Activities Of Daily Living Group Research Articles

Measures of functional status in older patients treated with palbociclib for advanced breast cancer

IntroductionLimited data are available on the effects of treatment for advanced breast cancer (ABC) in older patients because this population has limited enrollment in clinical trials. Data generated from the prospective, noninterventional POLARIS study of patients with hormone receptor-positive/human epidermal growth factor receptor 2–negative ABC may help bridge the gap in our understanding of the tolerability and outcomes in this vulnerable population. Materials and MethodsWe evaluated measures of geriatric impairments and activities of daily living in patients with ABC aged ≥70 years in POLARIS to evaluate the change within six months of palbociclib initiation. Geriatric impairments and activities of daily living (functional) status were assessed using the Geriatric 8 (G8) and Activities of Daily Living (ADL) screening tools. The G8, ADL, and Eastern Cooperative Oncology Group performance status (ECOG PS) scores were assessed at baseline and month six through end of treatment with palbociclib. ECOG PS scores were also stratified by G8 and ADL score severity subgroups (G8: ≤14 = impaired subgroup; >14 = not at all impaired subgroup; ADL: <18 = dependent subgroup, 18 = independent subgroup). ResultsAt data cutoff in November 2020, of 1282 POLARIS patients of all ages, 287 (22.4%) were ≥ 70 years old and completed ≥6 months of palbociclib therapy. At baseline, 117 (45%; n = 260) of these patients had an ECOG PS score of 0, 143 (55%; n = 260) had ECOG PS score > 0, 248 (86%) had G8 scores (mean [SD] 13.6 [2.14]), and 256 (89%) had ADL scores (17.7 [1.03]) among the available 287 patients. At six months, 102 (40%; n = 255) had an ECOG PS score of 0, 153 (60%; n = 255) had ECOG PS score > 0, 198 (69%) had G8 scores (13.6 [1.99]), and 211 (74%) had ADL scores (17.6 [1.22]) among the 287 available patients. There was no mean change (standard deviation) from baseline to 6 months in mean ECOG PS scores (0.0 [0.61], P = 0.24), G8 scores (0.0 [2.17], P = 0.89), or ADL scores (0.0 [1.00], P = 0.62). DiscussionIn this subgroup analysis of older patients with ABC from POLARIS, functional status and impairment outcomes were preserved in older patients receiving palbociclib. G8, ADL, and ECOG PS scores were generally maintained during the first six months of palbociclib therapy.ClinicalTrials.govidentification number.NCT03280303

Factors associated with changes in activities of daily living from admission to discharge among older patients with pneumonia

IntroductionIt has not been fully elucidated that nutritional parameters affect the change of activities of daily living (ADL) during pneumonia treatment. This study assessed the impact of nutritional status, including erector spinae muscle (ESM) size on ADL changes from admission to discharge among older patients with community-acquired pneumonia (CAP). MethodsWe retrospectively included patients (age: ≥65 years) who were admitted to the hospital for CAP and underwent chest computed tomography (CT) on admission. ADL was evaluated using the Barthel index, and patients were divided into the maintained or improved ADL group and the declined ADL group from admission through discharge. The ESM cross-sectional area was measured on a single-slice CT image. Logistic regression models were applied for assessing factors associated with changes in ADL. ResultsA total of 523 patients hospitalized for CAP (median age 86 years) were evaluated. The declined group had significantly higher ADL levels on admission, a greater frequency of smoking history and malignancy, and a lower frequency of cerebrovascular disease and dementia. No significant difference in ESM size was observed between the groups. Multivariate analysis revealed that higher ADL levels on admission (odds ratio 1.034, interquartile range 1.026–1.043) and malignancy (3.002, 1.150–7.836) were associated with a decline in ADL, whereas cerebrovascular disease (0.579, 0.373–0.900) was related to improvement or maintenance of ADL. ConclusionsAlthough nutritional status might not affect the change of ADL among older patients hospitalized with pneumonia, a cerebrovascular disease history may be a good predictor for ADL improvement.

Cognitive transitions based on functional status in older adults with heart failure: a population-based study.

Cognitive impairment and functional status are both important determinants of poor outcomes in heart failure (HF). However, little is known about how functional status impacts the changes in cognitive status during the disease course. This study aimed to describe the cognitive transitions in patients with HF and assess the relationship of these transitions to functional status, which was assessed by the dependency of activities of daily living (ADL). This retrospective cohort study included 1764 patients with an International Classification of Diseases-10 code of HF (≥65years, mean age 82.3±7.9years, 39% male) from a long-term care and medical insurance database from Nobeoka city, a rural city of south-western Japan. Cognitive status at baseline and 6, 12, 18, and 24month time points was collected, and participants were stratified based on ADL status at baseline. Generalized estimating equations and multi-state modelling were used to examine associations between ADL dependency and cognitive changes/mortality. Transition probabilities were estimated using multi-state modelling. At baseline, there were 1279 (73%) and 485 (27%) patients with independent and dependent ADL, respectively. In overall patients, 1656 (93.9%) patients had normal/mild cognitive status and 108 (6%) patients had a moderate/severe cognitive status at baseline. The majority [104 (96%) patients] of patients with moderate/severe cognitive status at baseline had dependent ADL. In patients with moderate/severe cognitive status, the number of patients with dependent ADL always outnumbered that of the independent ADL throughout the follow-up. Multi-state modelling estimated that patients with dependent ADL and normal/mild cognitive status at baseline had 47% probability of maintaining the same cognitive status at 24months, while the probability of maintaining the same cognitive status was 86% for those with independent ADL. Patients with normal/mild cognitive status in the dependent ADL group at baseline had a higher risk of experiencing a transition to moderate/severe cognitive status at any time point during 24months compared with those with independent ADL [hazard ratio 5.24 (95% confidence interval 3.47-7.90)]. In older patients with HF, the prevalence of cognitive impairment was always higher for those with reduced functional status. Despite having a normal/mild cognitive status at baseline, patients with dependent ADL are at high risk of experiencing cognitive decline over 24months with substantially less chance of maintaining their cognitive status. ADL dependency was an important risk factor of cognitive decline in patients with HF.

Activities of daily living predict periprocedural myocardial infarction and injury following percutaneous coronary intervention: a cross-sectional study

BackgroundIn recent years, there has been growing interest in exploring the relationship between activities of daily living (ADL) and cardiovascular diseases. This retrospective cross-sectional study aimed to investigate the association of ADL measured by Barthel index (BI) with periprocedural myocardial infarction (PMI) and injury following percutaneous coronary intervention (PCI).MethodsEnrolled patients were stratified into impaired and unimpaired ADL groups according to their BI scores. Logistic regressions were conducted to explore the association of ADL on admission with periprocedural myocardial injury and infarction. Restricted cubic spline (RCS) curve and subgroup analysis were also performed.ResultsTotally, 16.4% of patients suffered from PMI; the mean age was 65.8 ± 10.4 years old. RCS analysis showed that the morbidity of periprocedural myocardial infarction and injury showed a downward tendency with increasing BI scores. Multivariable logistic regression analysis demonstrated that impaired ADL was an independent risk factor for periprocedural myocardial infarction (OR = 1.190, 95% CI [1.041, 1.360], P = 0.011) and injury (OR = 1.131, 95% CI [1.017, 1.257], P = 0.023). Subgroup analysis showed that the association between ADL and PMI was founded in several subgroups, while the association between ADL and periprocedural myocardial injury was founded only in BMI ≥ 24 kg/m2 subgroup.ConclusionImpaired ADL at hospital admission was an independent risk factor for periprocedural myocardial infarction and injury among patients following PCI.

Combination of the Barthel Index at Discharge with GRACE Leads to Improved One-Year Mortality Prediction in Older Patients with Acute Myocardial Infarction.

Many older patients with acute myocardial infarction (AMI) have impaired ability for activities of daily living (ADL). Impaired ADL leads to poor prognosis in elderly patients. The Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification in AMI patients but does not consider physical performance, which is an important prognosis predictor for older adults. This study assessed whether the Barthel Index (BI) score combine the GRACE score would achieve improved one-year mortality prediction in older AMI patients. This single-center retrospective study included 688 AMI patients aged ≥65 years who were divided into an impaired ADL group (BI ≤60, n = 102) and a normal ADL group (BI >60, n = 586) based on BI scores at discharge. The participants were followed up for one year. Cox survival models were constructed for BI score, GRACE score, and BI score combined GRACE score for one-year mortality prediction. Patients had a mean age of 76.29 ± 7.42 years, and 399 were men (58%). A lower BI score was associated with more years of hypertension and diabetes, less revascularization, longer hospital stays, and higher one-year mortality after discharge. Multivariable Cox regression analysis identified BI as a significant risk factor for one-year mortality in older AMI patients (HR 0.977, 95% CI, 0.963-0.992, P = 0.002). BI (0.774, 95% CI: 0.731-0.818) and GRACE (0.758, 95% CI: 0.704-0.812) scores had similar predictive power, but their combination outperformed either score alone (0.810, 95% CI: 0.770-0.851). BI at discharge is a significant risk factor for one-year mortality in older AMI patients, which can be better predicted by the combination of BI and GRACE scores.

Increasing Functional Performance in Older Women

ABSTRACT The purpose of this study was to evaluate differential effects of a 16-week protocol where participants were randomized into a strength-training (ST) group, Activities of Daily Living (ADL) training group, and a control group. Six physical outcome measures were assessed using the Senior Fitness Test, pre and post study, across ninety women in an assisted living community. A series of repeated measures ANOVA revealed significant group × time interactions across the six physical domains measured (p ≤ .01). Post hoc analysis indicated that ST and ADL groups improved significantly more than the control group across each physical domain. The ST group also outperformed the ADL group in the 30 Second Chair Stand and 30 second arm curl. The key finding is that it is important to incorporate both strength and ADL training sessions because both facilitated significant improvements across all six fitness domains above and beyond controls.

Association between Overall Survival and Activities of Daily Living in Patients with Spinal Bone Metastases.

Objective: This study aimed to investigate the association between overall survival (OS) and activities of daily living (ADL) in patients with skeletal-related events. In this study, 265 patients whose clinical parameters were available before radiotherapy were investigated. Methods: Age, sex, ADL, pain, the primary site, spinal level of bone metastases, spinal instability, treatment strategy, including chemotherapy or palliative treatment, and OS were investigated. ADL patients with a Barthel index of ≥90 were classified as the high ADL group, while those with a score < 90 were classified as the low ADL group. For OS, patients surviving ≥160 days were classified as the non-poor prognosis group, and those who survived <160 days were classified as the poor prognosis group. Results: Age, sex, ADL, pain, the primary site, and treatment strategy for OS were different between the two groups (p < 0.1). Logistic regression analysis revealed that ADL, the primary site, and treatment strategy were significant predictors of OS (p < 0.05). High ADL, breast cancer, and chemotherapy had a positive effect on OS. Conclusions: It is suggested that improvements may be obtained by performing rehabilitation interventions to maintain and improve ADL, by constructing a system for monitoring spinal bone metastases with images before ADL decreases, and by performing interventions such as changes in treatment methods such as RT or surgery at appropriate times.

Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction.

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.

Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis.

Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently. This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses. Median follow-up duration was 58months. The incidentrates were 0.02per person-year in the higher ADL group and 0.06 per person-yearin the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57-4.64) compared with that in the higher ADL group. Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.

Cost of Cerebellar Ataxia in Hong Kong: A Retrospective Cost-of-Illness Analysis.

Background: Cerebellar ataxia affects the coordination and balance of patients. The impact of this disease increases burden in patients, caregivers and society. Costs and the burden of this disease have not been investigated in Hong Kong.Objectives: (1) To estimate the socioeconomic cost of cerebellar ataxia in Hong Kong for the base year 2019, (2) to assess the health-related quality of life (HRQoL) and severity of ataxia, and (3) to establish the correlation between the severity and cost of cerebellar ataxia and to examine the correlation between the severity of cerebellar ataxia and HRQoL.Methods: A retrospective cross-sectional study was conducted amongst 31 patients with cerebellar ataxia. Cost-related data were obtained through self-reported questionnaires. The severity of ataxia was assessed using the Scale for Assessment and Rating of Ataxia, and HRQoL was assessed using the Short Form (36) Health Survey (SF-36). Pearson correlation was used for normally distributed data, whereas Spearman correlation was used otherwise.Results: The mean severity of ataxia was 21 out of 40. The average direct and indirect costs of a patient with ataxia in 6 months were HKD 51,371 and HKD 93,855, respectively. The mean difference between the independent to minimally dependent in activities of daily living (ADL) group and the moderate to maximally dependent in ADL group for direct and indirect costs was HKD 33,829 and HKD 51,444, respectively. Significant expenditure was related to production lost (42%), caregiver salary (17%), and in-patient care (16%). The physical functioning (r = −0.58) and general health (r = −0.41) of SF-36 were negatively correlated with disease severity (p < 0.05). A significant, positive correlation was found between disease severity and direct cost (Spearman's rho = 0.39) and the cost of hiring a caregiver (Spearman's rho = 0.43).Conclusion: The mean cost for 6 months for patients with cerebellar ataxia in Hong Kong is HKD 146,832. Additional support, including employment, access to specialist consultants, informal home care and community participation, are some areas that should be addressed. Future study on a larger population with a prospective design is necessary to confirm the aforementioned claims.

Identification of Factors Related to Functional Decline of Korean Older Adults After Hip Fracture Surgery: A Cross-Sectional Study.

Reducing functional decline is an essential treatment goal in older adults after hip fracture surgery. The current study examined different effects of functional decline-related factors according to activities of daily living (ADL) and instrumental ADL (IADL) in older adults after hip fracture surgery. A total of 120 participants were included. In quantile regression, preoperative walking and fear of falling were significantly associated with ADLs in the 25th percentile ADL group. Fear of falling was the only significant factor in the poorest IADL group (25th percentile). Efforts should be made to reduce fear of falling after hip fracture surgery. Preoperative walking status was significant in patients with poor ADL after hip fracture surgery; therefore, walking status should be taken into consideration when planning rehabilitation care in this group, so that the best possible ADL outcomes can be attained. [Research in Gerontological Nursing, 12(6),312-320.].

Predictive Factors for Long-term Outcome of Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease.

Despite the recognition of the usefulness of subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson’s disease (PD), preoperative predictive factors for the long-term outcome of STN-DBS are not sufficiently established. We performed this study to determine such predictive factors. The subjects were 66 patients who were classified into two groups on the basis of their activities of daily living (ADL) evaluated five years after the STN-DBS surgery: 33 patients were assigned to the independent ADL group (group I) and the remaining 33 patients to the dependent ADL group (group D). Group I patients showed a Schwab and England (S&E) scale score of more than 70 during the off-period, indicating that these patients can maintain their independent ADL all the time. Group D patients showed a score of 70 or lower during the off-period, indicating that these patients cannot maintain their independent ADL for an entire day. We studied the differences in the preoperative state between these two groups. Statistically significant differences were noted in PD onset age, age at surgery, preoperative unified Parkinson’s disease rating scale (UPDRS) part I score, part II score, total subscore for axial symptoms in part III, mini-mental state examination (MMSE) score and S&E score. Multiple logistic regression analysis showed that the significant independent variables related to long-term independent ADL were the age at surgery, MMSE score and preoperative S&E scale score during the off-period. The PD onset age, age at surgery, preoperative high-level ADL, cognitive function, and axial symptoms are important predictive factors for the long-term outcome of STN-DBS.

Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction.

BackgroundAge is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI.DesignSingle-center, observational, and retrospective cohort study.MethodsPreserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL.ResultsThe prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively).ConclusionPrehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex.

[Association between the hypersensitive C-reactive protein and activities of daily living among elderly adults in longevity areas of China].

To explore the association between the hypersensitive C-reactive protein (hs-CRP) and activities of daily living (ADL) in elderly adults in longevity areas of China. This analysis included data on 2 352 adults aged ≥65 years from eight longevity areas from the Chinese Longitudinal Healthy Longevity Survey in 2012. We excluded information on adults who lacked ADL or blood test data; the final study population comprised 2 227 elderly adults. Using questionnaires, body measurement, and blood biochemical examination, information on demographic characteristics, lifestyle, ADL, blood pressure, blood lipids, and biomarkers was collected. Study participants who were able to independently carry out the six kinds of activities of daily living (bathing, dressing, indoor activities, toileting, eating, bowel and bladder control) comprised the normal ADL group, and those who could not were included in the impaired ADL group. A multivariate logistic regression model was used to analyze factors influencing ADL impairment. Among the 2 227 participants, 1 674 (75.2%) were included in the normal ADL group and 553 (24.8%) in the impaired ADL group. Among all participants. Adults in the normal ADL group had lower hs-CRP levels (P50 (P25-P75)=0.88; 0.38-2.29 mg/L) than those in the impaired ADL group (1.27; 0.47-4.28 mg/L); (Z=- 4.71, P<0.001). Participants in the normal ADL group also had lower hs-CRP elevation rates (214; 12.8%) than those in the impaired ADL group (125; 22.6%); (χ(2)= 31.06, P<0.001). Multivariate logistic regression analysis indicated that each age increase of one year increased the risk of ADL impairment by 1.08 times (OR 1.08 (95%CI: 1.07-1.10); P<0.001). Participants with increased hs-CRP levels, those of Han nationality, and participants with a previous history of stroke had a higher risk of ADL impairment (OR(95% CI) values were 1.42(1.04-1.94), 1.87(1.13-3.08), 2.81(1.87-4.23); P<0.05). Elderly adults who participated in recreational activities had a lower risk of impaired ADL (OR 0.29 (95%CI: 0.22-0.38); P<0.001). In this study among elderly adults living in longevity areas of China, hs-CRP levels were related to ADL and elevated hs-CRP was associated with a higher risk of ADL impairment.

Retrieval cue and delay interval influence the relationship between prospective memory and activities of daily living in older adults

ABSTRACTObjective: Older adults commonly experience mild declines in everyday functioning and the strategic aspects of prospective memory (PM). This study used multiprocess theory to examine whether the strategic demands of retrieval cue type (event vs. time based) and delay interval length (2 vs. 15 min) influence the relationship between PM and activities of daily living (ADLs) in older adults. Method: Participants included 97 community-dwelling older adults recruited from the Western Australia Participant Pool. Participants were administered the Memory for Intentions Screening Test (MIST) and Prospective and Retrospective Memory Questionnaire (PRMQ) as part of a larger neurocognitive assessment. A knowledgeable informant completed the Activities of Daily Living Questionnaire (ADLQ), from which a cutpoint of ≥1 was used to classify participants into “ADL normal” (n = 37) or “mild ADL problems” (n = 60) groups. Repeated measures multivariate analysis of variance (MANOVA) controlling for age was conducted with ADL group as the between-subjects factor and either MIST or PRMQ cue and delay scores as the within-subjects factors. Results: We observed a significant ADL group by PM interaction on the MIST, with pair-wise analyses showing that the mild ADL problems group performed worse than ADL normal participants on the 15-min time-based scale (p < .001, Cohen’s d = 0.71). No other MIST or PRMQ cue–delay variable differed between the two ADL groups (ps > .10). Conclusion: Findings indicate that decrements in strategically demanding cue monitoring and detection over longer PM delays may partly explain older adults’ mild problems in everyday functioning. Findings may inform neuropsychological interventions aimed at maintaining ADL independence and enhancing quality of life in older adults.

Association between Drinking Behavior and Activities of Daily Living in Community-dwelling Older Adults

As the elderly are more vulnerable to drinking than young adults, elucidation of the relationship between drinking habits of old age and ADL is an important issue from the perspective of public health science. This study explores the relationship between drinking habits of the elderly and impaired Activities of Daily Living (ADL) and provides basic materials to prevent impaired ADL in the old age. This study analyzed a total of 4,134 elderly people over the age of 65 who participated in 2011 Korean Longitudinal Survey of Aging. Drinking habits were classified into 'no drinking (no drinking experience in lifetime)', 'past drinking (have drinking experience in the past but presently do not drink)' and 'currently drinking'. ADL were classified into ‘normal group’ and ‘Impaired ADL group’. To compare the relationship between alcohol drinking and impaired ALD, the odds ratio (OR) and 95% confidence intervals (CI) were presented using hierarchical logistic regression. As the result of multivariate analysis (adjusted model), even after all confounding variables were adjusted, drinking had significant relationship with ADL impairment. Past drinkers has 6 times more risk of ADL impairment (OR=5.86, 95% CI: 3.07-11.19) than nondrinkers and current drinkers 4 times more risk (OR=3.94, 95% CI: 2.08-7.48) (p<0.05). As drinking in old age is associated with impaired ADL, moderation is required on drinkers for healthy aging.

Loss of occlusal support affects the decline in activities of daily living in elderly people receiving home care

PurposeThis study aimed to clarify whether the absence of occlusal support would lead to a decline in the activities of daily living (ADL) in elderly people receiving home care. MethodsThe subjects of this study were 322 elderly individual aged 65 and older who were receiving home care during a one-year observation period. The subjects were divided into two groups according to the change in the total score of the Barthel Index (BI) during the prospective cohort study period (the dependent variable): the maintained/improved activities of daily living group, in which the score was unchanged or improved, and the worsened activities of daily living group, in which the score decreased. The relationship between occlusal status (the presence or absence of occlusal support) at the baseline measurement and each BI score change was evaluated in the slightly, moderately and totally dependent ADL subgroups. ResultsThe number of subjects in the maintained/improved and the worsened ADL groups was 152 and 170, respectively. The baseline characteristics of cognitive function and occlusal support were significantly different between the maintained/improved and the worsened ADL groups (p<0.05). Among the ADL subgroups, significantly reduced scores in mobility and toilet use were observed only in the slightly dependent group (p<0.05). ConclusionsOur results suggest that the loss of occlusal support may be an important factor in the decline of ADL in elderly people receiving home care, especially slightly dependent people.

Resting Energy Expenditure in Patients with Stroke during the Subacute Phases - Relationships with Stroke Types, Location, Severity of Paresis, and Activities of Daily Living

Background: The energy demands in patients with stroke during the subacute phases are unclear. However, this information is essential for appropriate clinical and nutritional management. The aims of this study were to determine the resting energy expenditure (REE) during the subacute phases, examine its relationships with stroke types, location, severity of hemiparesis, and activities of daily living (ADL), and evaluate whether estimation of REE from the Harris-Benedict equation (HB) requires the addition of a ‘stress factor' to capture possible additional REE imposed by stroke. Methods: We measured REE in 95 patients with subacute stroke (53.5 ± 16.6 days post-stroke) with indirect calorimetry, and compared it with predicted values of energy expenditure estimated from the HB (expressed as percentage). Patients were admitted for rehabilitation of their first ischemic or nonsurgical hemorrhagic stroke. The severity of hemiparesis was assessed with the motor items of the Stroke Impairment Assessment Set (SIAS). The ADL was assessed with the Functional Independence Measure (FIM). We compared REE and %HB of the two groups divided by hemiparesis severity and ADL limitation using the Student's t-test, and those of the five groups divided by stroke location. The correlations between REE and the motor items of the SIAS and the FIM score were assessed with the Spearman rank correlation test. A multiple regression analysis for REE was conducted. Results: The average body weight (BW) was 57.1 ± 11.3 kg. The average body mass index (BMI) was 22.5 ± 4.0. The mean REE (%HB) was 1,271 ± 284 kcal/day (106.0 ± 17.3%). REE and %HB of the low ADL group was less than that of the high ADL group (p < 0.05). The REE had a positive correlation with the FIM score (rs = 0.51, p < 0.01). The motor items of the SIAS were not significantly correlated with REE. BW, FIM, and stroke location were independent predictors of REE. Conclusions: Analysis of energy expenditure suggests that stroke patients are not hypermetabolic during the subacute phase. The ‘stress factor' in stroke patients during the subacute phase was 1.0-1.1. This finding provides important information for improving nutritional management during the subacute phase in patients with stroke.

Prognosis-related factors concerning oral and general conditions for homebound older adults in Japan.

The present study examined the relationship between oral function, such as eating/swallowing, and life prognosis among a homebound elderly population, considering physical and mental function. The participants were 511 homebound older adults aged 65 years or older living in four Japanese prefectures. Sex, age, activities of daily living (ADL), cognitive function, underlying disease, nutritional status as Mini-Nutritional Assessment-Short Form (MNA(®)-SF), swallowing function, dietary modification and occlusal status were examined at baseline. Participants were categorized into poor outcome (died or admitted to hospital or nursing home) and good outcome (still under home care) groups at 1-year follow up, and significant related baseline factors were analyzed. In addition, these groups were compared by the ADL subgroup divided into <60 (lower) and ≥60 (higher) by Barthel Index. In total, 473 participants were followed up (poor outcome group 177 [37.4%], good outcome group 296 [62.6%]). Sex, age, ADL, MNA(®)-SF, swallowing function, dietary modification and occlusal support were significantly different between these groups. Logistic regression analysis showed that sex and MNA(®)-SF score were significantly related to prognosis in the lower ADL group, and sex, age, Charlson Comorbidity Index and occlusal support were significantly related in the higher ADL group. ADL was strongly correlated with life prognosis in homebound older adults. Within the higher ADL participants, occlusal support was related to this outcome.

Quality of Life and Its Associated Factors Using WHOQOL- BREF Among Elderly in Urban Puducherry, India

Quality of Life (QOL) among elderly is a neglected issue especially in developing countries including India. To assess the QOL and its associated factors among elderly population. A community based cross-sectional study was conducted among 300 elderly subjects in urban Puducherry, India. Data on QOL was assessed by World Health Organization Quality of Life BREF (WHOQOL-BREF) and Activities of Daily Living (ADLs) by Katz ADL scale. Socio-demographic factors and chronic morbid conditions were recorded by using structured questionnaire. Independent sample test and multiple linear regression analysis. Majority (64%, 192) were in the (60-69) years' age-group. Overall mean Standard Deviation (SD) score of QOL was 49.74 (10.21). QOL was significantly low among those with no schooling, nuclear family, not receiving pension, not with partner, having musculoskeletal disorder, low vision and impaired ADL groups in univariate analysis. Multiple linear regression analysis revealed that older age (p=0.014), no schooling (p=0.004), without spouse (p=<0.001), nuclear family (p=0.039), musculoskeletal disorder (p=<0.001), low vision (p=0.049) and hearing impairment (0.001) were associated with low QOL score. QOL score among elderly is average, while social relationship domain of QOL score was found to be low. Health education with regard to activity and environmental changes and increase in social relationship may help in improving the QOL among the elderly population.