Activities Of Daily Living Status Research Articles

Association Between Quadriceps Muscle Thickness or Echo Intensity, Malnutrition, and Activities of Daily Living in an Integrated Medical and Long-Term Care Facility: A Cross-Sectional Study

Background &AimsMalnutrition and physical function impairment are prevalent concerns in long-term care facilities. This study investigated the relationship between quadriceps muscle thickness (QMT) or echo intensity (QEI), nutritional status, and activities of daily living (ADL) in residents of an Integrated Facility for Medical and Long-term Care (IFMLC) in Japan. MethodsUsing a cross-sectional design, 126 residents (86 women, median age 89 years) at an IFMLC were assessed. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria including disease burden/inflammation, while ADL status was evaluated using the Barthel Index (BI). QMT and QEI, indicative of muscle mass and intramuscular adipose tissue, were measured by ultrasound. Multivariate logistic and linear regression analyses were conducted to explore the association of QMT or QEI with malnutrition and ADL. Results62 residents (49%) were in the lower QMT group and 63 residents (50%) were in the upper QEI group. The prevalence of severe malnutrition in the lower QMT group was significantly higher than that in the upper QMT group. Moreover, the lower QMT group had significantly lower BI points than the upper QMT group. The upper QEI group had significantly lower BI points than the lower QEI group. lower QMT was associated with severe malnutrition (odds ratio 3.170; 95% CI 1.238 to 8.725; P = 0.016). Furthermore, both lower QMT (B = −12.520; 95% CI −17.069 to −7.973; P < 0.001) and upper QEI (B = −7.598; 95% CI −12.565 to −2.631; P = 0.003) showed an independent correlation with lower BI scores. ConclusionThis study found a relationship between lower QMT correlated with severe malnutrition and poor ADL, while higher QEI is associated with poor ADL.

Interactions between patterns of multimorbidity and functional status among hospitalized older patients: a novel approach using cluster analysis and association rule mining

BackgroundMultimorbidity (MM) is generally defined as the presence of 2 or more chronic diseases in the same patient and seems to be frequently associated with frailty and poor quality of life. However, the complex interplay between MM and functional status in hospitalized older patients has not been fully elucidated so far. Here, we implemented a 2-step approach, combining cluster analysis and association rule mining to explore how patterns of MM and disease associations change as a function of disability.MethodsThis retrospective cohort study included 3366 hospitalized older patients discharged from acute care units of Ancona and Cosenza sites of Italian National Institute on Aging (INRCA-IRCCS) between 2011 and 2017. Cluster analysis and association rule mining (ARM) were used to explore patterns of MM and disease associations in the whole population and after stratifying by dependency in activities of daily living (ADL) at discharge. Sensitivity analyses in men and women were conducted to test for robustness of study findings.ResultsOut of 3366 included patients, 78% were multimorbid. According to functional status, 22.2% of patients had no disability in ADL (functionally independent group), 22.7% had 1 ADL dependency (mildly dependent group), and 57.4% 2 or more ADL impaired (moderately-severely dependent group). Two main MM clusters were identified in the whole general population and in single ADL groups. ARM revealed interesting within-cluster disease associations, characterized by high lift and confidence. Specifically, in the functionally independent group, the most significant ones involved atrial fibrillation (AF)-anemia and chronic kidney disease (CKD) (lift = 2.32), followed by coronary artery disease (CAD)-AF and heart failure (HF) (lift = 2.29); in patients with moderate-severe ADL disability, the most significant ARM involved CAD-HF and AF (lift = 1.97), thyroid dysfunction and AF (lift = 1.75), cerebrovascular disease (CVD)-CAD and AF (lift = 1.55), and hypertension-anemia and CKD (lift = 1.43).ConclusionsHospitalized older patients have high rates of MM and functional impairment. Combining cluster analysis to ARM may assist physicians in discovering unexpected disease associations in patients with different ADL status. This could be relevant in the view of individuating personalized diagnostic and therapeutic approaches, according to the modern principles of precision medicine.

Predictors of type of powered mobility aid for patients: a retrospective study in a Singapore acute hospital

Purpose Rehabilitation professionals prescribe patients with suitable powered mobility aids (PMAs) based on patient characteristics, e.g., age and mobility. However, there is paucity of literature examining patient characteristics associated with PMA types in Asian contexts. This research aims to study (i) characteristics of Singapore PMA users and (ii) correlations between characteristics and two PMA types – motorised wheelchairs and powered scooters. It is hypothesised that patients’ age, mobility status and medical conditions have correlations with PMA types. Methodology A cross-sectional, retrospective study design was used to investigate characteristics of patients (age ≥ 21 years) at Tan Tock Seng Hospital Occupational Therapy Seating Clinic between 2017 and 2019. Comparisons of proportions of motorised wheelchair users versus powered scooter users based on characteristics were analysed using Chi-square test. Subsequently, statistically significant patient characteristics were selected for a multiple logistic regression. Results Among 352 patients, 21% and 79% were prescribed motorised wheelchairs and powered scooters, respectively. Patients aged 61–90 years were twice those aged 21–60 years. Males were double of females. Patients of (i) an older age, (ii) more ambulant, (iii) independent in transfers and (iv) in activities of daily living (ADLs), were more likely powered scooter users. Conversely, patients of (i) a younger age, (ii) less ambulant, (iii) require assistance in transfers and (iv) in ADLs were more likely motorised wheelchair users. Patients’ gender and caregiver status showed no statistically significant correlations with PMA types. Conclusions Rehabilitation professionals could consider patients’ age, mobility status, transfer status and ADL status when prescribing PMA for Asian populations.

Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke

Purpose To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. Materials and Methods 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. Results Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). Conclusions Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.

Serum 25-Hydroxyvitamin D and Risk of Disability in Activities of Daily Living among the Oldest-Old: An Observational and Mendelian Randomization Study

BackgroundVitamin D deficiency and disability are both prevalent among older adults. However, the association between them has rarely been investigated in the oldest-old subjects (aged ≥80 y), and the causality remains unclear. ObjectiveThis study aimed to elucidate the causal effect of vitamin D on the incident risk of disability in activities of daily living (ADL) among Chinese oldest-old based on the 2012–2018 Chinese Healthy Ageing and Biomarkers Cohort Study. MethodsSerum 25-hydroxyvitamin D [25(OH)D] concentrations and ADL status at baseline and follow-up interviews were documented. Cox regression models were applied among 1427 oldest-old (mean age, 91.2 y) with normal baseline ADL status. One sample Mendelian randomization (MR) analyses were performed on a subset of 941 participants with qualified genetic data, using a 25(OH)D-associated genetic risk score as the genetic instrument. ResultsDuring a median follow-up of 3.4 y, 231 participants developed disability in ADL. Serum 25(OH)D concentration was inversely associated with the risk of disability in ADL [per 10 nmol/L increase hazard ratio (HR) 0.85; 95% CI: 0.75, 0.96]. Consistent results from MR analyses showed that a 10 nmol/L increment in genetically predicted 25(OH)D concentration corresponded to a 20% reduced risk of ADL disability (HR 0.80; 95% CI: 0.68, 0.94). Nonlinear MR demonstrated a monotonic declining curve, with the HRs exhibiting a more pronounced reduction among individuals with 25(OH)D concentrations below 50 nmol/L. Subgroup analyses showed that the associations were more distinct among females and those with poorer health conditions. ConclusionsOur study supports an inverse causal relationship between serum 25(OH)D concentration and the risk of disability in ADL among Chinese oldest-old. This protective effect was more distinct, especially for participants with vitamin D deficiency. Appropriate measures for improving vitamin D might help reduce the incidence of physical disability in this specific age group.

Does Old Age Comprise Distinct Subphases? Evidence from an Analysis of the Relationship between Age and Activities of Daily Living, Comorbidities, and Geriatric Syndromes.

Older individuals are usually treated as a homogenous group despite evidence that old age consists of distinct subphases. This observational study including 493 older patients aimed to identify differences among age subgroups of older persons. Receiver operating characteristic (ROC) curve analysis was then applied to identify the optimal age cutoff points to distinguish those age groups. Data were collected on the demographics of older patients, their medical and medication histories, dependence on activities of daily living (ADLs), and instrumental activities of daily living (IADLs). Non-parametric tests (Kruskal-Wallis and Mann-Whitney U tests) and ROC curves were used for statistical analysis. The 65-79 and ≥80 years of age groups showed distinct frailty status, comorbidity, and dependency in ADLs. The median age to remain completely independent in IADLs was 76-79 years, while the median age for being free from geriatric syndromes was slightly higher (77-80 years) and reached 82 years for the absence of delirium, falls, and swallowing problems. In the ROC analysis, the optimal cutoff ages for the presence of frailty, cognitive impairment, and dependency in ADLs were 80-82 years. The 65-79 and ≥80 years of age groups differed significantly in numerous parameters, underscoring the need to address these distinct age groups differently, both for applying medical therapies and interventions, as well as for conducting health research.

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

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.

Functional Impairment is Associated with Poor Long-Term Outcomes after Arteriovenous Access Creation

Functional impairment affects outcomes after a variety of procedures. However, the impact of functional impairment on outcomes of arteriovenous (AV) access creation is unclear. We aimed to evaluate the association of patients' ability to ambulate and perform activities of daily living (ADL) with AV access outcomes. We retrospectively reviewed patients undergoing AV access creation at an urban, safety-net hospital from 2014-2022. We evaluated associations of impaired ambulatory and assisted ADL status with 90-day readmission, 1-year primary patency, and 5-year mortality. Among 689 patients receiving AV access, mean age was 59.6 ± 13.9 years, 59% were male, and 60% were Black. Access types included brachiocephalic (42%), brachiobasilic (26%), radiocephalic (14%), other autogenous (5%) fistulas and prosthetic grafts (13%). Impaired ambulatory status was identified in 35% and assisted ADL status, when assessed, was identified in 21% of patients. Ninety-day readmission was more likely in patients with impaired ambulatory (58% vs. 39%, P<.001) and assisted ADL (56% vs. 41%, P=.004) status. On Kaplan-Meier analysis, 1-year primary patency was lower for patients with impaired ambulatory status (44% ± 3% vs. 29% ± 3%, P=.001), but was not significantly different for patients with assisted ADL status (41% ± 3% vs. 32% ± 5%, P=.12). Five-year survival was lower for patients with impaired ambulatory status (53% ± 5% vs. 74% ± 4%, P<.001), but was not significantly different for patients with assisted ADL status (45% ± 9% vs. 71% ± 4%, P=.1). On multivariable analysis, increased likelihood of 90-day readmission was significantly associated with impaired ambulatory status (OR 2.03, 95% CI 1.4-2.94, P<.001) and assisted ADL status (OR 1.66, 95% CI 1.07-2.57, P=.02). One-year primary patency was not significantly associated with impaired ambulatory (HR 1.25, 95% CI .98-1.6, P = .07) or assisted ADL status (HR 1.13, 95% CI .87-1.48, P=.36). Increased likelihood of 5-year mortality was associated with impaired ambulatory (HR 1.65, 95% CI 1.04-2.62, P=.04) and assisted ADL status (HR 2.63, 95% CI 1.35-5.11, P=.004). Impaired ambulatory and assisted ADL status were associated with increased readmissions and long-term mortality after AV access creation. Approximately half of patients with functional impairment were not alive at 5 years. Setting outcome expectations as well as prospectively examining the impact of physical therapy and visiting nursing services for functionally impaired patients undergoing AV access creation are warranted.

Decision-making for intensive rehabilitation in patients with Trousseau syndrome: Insights from a case series.

Patients with Trousseau syndrome, a common complication of advanced cancer, typically have poor survival. For that reason, there is a need to determine the effectiveness of rehabilitation treatment and develop a comprehensive treatment strategy earlier than that in the general stroke population. We investigated the relationship between physical function and its outcome 1 month after the start of intensive rehabilitation treatment in patients with Trousseau syndrome, to obtain insights for determining the indications for intensive rehabilitation in these patients. The development of Trousseau syndrome may worsen the performance status (PS), often necessitating a reevaluation of the indications for treatment of the primary cancer. Furthermore, the primary cancer may progress during rehabilitation therapy. These patients were diagnosed with Trousseau syndrome. All patients underwent training under the supervision of a therapist for 2 to 3 hours per day, 7 days per week, with a focus on exercise therapy. The functional independence measure (FIM) 1 month after admission to the convalescent rehabilitation ward, modified Rankin scale (mRS) score on admission and on the date of last assessment, and its outcome was examined. The time from stroke onset to admission to rehabilitation ranged from 22 to 60 days. Primary cancers were lung, bladder, prostate, ovarian, uterine, and unknown primary. Four patients had advanced cancer with distant metastasis. Two patients were discharged to home with independent activities of daily living (ADL) status. Two patients were transferred to palliative care, and 3 patients died. The 2 patients with independent ADL status had a mean motor score of 90 and a mean cognitive score of 30 on FIM, while the other 5 patients had a mean motor score of 29 and a mean cognitive score of 21 at 1 month of admission. Patients with mRS > 3 on admission did not have independent ADL status at 1 month. Intensive rehabilitation therapy may be indicated for patients with Trousseau syndrome who are expected to improve physical function after approximately 1 month of rehabilitation. Palliative care should be considered if recovery is inadequate.

A prediction model for low functional status after colorectal cancer surgery: A retrospective cohort study using administrative data

IntroductionColorectal cancer (CRC) accounts for 10% of all cancer incidences globally and often affects older populations and people with poor nutrition. As such, we developed a prediction model for low functional status following CRC surgery using inpatient data collected during routine practice, and investigated the relationship between low functional status and outcomes. MethodsData from 690 patients who underwent CRC surgery were analysed, and the Barthel Index was used to evaluate functional status [activity of daily living (ADL)]. A low-ADL status was defined as a lower score at discharge than at admission, and unchanged complete dependence from admission to discharge. The model input data included 10 basic characteristics, eight comorbidities, and four laboratory parameters. The final model was developed using stepwise logistic regression. ResultsThe low-ADL predictive model was successfully developed using nine variables: age, ADL dependence, nursing home residency, ambulance use, disturbance of consciousness on admission, diabetes, cerebrovascular disease, low creatinine, and low protein (c-statistics = 0.857). Only 6.5% of high-ADL patients were unable to return home following discharge; in contrast, 53.5% of low-ADL patients were unable to return home. Low-ADL patients also had significantly longer post-operative hospital stays and higher medical costs than high-ADL patients. ConclusionLow-ADL patients had decreased rates of discharge to homes, experienced longer hospital stays, and incurred higher medical costs than high-ADL patients. Pre-operative prediction of low ADL status is important, and essential for taking efficient preventive measures.

Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China.

Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up). This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults. Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors. Overall, 13% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas. Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority.

The prognostic value of comprehensive geriatric assessment on the management of older patients with small cell lung cancer.

The prognostic value of a comprehensive geriatric assessment (CGA) for the management of older small cell lung cancer (SCLC) patients remains to be established. A retrospective cohort enrolled 21 SCLC patients over 65 years from March 2018 to 2019 at the Yonsei Cancer Center. The CGA included the following instruments: frailty, body mass index, sarcopenia (circumference of arm and calf, Timed Up and Go test, grip strength), comorbidity, polypharmacy, activities of daily living (ADL), Instrumental ADL, nutrition, depression, and cognitive function. The correlations of oncological and geriatric variables with overall survival (OS) were determined. The log-rank test with Cox model and Kaplan-Meier method were used for the analysis. The median age was 75 years (range, 67 to 85). All patients had the Eastern Cooperative Oncology Group performance status 0-2. The median survival was 9.93 months (range, 1.53 to 36.30). Among CGA parameters, ADL and nutritional status had significant differences in OS in univariate analysis. In multivariate analysis, only nutritional status was independently associated with survival (hazard ratio, 0.17; 95% confidence interval, 0.05 to 0.57). Median OS for low nutritional status was 5.63 months and the normal nutrition group was 15.5 months (p = 0.004). Pre-treatment nutritional status measured by CGA appears to be a predictor of OS in older SCLC patients. However, for further generalization of the implication of CGA in SCLC, a larger scale study with prospective design is strongly needed.

A Comparative Study of Foot Range of Motion and Activities of Daily Living Status of Patients Following Ankle Arthrodesis and Tibiotalocalcaneal Arthrodesis

Subtalar arthrodesis in addition to ankle arthrodesis (AA) should have effect on foot motion and functional capabilities pertaining to activities of daily living (ADL); however, it is not well characterized. We compared the foot range of motion and ADL-related functional capabilities between patients who had undergone AA and tibiotalocalcaneal arthrodesis (TTC). Twenty-one AA patients and 10 TTC patients were enrolled. Foot sagittal motion arc was measured by radiographs. Patient satisfaction, ADL, footwear restriction, and rating scale scores were compared between the 2 groups. The mean sagittal motion arc in the AA group (23.5 ± 6.2°) was significantly greater than that in the TTC group (15.3 ± 3.5°). Patient satisfaction and overall ADL status was comparable in the 2 groups. Difficulties in climbing stairs, wearing rubber boots, and sitting in cross-legged position were more frequently reported in the TTC group. Our findings may be valuable for both surgeons and patients in predicting post-treatment ADL status and avoiding over expectations.

AGEISM, CONTACT, AND OLDER ADULT ADLS RELATE TO MENTAL HEALTH TRAINEES’ INTEREST IN GEROPSYCHOLOGY

Abstract Despite growing demand, few mental healthcare professionals specialize in clinical work with older adults. A better understanding of factors related to geropsychology interest may increase the pipeline of future geropsychologists. Graduate-level trainees (N=460; 67.4% doctoral; age=21-64) completed the Fraboni Scale of Ageism, Contact with Older Adults Scale, six indicators of interest in work with older adults, and an imagined “typical” older adult’s ability to complete activities of daily living (ADLs). 60% imagined full ADL independence. Between 14.1%-25.7% expressed strong interest in education/training related to treating older adults and having some older adult clients; only 6.7% planned to specialize in clinical work with older adults. In regression analyses (R-squared=16%-32%), more ageist attitudes, less contact, and being a master’s trainee were related to less interest. ADL status was significant only for interest in specialization; imagining more ADL-dependence related to higher interest in specializing in older adults. ADL status significantly moderated the relation of contact to interest in learning about issues related to older adults; ADL-based differences in interest were non-significant at low and average contact, but at high contact, interest in learning about older adults was significantly higher when the older adult was imagined as ADL-dependent rather than ADL-independent. Findings may indicate benevolent ageism partially motivates trainees’ interest in learning about/working with older adults whom they imagine need more help with basic tasks of daily living. Increasing contact, reducing ageist attitudes, and providing more clinical opportunities with older adults may facilitate trainees’ readiness and interest in future clinical work with older adults.

Event History Analysis of Factors Affecting Survival of Older Adults in Taiwan.

(1) Background: Due to rapidly increasing average age of Taiwan's population, it is very important to analyze the factors affecting the survival of older adults. (2) Methods: In this study, the 1989 Taiwan Longitudinal Study on Aging, which lasted 22 years and consisted of seven surveys, was used. Furthermore, Cox and Aalen's time-dependent frailty models were used to analyze factors that affect the survival of older adults. (3) Results: Based on past literature, we selected 15 important factors that were closely associated with the survival of older adults and constructed six models based on these factors. The study results showed that, in addition to background characteristics, physical and mental conditions, activities of daily living (ADL), physical performance, and self-rated health had a huge association with the survival of older adults. (4) Conclusions: We selected ten variables (age, gender, population, education level, ADL status, physical performance, self-rated health, smoking, chewing betel nut, and the presence of a spouse), and their combinations were used to generate reduced models, which could be considered as important markers that affect and predict the survival of older adults.

Survival Rate after Palliative Surgery Alone for Symptomatic Spinal Metastases: A Prospective Cohort Study.

The effect of spine surgery for symptomatic spinal metastases (SSM) on patient prognosis remains unclear. This study aimed to reveal the prognosis of patients with SSM after spine surgery. One hundred twenty-two patients with SSM were enrolled in this prospective cohort study. The patients who received chemotherapy after enrollment were excluded. The decision of surgery depended on patient's willingness; the final cohort comprised 31 and 24 patients in the surgery and non-surgery groups, respectively. The patients were evaluated by their performance status (PS), activities of daily living (ADL) and ambulatory status. Survival was evaluated by the Kaplan-Meier method. The PS, ADL and ambulation were significantly improved in the surgery group compared to non-surgery group. The median survival was significantly longer in the surgery group (5.17 months, 95% confidence interval (CI) 3.27 to 7.07) than in the non-surgery group (2.23 months, 95% CI 2.03 to 2.43; p = 0.003). Furthermore, the patients with a better PS, ADL and ambulatory status had a significantly longer survival. Surgery improved the PS, ADL, ambulation and survival of patients with SSM. In the management of SSM, spine surgery is not only palliative but may also prolong survival.

Caregiving burden and social support in family caregivers of patients with cancer: A cross-sectional study

Introduction Providing care for patients by family caregivers causes in several consequences known as “Caregiving Burden”, which affects the caregiver's health and the whole family process, considered in holistic healthcare/nursing. This study aimed to evaluate the caregiving burden and social support in family caregivers of patients with cancer and their influencing factors in a local area in Iran. Methods In this cross-sectional study, 190 family members of patients with cancer were studied through convenient sampling method. Data were collected using demographic data sheet enriched with Karnofsky Performance Status Scale and Katz Index of Independence in Activities of Daily Living (ADL), and Zarit Burden Inventory and Medical Outcomes Social Support Survey questionnaires. Results The results indicated intermediate performance status and moderate independence in ADL in patients. The mean score of caregiving burden was 43.95 ± 17.48 which indicates moderate to severe burden. The average social support in the caregivers was 60.25 ± 23.81% which shows above the average social support. Both performance status and dependence in ADL of patient had statistically significant effect on the caregiving burden in caregivers. Also a statistically significant negative relationship was observed between caregiving burden and social support in primary family caregivers of patients with cancer. Discussion Considering the increasing importance of primary care provided by families, developing strategies for providing caregiver's needs through family care in cancer nursing is essential. So supporting caregivers through family nursing in holistic healthcare by providing social support, can play a significant role in reducing caregiving burden in healthcare services considering the qualified holistic healthcare/nursing.

Association of frailty and functional recovery in an Acute Care for Elders unit: a prospective observational study

BackgroundEvidence on the effects of Acute Care for Elders (ACE) units in frail older adults remains limited. Therefore, we aimed to evaluate the effects of the ACE unit on functional outcomes in frail older adults.MethodsIn this prospective observational study, we enrolled 114 consecutive patients aged 65 years and older admitted to the ACE unit for acute medical conditions between October 2019 and September 2020. The FRAIL scale (5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) was used to classify the patients into three groups: robust (score = 0, n = 28), prefrail (score = 1–2, n = 57), and frail (score = 3–5, n = 29). The primary outcome was the activities of daily living (ADL) measured by the Barthel Index at admission and before discharge. Paired sample t-test was employed to determine the difference in ADL. Multiple linear regression analysis, with adjustment for covariates, was conducted to examine the association between frailty status and change in ADL.ResultsAmong 114 patients enrolled (mean age, 79.8 ± 8.1 years; mean length of stay, 6.4 ± 5.6 days), 77 (67.5%) were female. ADL at admission (60.3 ± 31.9) and before discharge (83.7 ± 21.6) were significantly different (P < 0.001). After covariates adjustment, a significant association between frailty status and change in ADL was found (prefrail vs. robust: β = 9.0, 95% confidence interval [CI] 0.3–17.6, P = 0.04; frail vs. robust: β = 13.4, 95% CI 2.7–24.0, P = 0.01).ConclusionsOlder adults with frailty experienced functional improvement after admission to the ACE unit. Prefrail and frail groups were associated with a more significant change in ADL between admission and discharge compared to the robust group.

Association between dietary hardness score and activities of daily living among individuals aged 90 years.

ObjectivesWith the rapidly aging world population, Japan has many older people with difficulties in maintaining oral health. This study aimed to investigate the relationship between dietary hardness score and performance of activities of daily living (ADL) of 90‐year‐old individuals in rural areas of Japan.Material and MethodsA total of 236 individuals (64 men and 172 women) aged 90 years in Mitsugi town, Hiroshima, Japan, were included. Assessment of oral status and survey of ADL were performed. The association of ADL with dietary hardness score and the number of remaining teeth was determined.ResultsThe mean dietary hardness score was 8.3 ± 2.6. Eighty individuals showed independence in ADL, whereas 156 individuals showed dependence. Logistic regression analysis, adjusted for potential confounding factors, showed that dietary hardness score was associated with ADL status but not the number of remaining teeth.ConclusionOur findings suggest that a low dietary hardness score is associated with dependence on ADL in 90‐year‐old individuals.