Activities Of Daily Living Staircase Research Articles

Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. DesignPlanned analysis of a randomized controlled trial with 3- and 12-month follow-ups. SettingGeriatric ward, ordinary housing, and residential care facilities. ParticipantsOf 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. InterventionIndividually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome MeasuresIndependence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes. ResultsThere were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207). ConclusionsIn older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.

Disability and quality of life in individuals with muscular dystrophy

In the county of Orebro, Sweden, 32 individuals with myotonic disorders and 25 with other types of muscular dystrophy were examined. Disability was assessed with functional tests and standardized observations of muscle function (mainly based on those proposed by Dr. Brooke), a new self-administered questionnaire regarding the Activities of Daily Living (ADL) and the ADL staircase (based on Katz ADL index). The results of the different tests of disability were highly correlated. The Sickness Impact Profile and the Kaasa test were used for assessing the quality of life, and no significant differences were found between the groups of muscular dystrophy. In an explanatory factor analysis three main factors of disability were found. The factors walk and move" and "finger function" were fair to good associated with the quality of life. This study offers an approach for research on the consequences of muscular dystrophy using established as well as new methods."

Detecting longitudinal changes in activities of daily living (ADL) dependence: Optimizing ADL staircase response choices

IntroductionUsing a sum score based on a three-graded response scale for the activities of daily living staircase has previously been found to increase the statistical power compared to dichotomize...

Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skåne.

ObjectivesTo determine the relationship between long-term change in activities of daily living (ADL) and falls in the elderly and to identify characteristics of groups at risk for falls.MethodsThis was a 6-year, prospective cohort study using data from the Good Aging in Skåne study in southern Sweden, involving 1,540 elderly subjects, including the oldest-old (age, 60–93 years). The subjects were recruited from the general population. ADL was measured at a baseline and follow-up assessment, using Sonn and Åsberg’s revised scale and the ADL staircase. Falls were recorded in a period of 6 months before the follow-up assessment. The association between falls and change in ADL was calculated using adjusted, multiple logistic regression analysis and presented in odds ratios (ORs).ResultsThirteen percent of the study population reported one or several falls in the measured period. Over the course of 6 years, one in four participants changed their ADL status, and parts of this category had an increased risk for falls compared with those who stayed independent in ADL or who had no change in the ADL staircase. Groups with different characteristics had a prominent risk for falls: those with a reduction of two to eight steps in the ADL staircase (OR, 4.05; 95% confidence interval [CI], 1.62–10.11) and those becoming independent from dependency in instrumental ADL (OR, 4.13; 95% CI, 1.89–9.00). The former group had advanced age with a greater burden of cognitive impairment, gait disability, arrhythmia, and fall risk medications. The latter group had a higher prevalence of ischemic heart disease and low walking speed.ConclusionBoth deterioration and improvement in ADL over the course of 6 years increased the risk for falls in a general elderly population. Interventional efforts may require different strategies, as groups with different characteristics were at risk. Those at risk with improved ADL function may have a history of sufficient burden of comorbidity combined with obtained mobility for exposure to a fall event.

Case managers for frail older people: a randomised controlled pilot study

The aim was to test sampling and explore sample characteristics in a pilot study using a case management intervention for older people with functional dependency and repeated contact with the healthcare services as well as to investigate the effects of the intervention on perceived health and depressed mood after 3 months. The aim was also to explore internal consistency in the life satisfaction index Z, activities of daily living-staircase and Geriatric Depression Scale-20. This pilot study was carried out in a randomised controlled design with repeated follow-ups. In all, 46 people were consecutively and randomly assigned to either an intervention (n = 23) or a control (n = 23) group. Two nurses worked as case managers and carried out the intervention, which consisted of four parts. No differences were found between the groups at baseline. The results showed the participants had low life satisfaction (median 14 vs. 12), several health complaints (median 11) and a high score on the Geriatric Depression Scale (median 6) at baseline, indicating the risk of depression. No significant effects were observed regarding depressed mood or perceived health between or within groups at follow-up after 3 months. Cronbach's alpha showed satisfactory internal consistency for group comparisons. The sampling procedure led to similar groups. The life satisfaction, functional dependency and symptoms of depression measures were reliable to use. No changes in perceived health and symptoms of depression were found after 3 months, indicating that it may be too early to expect effects. The low depression score is noteworthy and requires further research.

Activities of daily living among St Petersburg women after mild stroke

The aim of the present study was to determine how women living in St Petersburg, Russia, who have had a mild stroke, describe their performance in activities of daily living (ADL) and to elicit possible causes of their occupational dysfunction. Thirty-six women who had experienced a mild stroke and been referred to a rehabilitation centre participated in the study. Data collection was conducted through interviews, including the 'ADL Staircase' and a modified 'Frenchay Activities Index for Stroke Patients'. Additional data were collected through field notes and information from team members and relatives. The results showed that women who have had a mild stroke and ADL limitations experience occupational dysfunction in ADL that is most often caused by a combination of overprotection from relatives, the women's own feelings of anxiety and insecurity, and an overemphasizing of their disability. The results are limited, based on the small sample and restricted geographic area. There is a need to further investigate how individuals who have had a mild stroke can be physically and socially rehabilitated and reintegrated into the community in countries with developing economies such as Russia.

Changes in ADL Dependence and Aspects of Usability Following Housing Adaptation—A Longitudinal Perspective

To investigate longitudinal changes in activities of daily living (ADL) dependence and aspects of usability in housing among clients receiving housing adaptation grants in Sweden. The ADL Staircase and the Usability in My Home instruments were used to collect data on three occasions: at baseline 1 month before housing adaptation, at follow-ups 2 to 3 months after housing adaptation completion, and after another 6 to 7 months. In all, 131 clients, living in ordinary housing 24 to 93 years of age were consecutively enrolled. Overall ADL dependence did not change significantly whereas dependence in "Bathing" decreased over time. "Activity aspects" and "Personal and social aspects" of usability improved at different phases in the process. This study delivers new insights about the complexity of longitudinal person-environment-activity transactions, specifically targeting activity and usability. The results are useful for developing efficient strategies for evaluating housing adaptations within occupational therapy practice and research.

Alternative data treatment principles for categorical ADL data.

Scaling methodology represents a problem in assessments of activities of daily living (ADL) and little is known about how the results of these assessments are affected by data treatment principles and statistical methods. The aims of this paper are to: (i) describe alternative ways of transforming a response pattern on ADL into a single number; and (ii) to present and compare different ways of analysing both changes in ADL capacity from one occasion to another and also differences in ADL between one group and another. Three datasets based on assessments with the ADL Staircase were used. Four different data treatment principles were described and the development of a novel principle to transform response patterns into ranks was put forward. Thereafter, different paired-data cases and two-sample cases were analysed, using different statistical standard methods to explore possible variations in results. The results demonstrated a few marked differences among P values, no matter which data treatment principle or statistical method was used. That is, different principles and methods yield similar results in terms of P values, although there are important differences as regards selection bias. Principles and methods respecting the ordinal character of ADL data encourage the use of non-parametric methods and the novel rank principle presented here is a useful alternative.

Quality of Care in Geriatric Rehabilitation: Clients' Perceptions, ADL Dependence, and Subjective Well-being in a One-year Perspective

World-wide, the development of community-based geriatric rehabilitation has received increased attention. In Sweden, national reforms during the 1990s aimed at improved quality of geriatric rehabilitation. This paper focuses clients' perceptions of the rehabilitation process, dependence in activities of daily living (ADL), and subjective well-being in a one-year perspective. A study-specific questionnaire, a revised version of the ADL Staircase, and the Göteborg Quality of Life Instrument were administered, in 1996 (N = 278) and 1997 (N = 233). Even if 77% of the clients were content as regards rehabilitation quality, in 1997 contentment diminished among clients in sheltered housing facilities. Most clients also reported a diminished contentment with the training provided during the period investigated. Most clients were dependent in ADL, but in sub-groups independence in some activities diminished over the study period. In contrast, in some aspects sub-groups scored their subjective well-being lower on the second measurement than on the first. The investigation of clients' perceptions of quality of care is a multifaceted matter, and the results of this study were partly ambiguous. Still, since valid descriptions of variables at target for rehabilitation is one important key to the continuous process of quality development, this study produced information valuable for further studies following geriatric rehabilitation processes over time. The implementation of this study could be applicable in similar settings.

Exploration of subjective well-being and dependence in daily activities at the beginning of the geriatric rehabilitation process: a challenge to traditional goal-setting and evaluation procedures?

The objectives of this study were to describe a population of elderly patients at the beginning of their rehabilitation period as regards subjective well-being and dependence in activities of daily living (ADL). In a Swedish rural county 244 patients aged 65+ who had begun rehabilitation within the last month were targeted. One part of the self-administered Göteborg Quality of Life Instrument and a revised version of the ADL Staircase were used. No correlation was found between subjective well-being and ADL dependence. However, significant correlations between ADL dependence and separate subjective well-being items were found in three out of 17, i.e. the items ‘energy’, ‘leisure’, and ‘sense of significance and appreciation outside home’. Overall subjective well-being did not show any gender differences, but significant gender differences due to the distribution of scores was shown; females scored the items ‘health’, ‘sleeping’, and ‘economy’ as bad to a larger extent than males. Males were significantly more dependent than females in three out of nine ADL: ‘going to the toilet’, ‘dressing’, and ‘cooking’. Additional knowledge of subjective well-being and ADL dependence at the beginning of the rehabilitation process challenges the traditional goal-setting and evaluation procedures of geriatric rehabilitation services.

Quality of life in the elderly population: an example exploring interrelationships among subjective well-being, ADL dependence, and housing accessibility

During recent decades, research on quality of life has gained increasing interest. In gerontology, the assessment of objective as well as subjective dimensions is recommendable, and the most innovative research will involve the study of the interrelationships of several components. In empirical research objective environmental factors have rarely been explored. The aim of this study was to explore the interrelationships among subjective well-being, dependence in activities of daily living (ADL), and objective housing accessibility in the elderly population in ordinary housing. A random sample of 133 subjects aged 75–84 was multi-dimensionally assessed. The Gothenburg Quality of Life Instrument, a revised version of the ADL Staircase and the Enabler were administered at home-visits. Most of the subjects rated their general well-being as high. One-third were independent in ADL, and 1/5 did not have any objective housing accessibility problems. Different aspects of physical well-being covaried significantly with ADL dependence, but even more strongly with objective housing accessibility. Theoretically, the results relate to the Lawton model of `The Good Life'. In conclusion, inaccessible housing represents a potential health problem, since it threatens the independence and subjective well-being of elderly people. The results presented in this study provided increased knowledge of importance for geriatric rehabilitation and society planning to meet the needs of senior citizens.