Association of frailty with cognitive functioning in older adults: The Chain-mediated effects of sleep and mood regulation and the moderating role of activities of daily living.

Activities of daily living, physical activity, and care situation in chronic critical illness survivors one year after disease onset: A prospective cohort study.

Current status and factors influencing analysis on readiness of hospital discharge among elderly patients following hip and knee arthroplasty under the concept of enhanced recovery after surgery: A cross-sectional study.

A cross-sectional study of caregiving tasks and mental health outcomes among diverse family dementia caregivers.

To assess how key risk factors contribute to differences in low patient activation between dual-eligible and Medicare-only beneficiaries and to examine whether these contributions vary by disability status or age-informing more equitable engagement strategies. This observational study used nationally representative data from the 2019-2022 Medicare Current Beneficiary Survey. Survey-weighted descriptive statistics assessed variation in risk factors between dual-eligible and Medicare-only beneficiaries. Survey-weighted logistic regression models with state, year, state, and regional fixed effects estimated associations between individual risk factors and low patient activation, defined as limited knowledge, skills, and confidence to manage one's health. Marginal effects were reported. The Fairlie decomposition method quantified the extent to which specific factors (e.g., spoken English proficiency, education, vision impairment) explained differences in low patient activation. Subgroup analyses examined whether these explanatory factors differed by age and disability status. The analytic sample included 23,805 community-dwelling, continuously enrolled Medicare beneficiaries, representing 39,591 unweighted beneficiary-years. Among 189,843,094 weighted beneficiary-years, 14.4% were dual-eligible and 85.6% were Medicare-only. Low patient activation was more prevalent among dual-eligible (42.5%) than Medicare-only beneficiaries (32.1%). Among older beneficiaries, differences in activation were explained by limited English proficiency, poor perceived health, psychological distress, vision impairment, and difficulties with activities of daily living (ADL). Among disabled beneficiaries, differences were primarily driven by the presence of an intellectual disability and instrumental ADL (iADL) difficulties. Low educational attainment contributed to differences across both subgroups. Different factors contribute to low patient activation among dual-eligible versus Medicare-only beneficiaries, with notable variation between older and disabled subgroups. These findings support the need for tailored engagement strategies and policy efforts focused on improving activation among high-need Medicare populations. Targeted interventions may help reduce activation gaps, promote equity, and improve health outcomes.

Introduction: Hemiplegic Cerebral Palsy (CP) significantly affects balance, functional abilities, daily activities, and overall quality of upper extremity skills. Virtual Reality (VR) can enhance the quality of life in children with CP by controlling training intensity and providing feedback to deliver customised treatment in a fun, safe, and engaging environment. Aim: To examine the effectiveness of VR on balance, functional abilities, daily activities, and the quality of upper limb skills in children with hemiplegic CP. Materials and Methods: A systematic search of Web of Science, Physiotherapy Evidence Database (PEDro), EBSCO, Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Excerpta Medica database (EMBASE) and ProQuest was conducted for articles published between March 2014 and September 2024. Randomised Controlled Trials (RCTs) were included if the sample comprised children with hemiplegic CP and reported outcomes related to balance, function, daily activities, and upper limb skills. Pre and postintervention mean differences, standard deviations, 95% Confidence Intervals (CI), and p-values were calculated, along with the difference between intervention and control groups after treatment. Random-effects models were used to interpret pooled effects based on improvements in balance, function, daily activities, and upper limb skill quality. Heterogeneity was assessed using the I2 statistic. Results: Fifteen randomised trials were included. Results revealed significant improvements in the VR groups compared to the control groups for balance (MD 4.84; 95% CI: 1.44-8.23; p<0.05), hand function (MD 2.05; 95% CI: 0.17-3.92; p=0.03), and upper extremity skill quality (MD 5.12; 95% CI: 3.50-6.74; p<0.05). However, no significant improvement was observed for Activities of Daily Living (ADL) (MD 0.86; 95% CI: -8.93 to 7.21; p=0.83). Conclusion: VR-based rehabilitation may improve balance, functional abilities, and upper extremity skill quality more effectively than conventional rehabilitation in children with CP. However, VR did not show a significant effect on activities of daily living.

Upper and lower trunk accelerometer-based metrics during gait as predictors of physical function in older adults.

Low intrinsic capacity, delirium, and urinary incontinence are associated with poor trajectories of activities of daily living in older patients after discharge.

Octopus arms: A phenomenological study on radiotherapy experiences of patients with lung cancer.

ABSTRACT Objective As neuropsychological tests insufficiently reflect impairments in activities of daily living (ADL), behavioral observation using Moss Attention Rating Scale (MARS) is necessary. Although MARS scores are associated with ADL independence, their longitudinal relationship remains unclear. This study aimed to investigate whether changes in MARS scores over time are associated with ADL independence in patients with mild-to-moderate acute stroke who could undergo neuropsychological tests. Methods This single-center, prospective longitudinal cohort study included 60 patients (median age: 73.5 years) hospitalized for acute stroke for ≥14 days. The median interval from stroke onset to initial evaluation was 3 days. The primary outcome was ADL independence, measured using the Barthel Index (BI) at 2 weeks. Results Multiple regression analysis identified MARS as a significant predictor of BI at 2 weeks. Neuropsychological tests revealed floor effects, whereas MARS did not. Receiver operating characteristic curves demonstrated strong discriminative ability of MARS for predicting BI ≥ 60 (area under the curve: 0.96 [baseline], 0.93 [1 week]). Conclusions MARS is more effective than conventional neuropsychological tests for assessing attention-related ADL independence, particularly in early stroke rehabilitation. Clinical trial registration UMIN000055922

The increasing prevalence of chronic diseases, functional decline, and cognitive impairments, together with the limitations of episodic clinical assessments, has created a critical need for automated and continuous monitoring of Activities of Daily Living (ADLs) to support timely intervention, personalized care, and independent living. This review systematically examines how ambient sensing, wearable devices, and fusion-based systems have been applied to ADL monitoring in home environments. We analyze 109 peer-reviewed studies published between 2013 and 2024, focusing on reported performance trends, study scale, sensing configurations, and methodological characteristics. Given the substantial heterogeneity across experimental settings, participant populations, activity definitions, and evaluation protocols, reported metrics are interpreted descriptively rather than as directly comparable measures. Overall, wearable-based systems frequently report higher performance metrics in controlled settings, ambient systems offer advantages related to privacy and unobtrusiveness, and fusion-based approaches provide richer contextual information but face scalability challenges. Across all modalities, limited dataset diversity, small sample sizes, inconsistent evaluation practices, and insufficient reporting of real-world deployments remain persistent gaps. This review synthesizes recent advances in sensor-based activity recognition for monitoring activities of daily living, with a particular emphasis on AI-driven approaches.

To gain a comprehensive understanding of participation, particularly the construct 'involvement', in daily life activities from the perspective of children and young people with childhood-onset disabilities. We conducted a scoping review of literature from PubMed, CINAHL, and PsycINFO. We included articles if they examined the experiences of involvement in activities from the perspective of children and young people with childhood-onset disabilities, used qualitative methods, and were published in peer-reviewed journals after 2001. Data (e.g. age, narratives on involvement) from included studies were extracted, mapped, and thematically synthesized. Of 5241 articles, 30 met the inclusion criteria. We identified six concepts representing the experience of involvement in activities from the perspective of children and young people with childhood-onset disabilities. One concept reflected a continuum of inner dedication or investment in activities, ranging from non-involvement to involvement overload, which can be understood as the in-the-moment experience of involvement, representing the core of the involvement experience. Five additional ideas captured how children and young people process, interpret, and reflect on their experiences of involvement. Results can inform paediatric rehabilitation measures and interventions focused on involvement. Future research should explore children and young people's involvement in undesirable activities and whether the concepts of involvement vary by context (e.g. country, activity setting) and personal factors (e.g. age, type of disability).

Nipocalimab, efgartigimod, and rozanolixizumab (the last two cyclically dosed) are approved neonatal Fc receptor (FcRn) blockers for treating generalized myasthenia gravis (gMG). No trials have directly compared these therapies; hence, indirect treatment comparisons (ITCs) were conducted to evaluate their relative efficacy. Matching-adjusted indirect comparisons (MAICs) and Bucher ITCs were used to compare nipocalimab vs. efgartigimod and rozanolixizumab for changes from baseline (CFB) in Myasthenia Gravis Activities of Daily Living (MG-ADL) total score observed in their phase3 registration trials. Bucher ITCs used the relative treatment effect vs. placebo. As there was considerable cross-trial heterogeneity, including uncertainty in using the placebo arm as a common comparator, active treatment arms were used in unanchored MAICs. MG-ADL CFB was compared between trials (1) at multiple timepoints to evaluate onset of action and disease control over time, and (2) using area under the curve (AUC) as a measure of cumulative effect normalized per week of follow-up. In both Bucher ITCs and MAICs, nipocalimab had a comparable MG-ADL CFB at week1 vs. the other FcRn blockers. In MAICs, MG-ADL CFB was significantly greater with nipocalimab vs. efgartigimod at week8 sustained up to 24weeks (p < 0.05), and vs. rozanolixizumab at week10 sustained up to 14weeks (p < 0.05); results numerically favored nipocalimab in corresponding Bucher ITCs. Using normalized AUC, MG-ADL CFB with nipocalimab was significantly greater in MAICs (p < 0.05) and numerically greater in Bucher ITCs vs. the other FcRn blockers. Sustained disease control is an important consideration in managing chronic diseases with fluctuating symptoms such as gMG. Study results showed that nipocalimab provided a comparable onset of action and consistent and sustained disease control that was numerically or statistically significantly greater (depending on ITC method) when compared with the symptom-based cyclic FcRn blockers efgartigimod and rozanolixizumab.

Introduction: Geriatric syndromes are important clinical conditions that are common in elderly individuals, usually occur as a result of the interaction of more than one system, and negatively affect elderly health. Early identification of risk factors associated with these syndromes and timely implementation of appropriate interventions may contribute to the prevention of future health problems. Fear of falling is a significant risk factor that affects the quality of life in older adults both directly and indirectly. In this study, we aimed to evaluate the distribution of geriatric syndromes by gender and their association with fear of falling.Methods: This study was conducted by retrospectively analyzing the data of comprehensive geriatric assessment performed by a geriatrician in individuals aged 65 years and older who applied to the geriatric outpatient clinic of a tertiary hospital between June 2023 and August 2024. Demographic characteristics of the participants [age, sex, education level (≤5 years, &amp;gt;5 years), and living alone status], comorbidities, and geriatric syndromes were recorded. Within the scope of geriatric syndromes, the following were assessed: functional status [activities of daily living (ADL) and instrumental activities of daily living (IADL)], frailty, sarcopenia, nutritional status, depressive symptoms, cognitive function, sleep disorders, urinary incontinence, history of falls, fear of falling, and polypharmacy.Participants were divided into two groups based on the presence of fear of falling, and logistic regression analysis was performed to identify factors independently associated with fear of falling.Results: A total of 294 patients were included in the study (68.4% female; mean age 76.14 ± 6.77 years). Among the geriatric syndromes, dependence in instrumental activities of daily living (IADL), frailty, sarcopenia, cognitive impairment, urinary incontinence, and fear of falling were more frequently observed in women (p=0.032, 0.030, 0.014, 0.020, 0.011, and 0.034, respectively), while nutritional problems were more prevalent in men (p=0.031).The prevalence of fear of falling was found to be 46.6%. Fear of falling was significantly associated with dependence on basic and instrumental activities of daily living (ADL/IADL), frailty, sarcopenia, depression, urinary incontinence, and history of falls. Age, frailty, history of falls, and depression were identified as independent predictors of fear of falling (p&amp;lt;0.001, 0.016, &amp;lt;0.001, and 0.001, respectively).Conclusion: The fact that certain geriatric syndromes are more commonly seen in women may suggest that greater attention should be given to the health needs of older women. Early recognition of modifiable risk factors, such as fear of falling, may contribute to the prevention of frailty and depression. Screening and proper management of this risk factor, especially in primary healthcare settings frequently accessed by older adults, can significantly contribute to improving their quality of life. Prospective multicenter studies are needed to establish causality.

Background: Generalized myasthenia gravis (gMG) severely impacts activities of daily living. Productivity losses and the need for care can impact household finances and consequently government public accounts. This study adopts a governmental perspective framework to assess the fiscal consequences of treating gMG that is inadequately controlled by standard therapy, beyond healthcare costs. Savings in tax revenue loss and benefit payments are considered. Objectives: To value the fiscal consequences of treating adults with acetylcholine receptor–antibody positive (AChR-Ab+) gMG with efgartigimod vs current treatments. The lifetime impact on people living with gMG and their caregivers is considered from the perspective of Canada’s public accounts. Methods: A lifetime Markov cohort simulation following adults with gMG according to their Activities of Daily Living (MG-ADL) score was linked to labor and fiscal stages of both patients and care- givers. Based on the MyRealWorld MG study, MG-ADL scores defined the labor market characteristics of both individuals with gMG and their caregivers. National statistics data on sex- and age-specific labor outcomes were used to model patients with minimal symptoms. Benefit payments and tax revenue losses attributable to gMG were estimated and valued according to national official sources. Public healthcare costs were included. The difference between efgartigimod and current treatments was assessed by discounted lifetime incremental fiscal consequences. Sensitivity analyses were applied to the fiscal parameters. Results: Without active treatments, the lifetime fiscal burden associated with individuals with gMG and their caregivers was estimated at CAD$1.24 million in government expenditures. Compared with the current weighted bundle of treatments in Canada, efgartigimod was estimated to save CAD$458 754 per treated adult. Results were sensitive to the distribution of the bundle of treatments. Discussion: Beyond healthcare costs, gMG severely impacts productivity and governmental accounts. Decision-makers should be provided evidence of fiscal consequences when assessing healthcare technologies. The public sector in Canada was estimated to have a return of CAD$1.58 per every CAD$1 spent on efgartigimod for people with gMG compared with the current bundle of treatments. Conclusions: Improving health outcomes and reducing the need for informal caregivers benefits those affected by gMG and governmental accounts.

Activities of daily living (ADL) are an important outcome of surgery for elderly patients. As life expectancy increases, interest in minimally invasive surgery (MIS) is increasing. However, there is limited evidence regarding the effect of MIS on ADL, especially in the very elderly patients (≥ 80years). A total of 1009 consecutive patients (80-99years) undergoing elective surgery for gastrointestinal and hepatobiliary-pancreatic tumors between 2010 and 2025 were enrolled. Propensity score matching (PSM, 1:1) was performed in 869 patients after excluding those with benign tumors or missing data. A comparison was made between MIS (laparoscopic/robotic, n = 284) and open surgery (n = 284). The primary outcome was postoperative ADL decline. Severe postoperative ADL decline was defined as a decline of ≥ 30 points in the Barthel Index total score. Postoperative ADL decline was observed in 128 patients (14.7%) in the entire cohort. After PSM, postoperative ADL decline occurred in 17.3% and 19.4% of patients in the open and MIS groups, respectively (P = 0.59). Severe postoperative ADL decline was lower in the MIS than in the open groups (5.7% vs. 9.5%, P = 0.11). The 90-day readmission rate was also lower in the MIS groups (16.6% vs. 22.3%, P = 0.11). Intraoperative blood loss, ICU and hospital length of stay, and severe postoperative complications were significantly better in the MIS group. In high-risk or frail subgroups, such as those with poor performance status, care needs, and severe complications, MIS consistently demonstrated lower rates of severe postoperative ADL decline compared with open surgery. Compared with open surgery, MIS reduced the incidence of severe postoperative ADL decline and 90-day readmission. Subgroup analysis indicated that this trend was strongest in high-risk or frail patients. These results suggest that MIS may help maintain postoperative independence and prevent functional frailty in the very elderly patients.

The increasing number of older adults and longer life expectancy have led to various health challenges, including cognitive decline. Mild Cognitive Impairment (MCI) is a condition that occurs in the transitional stage between normal aging and dementia. It is characterized by decreased memory, attention, language, visuospatial ability, and executive function, although it does not yet significantly disrupt basic daily activities. However, this condition can influence the independence of older adults in performing Activities of Daily Living (ADL), particularly instrumental activities that require higher cognitive abilities such as managing finances, shopping, preparing meals, and using transportation. If cognitive decline is not properly managed, it may increase dependency, raise the risk of injury, and reduce the quality of life of older adults. This study aimed to analyze the relationship between Mild Cognitive Impairment and Activities of Daily Living among older adults at Posyandu Dewi Sartika Cokrobedog. The research applied a quantitative cross-sectional design with a sample of 93 older adults selected using purposive sampling. Cognitive function was assessed using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina), while daily functional ability was measured using the Lawton Instrumental Activities of Daily Living (IADL) scale. Data were analyzed using the Shapiro–Wilk normality test and Spearman Rank correlation. The results showed a significant relationship between Mild Cognitive Impairment and ADL independence (p &lt; 0.05) with a moderate correlation, indicating that better cognitive function is associated with greater independence in daily activities.

Abstract Neurological and musculoskeletal diseases have seriously impacted the quality of people’s lives. Various types of exoskeleton robots have been introduced to address this challenge in recent years. In this study, a lightweight and wearable underactuated cable-driven soft robotic intention-controlled glove exoskeleton (SRIG-Exo) is developed for assistance and rehabilitation training of individuals with injuries and disorders. The device comprises a soft robotic glove, a detachable cable connector, an underactuated linear actuator, and an active intention-controlled algorithm technique. The SRIG glove is equipped with tactile and flex sensors, along with tendons routed to facilitate finger movements. The detachable cable connector connects the glove with the actuator unit. The design of the linear actuator incorporates the threaded rod and nut mechanism to exert tension on the tendons. The intent signal from the glove sensors is utilized to activate the motor for opening and closing the hand, enabling active-controlled assistance and rehabilitation. This integration enhances the functionality and rehabilitation capabilities of the device. The constraints include the fingers having one degree of freedom (DoF), the control system requiring partial finger movement, and the wearer’s strength capability for normal device usage. The SRIG-Exo can support a maximum cable displacement range of 10 cm with a maximum grasping force of 30 N. Socially, this SRIG-Exo may improve independence in activities of daily living (ADLs), such as eating and drinking, for individuals with weakened strength and hand disorders, offering significant social and economic benefits.

The global rise of the oldest-old (≥80 years) presents a critical challenge to healthcare systems. To evaluate 10-year changes in healthy life expectancy (HLE) among this population in China, assessing trends in morbidity compression and expansion by socioeconomic status (SES) and sex. We analyzed two community-based cohorts (1998-2008, n = 7160; 2008-2018, n = 7945) from the Chinese Longitudinal Healthy Longevity Survey. Using a Markov multi-state model, we estimated HLE at age 80 across four health dimensions: physical performance, activities of daily living (ADL), cognitive function, and self-perceived health (SPH). SES was assessed by education background, financial status, and occupation. Women consistently lived longer but with more unhealthy years. Between the two decades, we observed a compression of cognitive impairment across most SES and sex groups. Conversely, an expansion of poor SPH was observed across different SES and sex groups. Trends in physical performance and ADL disability were more heterogeneous, varying significantly by sex and SES, with socioeconomically advantaged groups and women generally experiencing better health spans. Extended lifespan in China's oldest-old over the past two decades coincides with improved cognitive health but an expansion of morbidity in other domains. These findings underscore the need for sex-specific and SES-tailored strategies to address the growing long-term care needs of this population.

Parkinson's disease (PD) is the fastest-growing neurodegenerative disease affecting 90 thousand new Americans each year. PD includes motor and non-motor symptoms, resulting in progressive disability and difficulty in completing activities of daily living. Freezing of Gait (FoG) is one of the common disabling symptoms of PD, characterized by difficulties in initiating walking, resulting in gait abnormalities and increased risk of falling (RoF) and fear of falling (FoF). Clinical management of FoG is difficult as it is minimally responsive to both pharmacological and surgical interventions. In fact, these interventions can paradoxically worsen of FoG. Additionally, PD patients with FoG have reported worse health-related quality of life (HR-QoL) due to limitations in mobility, activities of daily living (ADL), bodily discomfort, stigma, and social isolation. Despite its increasing treatment and management of FoG is difficult due to its paroxysmal and heterogeneous nature. Therefore, there is a growing need for effective, evidence-based management and intervention approaches for FoG. Some current techniques used to manage FoG are physical therapy, exercise, gait training, and balance training; however, due to a lack of patient adherence, accessibility concerns, and the need for continuous supervision and individualized feedback, the long-term effectiveness of these interventions remains limited and challenging to achieve in real-world settings. A new promising avenue for managing PD is the use of wearable technology, which can provide audiovisual, via augmented and virtual reality (AR/VR), and tactical cueing to offset FoG, thereby enhancing independence in PD patients. In this comprehensive review, we will provide an overview of the symptoms, monitoring, and treatment of PD, with a focus on the neuroanatomy and treatment of FoG. We will review and critique the extant literature on the use of AR/VR technology in the management of FoG. Finally, the challenges and risks associated with wearable technology in FoG management will also be identified.