairments. We examined use of postoperative physical, nutritional, and psychosocial services among a cohort of older adults with HNC comanaged by geriatricians and surgeons. Materials and MethodsOur sample consisted of older adults who were referred to the Geriatrics Service at Memorial Sloan Kettering Cancer Center between 2015 and 2019 and took a geriatric assessment (GA) prior to undergoing HNC surgery. Physical, nutritional, and psychosocial service utilization was assessed. Physical services included a physical, occupational, or rehabilitation consult during the patient's stay. Nutritional services consisted of speech and swallow or nutritional consult. Psychosocial services consisted of psychiatry, psychology, or a social work consult. Relationships between each service use, geriatric deficits, demographic, and surgical characteristics were assessed using Wilcoxon rank-sum test or Chi-square test. ResultsIn total, 157 patients were included, with median age of 80 and length of stay of six days. The most common GA impairments were major distress (61%), depression (59%), social activity limitation (SAL) (54%), and deficits in activities of daily living (ADL) (44%). Nutritional and physical services were used much more frequently than psychosocial services (80% and 85% vs 31%, respectively). Receipt of services was associated with longer median length of hospital stay, operation time, and greater deficits in ADLs. SAL was associated with physical and psychosocial consult and lower Timed Up and Go (TUG) score; instrumental ADL (iADL) deficits were associated with physical services; and depression and distress were associated with psychosocial services. DiscussionThe burden of psychosocial deficits is high among older adults with HNC. Future work is needed to understand the limited utilization of psychosocial services in this population as well as whether referral to psychosocial services can reduce the burden of these deficits.

Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes.

Assessing patients' activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes. To investigate the association between patients' ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition. Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission. Two inpatient units at the Johns Hopkins Hospital. Hospitalized patients with various diagnoses, including neurosurgical, stroke, and general neurology (N = 1,899). People with lower AM-PAC scores (every 10-point difference) had increased odds (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.4-1.8) of being in the highest length-of-stay quartile (≥8 days), having an injurious fall (OR = 1.7; 95% CI = 1.3-2.2), acquiring a pressure injury (OR = 2.7; 95% CI = 1.5-5.3), and being discharged to a postacute care facility (OR = 3.02; 95% CI = 2.1-2.7). Greater functional impairments in ADLs, measured with the AM-PACS IASF, were significantly associated with worse outcomes. AM-PAC IASF scores may be useful in identifying patients with ADL deficits and targeting occupational therapy services for patients who are at higher risk for negative outcomes. What This Article Adds: Early assessment of ADL function in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes.

Evaluation of a commonly used tool: Does the 5-item frailty index predict phenotypic frailty?

BackgroundThe simplified frailty index (sFI) is a commonly used instrument to estimate postoperative risk, but its correlation with phenotypic frailty has been questioned. This study evaluates the relationship between sFI and phenotypic frailty, as measured by the Sinai Abbreviated Geriatric Evaluation (SAGE). MethodsCharts were retrospectively reviewed from patients ≥75 years old who underwent surgery between 2012–2022. The sFI score was calculated by adding 1 point for hypertension, COPD, congestive heart failure, functional dependence, and diabetes (score 0–5). SAGE was calculated by adding 1 point for normal gait speed, normal Mini-Cog©, and independent activities of daily living (ADL) (0–3). Spearman rank correlation was used to test the relationship between sFI and SAGE. SAGE components were used as binary-dependent outcomes in covariate-adjusted logistic regression modeling to evaluate associations with sFI scores while adjusting for potential confounders. Results334 patients were assessed, with a mean age of 84.0. SAGE and sFI scores were significantly associated, with a modest inverse relationship (r=-0.24, p<0.0001). Each 1-point increase in sFI score was associated with increased odds of ADL deficit (OR 2.3, 95%CI [1.5–3.8], p<0.0001) and abnormal gait speed (OR 1.9, 95%CI 1.2–3.0, p<0.01). The sFI score was not associated with deficits in the Mini-Cog (OR 1.5, 95%CI [0.96–2.3], p=0.07). ConclusionHigher sFI was significantly associated with increased phenotypic frailty, particularly with the loss of physical condition and function but not associated with cognitive deficit. Therefore, sFI may not be an appropriate tool to estimate postoperative complications related to cognition, such as delirium risk.

Psychological distress among medically complex veterans with a recent emergency department visit.

Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns of distress emerge over time. A secondary data analysis was used to examine self-reported psychological distress (defined as ≥14 unhealthy days due to poor mental health in the past month) at 30 and 180 days following enrollment in a randomized control trial of 513 medically complex Veterans after a nonpsychiatric ED visit. We used a multivariable ordered logistic regression model to examine the association of a priori factors [baseline psychological distress, age, race, income, health literacy, deficits in activities of daily living (ADL), and deficits in instrumental activities of daily living] with three psychological distress classifications (no/low, intermittent, and persistent). Among 513 Veterans, 40% reported at baseline that they had experienced high psychological distress in the previous month. Older age was associated with lower odds of high psychological distress (OR = 0.95; 95% CI: 0.94-0.97). Baseline factors associated with significantly higher odds of persistent psychological distress at 30 and 180 days assessments, included having the inadequate income (OR = 1.61; 95% CI: 1.02-2.55), having low health literacy (OR = 1.63; 95% CI: 1.01-2.62), and reporting at least one ADL deficit (OR = 1.94; 95% CI: 1.13-3.33). Psychological distress at follow-up was common among medically complex Veterans with a recent ED visit. Future research should explore interventions that integrate distress information into treatment plans and/or link to mental health referral services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Divergence Between Informant and Self-Ratings of Activities of Daily Living Impairments in Parkinson's Disease.

ObjectiveTo examine the agreement between self- and informant-reported activities of daily living (ADL) deficits in Parkinson’s Disease (PD) patients, and to examine factors influencing ADL ratings.BackgroundIn PD, the loss of functional independence is an important outcome of disease progression. The valid assessment of ADL function in PD is essential, but it is unclear to what extent informants’ and patients’ perceptions of their daily functions concur, and how other factors may influence both ratings.MethodsData of 150 PD patients who underwent cognitive and motor testing, as well as their informants were analyzed. The 10-item Functional Activities Questionnaire (FAQ), completed separately by patients (FAQ-S) and their informants (FAQ-I), assessed ADL function. Weighted κ statistics summarized level of agreement, and a discrepancy score (FAQ-I – FAQ-S) quantified agreement. Correlation analyses between FAQ total scores, patient and informant characteristics, and cognitive scores were conducted, with post hoc regressions to determine the associations between both FAQ scores and cognition, independent of patient characteristics.ResultsThe sample included 87 patients with normal cognition, 50 with mild cognitive impairment, and 13 with dementia. Overall, there was fair to moderate agreement between patients and informants on individual FAQ items (0.27 ≤ κ ≤ 0.61, p < 0.004), with greater discrepancies with increasing cognitive impairment. Patients’ age, motor severity, non-motor burden, and depression also affected both ratings (0.27 ≤ r ≤ 0.50, p < 0.001), with motor severity showing the greatest influence on both ratings. Both the FAQ-I and FAQ-S were correlated with almost all cognitive domains. Post hoc regression analyses controlling for patient characteristics showed that the attention domain was a significant predictor of both the FAQ-S and FAQ-I scores, and memory was also a significant predictor of the FAQ-I score. Only 29.3% of patients agreed perfectly with informants on the FAQ total score, with informants most commonly rating ADL impairments as more severe than patients.ConclusionsPatient and informant ratings of ADL function using FAQ items showed moderate agreement, with only few items reaching substantial agreement. Ratings of both were associated with patient cognitive status, but also other characteristics. In addition to patient and informant reports, objective measures are needed to accurately classify ADL deficits in PD.

Performance of Activities of daily living in people with multiple sclerosis

ObjectiveMultiple sclerosis (MS) may result in activity and participation limitations, including the performance of activities of daily living (ADL). This study aims at systematically investigate ADL performance by using Assessment of Motor and Process Skills (AMPS) in people with MS (PwMS) of all disease types and within the Kurtzke Expanded Disability Status Scale (EDSS) range from 1.0 – 8.0. MethodsEight multiple sclerosis (MS) centres participated in data collection of a consecutive sample of PwMS. Participants were referred for assessment to occupational therapy (OT) by treating physician or recruited from neurology department in each hospital and assessed by EDSS and AMPS. The AMPS is an observational, criterion referenced ADL assessment, providing values for a person's ADL performance in terms of motor and process skills. Criterion referenced cut-off scores were established at 2.0 for motor skills and at 1.0 for process skills and both values above the cut-off score indicate competent (independent, safe, efficient and effortless) ADL performance. Process skills refer to the act of carrying out a series of actions and is summarized in terms of efficiency, like initiating without pauses, continuing actions through to completion, performing actions in logical order (sequences), choosing, and completing the task as planned (heeds). ResultsTwo hundred and ten PwMS were recruited (48 +/- 13 years of age, 145 women/65 men, average disease duration was 11.8 +/- 9.6 years, average EDSS was 4.8+/-1.8). Average motor skills score was 1.01+/- 1.12 (indicating need for assistance with evidence of increased clumsiness/physical effort) and average process skills score was 1.02 +/- 0.66 (risk zone, questionable efficiency and more likely to need assistance). Overall, motor skills and process skills decreased with increasing EDSS score. No need for assistance in motor skills was indicated in subjects with lower EDSS scores (1.0 – 2.5). In higher EDSS group (≥4.5), 57% of subjects needed assistance in motor skills and 27% in process skills. The competency in process skills was either questionable or reduced within all EDSS scores. However, 33–38% of subjects with higher EDSS scores (6.0–8.5) showed competent performance in process skills. Overall correlation between motor and process scores was moderate (r = 0.56, p<0.0001), but no significant relationships between motor and process skills were found in the lower EDSS (1–2.5) and high EDSS scores (8–8.5). Further, EDSS and disease type were significant predictors, explaining 52.7% of motor skills and 22.3% of process skills performance. ConclusionProblems in ADL performance were found in EDSS categories 1.0 to 8.0 and in all disease types, therefore it is advisable to screen all PwMS for ADL deficits and provide relevant rehabilitation interventions.

Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer)

BackgroundWhile radiation therapy (RT) improves function, and quality of life for patients with advanced cancers, patients frequently experience a period of acute toxicity during which functional abilities may decline. Little is understood about changes in functional outcomes after RT in older adults. This study aims to examine changes in daily function at 1 and 6 months following RT. MethodsWe reviewed the charts of 117 patients who underwent palliative RT on a prospective registry. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scores ranging from 0 to 6 and 0–8, respectively, were collected at baseline, one-month, and six months post-RT. Patients were classified as low deficit for ADL/IADL if they had 0–1 deficits and high deficit if they had 2+ deficits. ResultsOne-hundred seventy RT courses were identified; 99 were evaluable at each time point. The median age was 67 years. At baseline, 29.5 and 29.9% of patients were classified as high-deficit for ADL and IADL functioning, respectively. At one-month, the majority of patients who were low-deficit at baseline remained so for both measures while approximately one quarter of high-deficit patients showed improvement. Most patients identified as low-deficit at one-month remained so at six-months, while no high-deficit patients improved from one- to six-months. Factors associated with high ADL and IADL deficits included: time (six months), increasing age, and Hispanic/other race. Compared to those with ECOG score of 3, patients with lower scores (0–2) had lower odds of high deficit. ConclusionADL and IADL tools may be useful in describing changes in daily function after palliative RT and in identifying groups of patients who may benefit from additional supportive geriatric care interventions.

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.Methods and Results: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.

The impact of caregiver's depressive symptoms on trajectories of cognitive function in older adults with functional limitations

Family caregivers are important to older adults' health, but few studies have examined how caregivers' mental health is associated with older adults' cognitive function. This study examined the trajectories of cognitive function of older adults and whether caregivers' depressive symptoms shape the pattern of cognitive function trajectories. This 6-year longitudinal sample consisted 1188 older adults aged≥75 years with deficits in activities of daily living (ADL) and their family caregivers in Shanghai, China (Rounds 1-3). Cognitive function trajectories were identified based on an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression tested the association between caregivers' depressive symptoms and older adults' cognitive function trajectory. Three trajectory groups were identified: a "newly onset" group (50.4%) had an increased risk of being cognitive impaired during the 6-year period; a "never" group (46.2%) remained cognitive active; and a "chronic" group was largely persistently cognitive impaired (3.4%). Caregivers' depressive symptoms increased the relative risk of having the "onset" or "chronic" versus "never" trajectory. Among the four dimensions of depressive symptoms, only somatic complaints were associated with a higher risk of the "newly onset" trajectory in 6 years. The progression of cognitive function among older adults with deficits in ADL followed three distinct trajectories during a 6-year period. Addressing the mental health of caregivers may prevent or delay progression of cognitive impairment among older adults.

Effect of Geriatric Assessment and Intervention on Overall Survival Among Older Adults with Hematologic Malignancies

Background: Older adults with hematologic malignancies have inferior survival outcomes due to multiple factors including under-treatment, drug toxicity, treatment discontinuation and concerns of frailty. However, aging is heterogeneous and chronological age is a poor indicator of underlying health. Standardizing the approach to identify frailty is an unmet need in malignant hematology. We have established a multi-disciplinary clinical model designed to identify frailty and develop personalized treatment based on objective measures of health. We have standardized a geriatric assessment (GA) model to identify vulnerability, frailty and geriatric syndromes. Here we report, the largest cohort to date, of older adults with hematologic malignancies (HM) depicting geriatric deficits and interventions with long-term clinical outcomes. Methods: From Feb 2016 to October 2019, 311 older adults with HM were evaluated in our multi-disciplinary Cancer and Aging Resiliency (CARE) clinic. The CARE clinic is a 7-member team prescriptively evaluating the following domains: pharmacy, audiology, psychosocial needs, nutrition, physical functioning, and cognition. Geriatric syndromes were documented by CARE physician. Referral to CARE clinic is recommended for patients 60 years of age or older but all referrals are accepted independent of age. Data was abstracted by retrospective chart review. Descriptive statistics for patient characteristics, frailty measures, and prescribed interventions in each of the GA domains were provided. Univariable and multivariable Cox models were fit to associate clinical factors with OS. OS by Rockwood Clinical Frailty Scale and deficits in activities of daily living (ADLs) was evaluated by Kaplan-Meier method. Correlation between number of geriatric syndromes, clinical frailty score, and deficits in ADLs and instrumental ADLs (IADLs) was also assessed. Results: Over the 42-month study period, 311 older adults with HM with a median age of 75.9 years were evaluated in CARE clinic. Key demographic features and the frequency of specific frailty measures are outlined in table 1.Geriatric interventions were common with 59% requiring 1-2 interventions and 34% requiring 3+ interventions. In univariable analysis, any degree of frailty by Clinical Frailty Scale (Hazard Ratio [HR]: 2.63, 95% Confidence Interval [CI]: 1.43-4.82, p &amp;lt;0.01) and increasing number of geriatric syndromes (HR:1.13, 95% CI: 1.00-1.27, p = 0.04) were associated with inferior OS. In both univariable and multivariable analyses, 10-year increase in age (multivariable HR: 2.05, 95% CI:1.44-2.91, p&amp;lt;0.01), deficit in ADL (multivariable HR: 2.60, 95% CI: 1.38-4.87, p&amp;lt;0.01), diagnosis of acute leukemia (multivariable HR: 4.53, 95% CI:1.91-10.78, p&amp;lt;0.01), and prescribed nutrition intervention (multivariable HR: 2.04, 95% CI: 1.32-3.15, p&amp;lt;0.01) were associated with inferior OS. Anemia was also associated with OS in both univariable and multivariable analysis (multivariable HR for 1 g/dL increase in hemoglobin: 0.79, 95% CI: 0.69-0.91, p&amp;lt;0.01). Additional variables for univariable and multivariable analyses are presented in table 2. There was significant correlation between the Clinical Frailty Scale and number of geriatric syndromes (Spearman correlation p &amp;lt; 0.01). The same was true of correlation between ADL or IADL deficits and Clinical Frailty Scale (p &amp;lt; 0.01 for both). OS by Clinical Frailty Scale and ADL deficit is pictured in figure 1. Discussion: The Clinical Frailty Scale is predictive of OS among older adults with HM. GA-directed intervention is warranted in the vast majority of older adults with HM. In univariable analysis, Clinical Frailty Scale, increasing age, anemia, high risk HM, and increasing geriatric syndromes are associated with inferior OS. In multivariable analysis, age, anemia, and high risk HM remain significant. Nutrition and physical function are key modifiable risk factors predictive of inferior OS. Prospective studies focusing on geriatric interventions are warranted in this population with an emphasis on modifiable risk factors. This demonstrated prognostic significance of both geriatric assessments and interventions in older adults with HM should give way to future improvements in OS, quality of life, and treatment tolerability through GA-directed intervention. Disclosures No relevant conflicts of interest to declare.

What Enables Individuals to Be More Physically Active across Levels of Frailty?

Background: Physical activity is important in the management of frailty. Here we determine if specific frailty deficits relate to lower activity across degrees of frailty, and what types of physical activities are commonly reported. Methods: Accelerometer data from 6817 adults 20–85 years old (2003–2004/2005–2006 cycles) of the National Health and Nutrition Examination Survey were analyzed. Moderate-to-vigorous intensity physical activity (MVPA) was measured in 1-minute bouts. Frailty was measured with a 46-item frailty index consisting of chronic conditions, healthcare utilization, difficulties in activities of daily living (ADL), and laboratory deficits. Individuals were stratified into frailty groups: non-frail, <0.10 (53%; n = 3610); minimally frail, 0.10–0.20 (26%; n = 1776); and frail, >0.20 (21%; n = 1431). Linear regression models adjusted for age, sex, demographics, and accelerometer wear time. Results: Among the total sample, the presence of individual deficits were generally associated with lower MVPA. The presence of more chronic conditions, ADLs, abnormal laboratory values, and greater healthcare utilization had an independent dose association with lower MVPA. The effect of frailty deficits on MVPA were attenuated when examining individuals by frailty level. The number of ADLs, but not the number of chronic conditions or number of laboratory deficits, were independently associated with a lower MVPA level across frailty levels. Healthcare use was associated with less MVPA in the lower frailty groups. The two most popular reported physical activities were walking and cycling across all frailty levels. Conclusions: Deficits in ADLs, but not chronic conditions or laboratory deficits, were consistently associated with lower MVPA across frailty levels.

Association between fulfilling the recommendations for health-enhancing physical activity with (instrumental) activities of daily living in older Austrians.

SummaryAimThe aim of the study was to describe the association between fulfilling the recommendation for health-enhancing physical activity (PA), and deficits in activities of daily living (ADL) and instrumental activities of daily living (IADL) in 3308 subjects aged 65+ years from the Austrian Health Interview Survey 2014.MethodsThe proportion of subjects who fulfilled the minimal recommendations for health-enhancing PA was assessed with the Physical Activity Questionnaire of the European Health Interview Survey (EHIS-PAQ). The ADLs were assessed based on the Barthel index, and IADLs by the IADL scale of Lawton and Brody. Additionally, various sociodemographic and health-related factors were assessed.ResultsOf the participants 54.7% did not fulfil the minimal requirements for aerobic PA, and 67.1% not for muscle strengthening PA, 16.4% reported ADL deficits, and 47.1% IADL deficits. Adjusted for sociodemographic and health-related parameters, not fulfilling the recommendations for aerobe PA was associated with a higher chance for ADL deficits (odds ratio, OR 1.73, 95%-confidence interval 1.36–2.21), and IADL deficits (1.57; 1.34–1.84). Not fulfilling the recommendations for muscle strengthening PA also increased the chance for ADL and IADLs deficits (1.34; 1.04–1.72, and 1.29; 1.09–1.53, respectively).ConclusionThe number of participants who did not fulfil the minimal requirements for aerobic or strengthening PA was very high, and these participants showed significantly more problems in ADLs and IADLs. Therefore, all future efforts should focus on increasing participation and adherence in exercise programs for older people with the intention to improve their performance status and functions in daily life.

The emotional toll of caregiving for older patients with advanced cancer: Baseline data from a multicenter geriatric assessment (GA) intervention study in the University of Rochester NCI Community Oncology Research Program (UR NCORP).

10042 Background: Depression is common in caregivers (cgs) of patients (pts) with cancer. However, little is known about the association of health status of older pts with cancer with cg emotional health. Methods: Baseline data from a GA intervention study conducted at 68 oncology practices in the UR NCORP were analyzed. Pts aged ≥ 70 with an advanced solid tumor cancer or lymphoma with ≥ 1 GA impairment were enrolled; pts could enroll with 1 cg. Relationships between pt GA impairments (using 12 validated measures) and cg (spouses or live-in partners) emotional health including anxiety ( ≥ 5 on Generalized Anxiety Disorder-7 (GAD-7)), depression ( ≥ 2 on Patient Health Questionnaire-2), and distress ( ≥ 4 on distress thermometer) were evaluated in separate multivariate logistic models adjusted for pt (cancer type, treatment status) and cg (age, sex, race, education, income, comorbidity) characteristics. Results: Among 213 pts (mean age 76, 70-89), &gt;50% had ≥ 5 impaired GA measures. Of the 213 cg (mean age 73, 52-91), 23% screened positive for anxiety, 16% for depression, and 40% for distress. In bivariate analyses, number of GA impairments, ≥ 1 fall, pt anxiety ( ≥ 5 on GAD-7) and depression ( ≥ 5 on Geriatric Depression Scale (GDS)) were associated with all 3 cg outcomes; pt activities of daily living (ADL) deficits were associated with cg depression and distress. In multivariate analysis, number of GA impairments was associated with cg distress. In separate models, pt ADL deficit and depression were associated with cg distress, and pt ADL deficit was associated with cg depression. GA variables were not associated with cg anxiety in multivariate analysis. Conclusions: A high proportion of cg of older pts with cancer report distress. GA can help identify cg at risk for poor emotional health. Interventions for cgs should address the health status of older pts with cancer. [Table: see text]

Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing.

Backgroundthe number of people requiring care home support is projected to rise in future years, but little information is available on the needs of new care home residents.Objectiveto measure the health and functioning of people moving into care homes and how they have changed between 2002 and 2015.SettingEnglish Longitudinal Study of Ageing.Participantstwo hundred fifty-four of the 313 (1.99%) individuals who moved from the community into a care home, and were interviewed in the survey wave prior to entry.Main outcome measureschanges over time for number of health conditions and functional deficits (deficits in activities of daily living (ADL), and instrumental ADLs (IADLs)), assessed in the survey wave prior to admission.Resultsover time there were significant increases in the total number of health conditions and functional deficits amongst soon to be care home entrants (P = 0.0011), the proportion with high blood pressure (OR 1.37, 95% CI: 1.17–1.62, P < 0.0001), memory problems (OR 1.33, 95% CI: 1.11–1.61, P = 0.0021) or total number of IADL deficits (P = 0.008). Non-significant increases were observed in the proportion of care home entrants with cancer (OR 1.23, 95% CI: 0.93–1.65, P = 0.15), lung disease (OR 1.21, 95% CI: 0.85–1.75), heart disease (OR 1.12, 95% CI: 0.95–1.30) and arthritis (OR 1.11, 95% CI: 0.95–1.30). Stroke and ADL deficits did not increase. No differential ageing effect was observed.Conclusionsthe support needs of care home entrants in England appear to be increasing over time. This has important implications for the provision and funding of care home places and community services.

Executive Dysfunction and Behavioral Symptoms Are Associated with Deficits in Instrumental Activities of Daily Living in Frontotemporal Dementia

Background: Deficits in instrumental activities of daily living (ADLs) may be more prominent in behavioral variant frontotemporal dementia (bvFTD) than in nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) or semantic variant primary progressive aphasia (svPPA). It is uncertain whether frontotemporal dementia (FTD) subgroups exhibit different patterns and/or predictors of functional impairment. Methods: We examined data from participants diagnosed with bvFTD (n = 607), svPPA (n = 132), and nfvPPA (n = 155) who were included in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) and assessed with the Functional Activities Questionnaire (FAQ). Stepwise multiple linear regression analyses were performed to identify associations between FAQ scores and cognitive/behavioral deficits using the NACC UDS neuropsychological testing battery and the Neuropsychiatric Inventory Questionnaire. Results: FAQ scores were higher in bvFTD than svPPA or nfvPPA. Functional deficits across FTD subtypes differed in severity, but not pattern, and were driven by executive dysfunction and behavioral symptoms. Conclusion: Executive dysfunction and behavioral symptoms underlie instrumental ADL deficits in FTD, which are most prominent in bvFTD.

Development of a Proxy-Free Objective Assessment Tool of Instrumental Activities of Daily Living in Mild Cognitive Impairment Using Smart Home Technologies.

Background: The assessment of activities of daily living (ADL) is essential for dementia diagnostics. Even in mild cognitive impairment (MCI), subtle deficits in instrumental ADL (IADL) may occur and signal a higher risk of conversion to dementia. Thus, sensitive and reliable ADL assessment tools are important. Smart homes equipped with sensor technology and video cameras may provide a proxy-free assessment tool for the detection of IADL deficits.Objective:The aim of this paper is to investigate the potential of a smart home environment for the assessment of IADL in MCI.Method: The smart home consisted of a two-room flat equipped with activity sensors and video cameras. Participants with either MCI or healthy controls (HC) had to solve a standardized set of six tasks, e.g., meal preparation, telephone use, and finding objects in the flat.Results: MCI participants needed more time (1384 versus 938 seconds, p < 0.001) and scored less total points (48 versus 57 points, p < 0.001) while solving the tasks than HC. Analyzing the subtasks, intergroup differences were observed for making a phone call, operating the television, and retrieving objects. MCI participants showed more searching and task-irrelevant behavior than HC. Task performance was correlated with cognitive status and IADL questionnaires but not with participants’ age.Conclusion: This pilot study showed that smart home technologies offer the chance for an objective and ecologically valid assessment of IADL. It can be analyzed not only whether a task is successfully completed but also how it is completed. Future studies should concentrate on the development of automated detection of IADL deficits.

Synergistic effect of pain and deficits in ADL towards general practitioner visits.

Pain and activities of daily living (ADLs) deficits are common problems among elderly people who visit general practitioners (GPs). To examine whether the probability of visiting a GP is related to deficits in ADLs and pain, and whether these factors act synergistically towards GP visits. A total of 3097 subjects aged ≥65 years from the Austrian Health Interview Survey formed the cohort. Visiting the GP in the last 4 weeks, chronic pain (CP; pain for at least 3 months) and deficits in ADLs across 11 dimensions were reported. Binary logistic regression models were applied and were stepwise controlled for possible confounders. Based on odds ratios (OR), the synergy index (SI), population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated. Overall, 61.0% visited their GP; 51.2% were affected by ADL deficits and 42.2% by CP. In subjects with ADL deficits, the OR for GP consultation was 1.32 (95% confidence interval [CI] 1.11-1.56) and in subjects with CP, 1.93 (95% CI 1.63-2.27) in the fully adjusted model. The OR for those affected by both was 2.56 (95% CI 2.08-3.15); SI was 1.82 (95% CI 1.04-3.18), PAF was 0.27 (95% CI 0.08-0.47) and RERI was 0.70 (95% CI 0.13-1.27). There is a strong synergistic effect of CP and deficits in ADL in patients ≥65 years on visiting the GP. Prevention, screening, treatment and rehabilitation in this population should focus on both CP and ADL deficits.

Changes in health-related quality of life (HRQL) after bladder cancer (BC) diagnosis (DX): A longitudinal population-based study.

317 Background: Few studies have examined longitudinal changes in HRQL among BC patients. To our knowledge, this is the largest prospective population-based study to quantify HRQL changes from before to after BC DX and to compare their HRQL with a non-cancer cohort. Methods: Our sample included 179 BC patients (≥ age 65) and 376,986 non-cancer subjects within the SEER-Medicare Health Outcomes Survey database (1998-2007). We assessed HRQL as measured by physical (PCS) and mental (MCS) component summary scores of the veterans RAND 12-item health survey. An analysis of covariance model was used to estimate changes in HRQL scores for patients after BC DX relative to control subjects with adjustment for baseline HRQL scores and covariates. Results: 84.4% (N=151) of BC patients had non-muscle invasive BC (NMIBC) and 15.6% (N=28) had muscle invasive BC (MIBC). 49.2% and 39.1% of BC patients had ≥2 comorbid conditions and ≥1 activities of daily living (ADL) deficit, respectively. Compared to the control subjects, more BC patients were men (67.0% vs 38.5%; P&lt;0.01), current or former smokers (58.7% vs 37.3%; P&lt;0.01), and had income ≥ $50,000(15.1% vs 8.8%; P=0.02). Other baseline demographic and socioeconomic characteristics were similar (P&gt;0.05). After DX, BC patients reported a significant decline in PCS (1.9; 95% CI 0.1, 3.7) score compared to non-cancer controls whereas the decrease in MCS score (1.4; 95% CI -0.1, 3.0) was not statistically significant. For those with NMIBC, HRQL was not significantly different than that of the non-cancer cohort (P&gt;0.05) after DX. However, the PCS and MCS scores of MIBC patients decreased by 5.3 (95% CI 0.9, 9.8) and 3.8 points (95% CI -0.1, 7.7) after DX, respectively. Older age at BC DX, lower educational and income levels, smoking history, and higher numbers of comorbid conditions and ADL deficits were significantly associated with inferior PCS and MCS scores after BC DX (P&lt;0.01). Conclusions: Treatment-related side effects and/or symptoms due to BC adversely affect HRQL of BC patients, especially in those with MIBC, and should be consistently assessed by health care providers. Future research that examines interventions to improve HRQL is critical to improve BC care.