Independence In Activities Of Daily Living Research Articles

Investigation of neurogenic dysphagia in commonly seen neurological diseases

Neurological disorders lead to varying degrees of impairment in the functions of vital swallowing structures, such as the cortex, cerebellum, brainstem, cranial nerves, and muscles. Neurogenic dysphagia is observed in approximately 50% of common neurological disorders such as stroke, multiple sclerosis, and Parkinson’s disease. Although the pathophysiology and course of the disease vary, dysphagia may occur at any stage of swallowing, including oral preparation, oral, pharyngeal, and esophageal phases. Neurogenic dysphagia ranks among the top symptoms that restrict patients’ independence in daily life activities, reduce their quality of life and increase morbidity and mortality rates. Despite being a prevalent and highly impactful symptom among patients, neurogenic dysphagia can go unnoticed among the multiple symptoms experienced by neurological disorders due to their nature. It is important to be aware of disease-specific risk factors for the early detection of neurogenic dysphagia. Overlooked dysphagia can lead to complications such as aspiration pneumonia, dehydration, malnutrition, and weight loss. Among these complications, aspiration pneumonia is the most common, requiring attention due to its recurrent hospitalizations, inpatient treatment, and high healthcare costs. Many patients exhibit common neurogenic dysphagia symptoms such as drinking liquids in small sips, cutting solid foods into small pieces, decreased appetite, and prolonged meal times. The aim of this study is to examine various aspects of neurogenic dysphagia in different neurological disorders, including its etiology, risk factors, symptoms, and prevalence.

Do Older Mexican Americans With Dementia Benefit From Living Closer to the Border? Evidence From the HEPESE

This paper explores disparities in health outcomes among Hispanic older adults living near the United States (U.S.)-Mexico border. Hispanic older adults face significant barriers to healthcare access, stemming from multiple factors: limited income, high medical costs, elevated rates of chronic disease and dementia, and greater reliance on public insurance programs, relative to other racial, ethnic, and age groups. Likewise, Hispanic older adults diagnosed with dementia near the U.S.-Mexico border face documented barriers to healthcare, including higher costs, fewer adult day care centers, and a lack of health insurance. We use a health disparities and dementia care conceptual framework to explore the interactions of these social determinants of health for the older Hispanic American population. Using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, waves 8–9, 2012–2013 and 2016), complemented by the American Community Survey (ACS, 2011–2022), we conduct descriptive and regression model analyses to explore the relationship between living in U.S. counties and states that border Mexico and health outcomes such as mobility difficulties, self-care, self-reported health, and issues with activities of daily living (ADL) and instrumental activities of daily living (iADL). We control for demographic, health, and social support characteristics to account for individual level differences. We also examine how proximity to the border and caregiver and community resources affect outcomes for Mexican American older adults aged 80 and older—a growing demographic with limited data and a higher risk of health disparities. Our findings show that Hispanic older adults who reside closer to the border rely more on caregivers for instrumental and emotional support, report worse self-reported health, experience more difficulty paying bills, report lower independence in both ADL and iADL measures, and face an increased risk of dementia diagnosis, relative to their counterparts further from the border. Our findings suggest the urgency for better policies to address the needs of older Hispanic Americans with dementia in the border region. These policies require a focus on primary care, benefits counseling, and assistance in locating and accessing community services. The long-term focus should be to support flexible caregiving arrangements that increase the autonomy of both the care recipient and caregiver, community support, culturally competent caregiving, infrastructural improvements, and in-home support services for families coping with a dementia patient.

Association Between Sarcopenic Obesity and Activities of Daily Living in Individuals with Spinal Cord Injury.

Background/Objectives: Sarcopenic obesity adversely affects physical function and activities of daily living (ADL) in older individuals and patients undergoing rehabilitation. This condition is also common in individuals with spinal cord injury (SCI); however, its relationship with ADL in this group remains unclear. Hence, this study examined the association between sarcopenic obesity and ADL in individuals with SCI. Methods: This retrospective cross-sectional study identified sarcopenia using the low skeletal muscle mass index (SMI) and Asian Working Group for Sarcopenia reference values. Obesity was defined as a body fat percentage (%BF) exceeding 25% in men and 35% in women. Sarcopenic obesity was identified when both the sarcopenia and obesity criteria were met. The primary outcome, ADL, was measured using the Functional Independence Measure (FIM). Multiple linear regression models were used to analyze the associations among the SMI, %BF, and FIM scores, after adjusting for age, sex, lesion level, injury severity, comorbidities, and injury duration. Results: Of 82 participants (median age: 63.5 years; 18.3% women), 62.2% had sarcopenic obesity. Participants with sarcopenic obesity (54 vs. 69 points, p = 0.006) had significantly lower FIM motor scores than those without this condition. Multiple linear regression analysis revealed that SMI (β = 0.416, p < 0.001) and %BF (β = -0.325, p = 0.009) were independently associated with the FIM motor scores. Conclusions: Decreased SMI and increased %BF in patients with SCI were independently associated with decreased ADL independence. Routine body composition assessments are necessary for early detection and intervention in this population.

‘Can do’ versus ‘Do do’ in nursing home residents: identification of contextual factors discriminating groups with aligned or misaligned physical activity and physical capacity

BackgroundPhysical activity (PA) is fundamental to nursing home residents’ health. Likewise, physical capacity (PC) is essential to carry out activities of daily living. Although PC and PA are associated, misalignment has been reported in specific subgroups. Increased PC is oftentimes not linked to high PA (i.e., Can do - don’t do) and vice versa (i.e., Can’t do - do do). Therefore, identifying other contextual factors influencing PA in misaligned groups is important. This study aimed to identify contextual factors in nursing home residents with aligned or misaligned PA and PC.MethodsIn total, 180 nursing home residents (≥ 65 years, 79.4% females) were divided into four quadrants (Q1: Can do - do do; Q2: Can do - don’t do; Q3: Can’t do - do do; Q4: Can’t do - don’t do) based on thresholds for PA (≥ or < 2,500 steps/day) and PC (≤ or > 0.5 m/s gait speed). Kruskal-Wallis H test and effect sizes (ES) were applied to analyze quadrants’ differences regarding PA (steps per day), objective motor capacity, life-space mobility, activities of daily living (ADL), psychosocial well-being, cognition, subjective mobility-related concerns, and spatial orientation.ResultsSpecific contextual factors differed significantly between the groups. Compared to Q1, Q2 presents a significantly lower life-space mobility (ES: 0.35) and objective motor capacity (ES: 0-36-0.49); Q3 has a lower objective motor capacity (ES: 0.55–1.10); Q4 shows lower independence in ADL (ES: 0.57), life-space mobility (ES: 0.48), subjective mobility-related concerns (ES: 0.38) and objective motor capacity (ES: 0.99–1.08). No significant group differences were found for psychosocial well-being, cognition, and spatial orientation.ConclusionsThis study provides new insights into PA behavior of nursing home residents. Key variables linked to PA are objective motor capacity, life-space mobility, ADL, and subjective mobility-related concerns. Surprisingly, some potentially impactful variables such as cognition, orientation, and psychosocial well-being did not differ between the groups. This may suggest that these variables may not represent key targets for interventions aiming to improve PA. This study builds the foundation for further research into the underlying mechanisms behind PA behaviors and supports future efforts to plan specific, targeted interventions for nursing home residents.Trial registrationThe trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020.

Correlation Between Reduced Daily Living Competence and the Risk of Postoperative Delirium in Orthopedics and Trauma Surgery.

Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This study aimed to investigate the potential role of preoperative mobility as a risk factor for the development of postoperative delirium. Methods: To assess preoperative mobility, a comprehensive geriatric evaluation of daily living competence was conducted. This included the Katz Index of Independence in ADL, which assessed basic daily activities over the preceding 14 days, and the Instrumental Activities of Daily Living Scale (IADL). Postoperatively, delirium monitoring was performed twice daily for seven days using validated delirium screening tools, including the Nursing Delirium Screening Scale, the Confusion Assessment Method, and the 4ATest. Results: A significant correlation was observed between the incidence of delirium and the IADL scores in all patients, with p < 0.001 for men and p = 0.001 for women. Among emergency patients, the Katz Index scores significantly differed between those who developed delirium and those who did not (p = 0.015). Additionally, a significant correlation was found between the Katz Index and the incidence of delirium in both groups (p < 0.001). Conclusions: The findings of this study emphasize the necessity of preoperative geriatric assessment using tools such as the Katz Index or IADL to identify patients at risk of delirium. The results confirm the importance of enhanced postoperative monitoring for potential delirium. For elective patients, prehabilitation should be considered when reduced daily living competence is identified. For emergency patients, immediate postoperative interventions, including intensive mobilization and orthogeriatric co-management, are recommended.

ADL ACTIVITY OF DAILY LIVING DAN KUALITAS HIDUP PASIEN PASCA STROKE ISKEMIK

Ischemic stroke, also referred to as non-hemorrhagic stroke, results in the death of brain tissue due to impaired blood flow, primarily caused by blockages in the cerebral or cervical arteries and, less commonly, in the cerebral veins. This condition profoundly affects various aspects of an individual's life, including physical, emotional, psychological, cognitive, and social well-being. Following a stroke, many individuals experience reduced independence and mobility, which significantly detracts from their quality of life. Often, they face self-care deficits and require assistance to gradually regain the ability to perform activities of daily living (ADL) independently. This study aims to elucidate the strong relationship between ADL independence and the quality of life of post-ischemic stroke patients at Abdul Aziz Hospital in Singkawang City. Employing an analytic observational design with a cross-sectional approach, the research involved a sample of 60 respondents selected from the Neurology Polyclinic at RSUD dr. Abdul Aziz through purposive sampling. Data analysis was conducted using the Spearman Rank test with a 95% confidence level. The results indicate a significant relationship between ADL independence and the quality of life of these patients, as demonstrated by a p-value of 0.000 (p &lt; α) and a correlation strength of 0.514, categorized as moderate (0.40 – 0.599). These findings highlight that the level of independence in activities of daily living is intrinsically linked to the quality of life for post-ischemic stroke patients.

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

Neuropsychological outcomes following endovascular clot retrieval and intravenous thrombolysis in ischemic stroke.

Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management. Patients were recruited after acute treatment and invited to participate in an outcome assessment 90-120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group. Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20-86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups. Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

Analysis of the Recovery Process and Activities of Daily Living Independence in Pusher Behavior and Unilateral Spatial Neglect

ObjectiveTo investigate the recovery processes of pusher behavior (PB) and unilateral spatial neglect (USN) based on the severity of PB and USN, and to determine the relationship between activities of daily living (ADL) independence levels. DesignThis retrospective study aimed to examine the temporal changes and their association with ADL independence levels based on the severity of PB and USN. SettingRecovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022. ParticipantsWe included all patients with cerebrovascular disease admitted to the recovery ward of Moriyama Neurological Center Hospital between March 2017 and October 2022. A total of 174 patients with PB and USN were classified into 4 groups as follows: severe PB and severe USN (Group A), severe PB and mild USN (Group B), mild PB and severe USN (Group C), and mild PB and mild USN (Group D). InterventionsNot applicable. Main Outcome MeasuresKaplan-Meier survival analysis was used to determine whether the time to recovery from PB or USN (SCP: ≤1.75 points; Catherine Bergego Scale: 0 points) differed between groups. In addition, group differences in functional independence measure (FIM) scores and efficiencies were examined. ResultsThere were significant differences among Groups A and B, and Groups A and C, as determined by the log-rank test (P<.05), and recovery was prolonged when both PB and USN were severely impaired. Similarly, FIM scores and efficiencies were lower in Group A (P<.05). When PB and USN were severely impaired, ADL was adversely affected, and the recovery process was prolonged. In addition, when 1 of the 2 symptoms was severe and the other was mild, each recovery course tended to show improvement, suggesting that they exerted a mutual influence on each other. ConclusionsThese findings indicate that severity classification may help to determine functional prognosis in patients with PB and USN.

Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures.

Non-surgical treatment without weight-bearing restriction, even in the early post-injury phase, may have a favourable effect on the activities of daily living (ADLs) in elderly patients with peri-prosthetic femoral fractures (PFFs). This study aimed to assess the effectiveness of surgical and non-surgical treatments for PFFs in terms of ADL maintenance and clinical safety. This retrospective cohort study included 44 patients with PFFs proximal to the stem fixation site without stem loosening. Rehabilitation with weight bearing was initiated after internal fixation of the fracture site in the surgical group (n = 12) and immediately after the injury in the non-surgical group (n = 32). Clinical and radiological outcomes, including time until the first weight-bearing exercise, time until independent walking, ADL deterioration, and bone union rate, were compared between groups. Independent risk factors for ADL deterioration were also evaluated. The time until first weight-bearing exercise was shorter and the ADL deterioration rate was smaller in the non-surgical group than in the surgical group (8.8 ± 9.2 vs. 21 ± 13 days, P = 0.004; 6.2% vs. 12.5%, P = 0.04, respectively). Bone union rates were similar between groups (91% vs. 83%, P = 0.42), and aseptic loosening of the stem was not observed. Time until first weight-bearing exercise was identified as an independent risk factor for ADL deterioration (odds ratio, 1.13; 95% confidence interval, 1.01-1.26; P = 0.03). Non-surgical treatment of PFFs proximal to the stem fixation site without stem loosening, which does not restrict early weight-bearing exercise after injury, is an effective and safe treatment procedure that maintains ADL performance in elderly patients.

The effects of cognition and visual perception on activities daily living in the elderly

This study aimed to investigate the influence of cognition and visual perception on activities of daily living (ADL) among community-dwelling elderly individuals. Cognition was assessed using the Korean version of Montreal Cognitive Assessment, visual perception was assessed using the Motor Free Visual Perception Test -3, and ADL were assessed using the Modified Barthel Index. The results indicated that cognition, visual perception, and ADL were all positively correlated. Additionally, both cognition and visual perception were found to impact the ADL in the elderly. This study provides evidence that can be used to develop welfare and rehabilitation programs for the elderly, focusing on managing cognitive and visual perception abilities to support independent ADL and enhance quality of life.

Self-reported health, function, and use of health care services in older prostate cancer survivors compared to matched controls: a cross-sectional study.

Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls. A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70years 2 to 7years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models. The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls. Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls. This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

The effect of family-supportive therapy on the burden of caregivers and Activities of Daily Living among stroke patients

The role of family members in providing care for stroke patients at home is associated with heightened stress and burden on caregivers. Therefore, this study aimed to analyze the effect of family-supportive therapy on the burden of caregivers and Activities of Daily Living (ADL) among stroke patients.A quasi-experimental method was used with a pre-test and post-test control group. The intervention of family-supportive therapy was given to the treatment group, while the control group received home visits. Samples of 40 caregivers in two primary health care centers in Surabaya were recruited using a multi-stage sampling method. The variables were the burden of caregivers and ADL of stroke patients, while Zarit Burden's Interview Schedule and Katz Index of Independence in ADL were used as instruments. Data analysis was carried out using a Paired t-test and a Manova test.The results showed that the burden of caregivers in the treatment group decreased, but there was a re-increase after 2 weeks of therapy, and the burden in the control group also decreased. ADL of stroke patients in the treatment group increased and tended to persist up to 2 weeks after therapy, while the value in the control group decreased. Furthermore, family-supportive therapy did not have a significant effect on the burden of caregivers (p-value 0.12) and ADL (p-value 0.21). To address this challenge, modifying services through the implementation of community health programs, individual health efforts for stroke patients in the hospital and at home, group services for families providing primary health care, and home visits could be a comprehensive effort.The study found that family-supportive therapy and health education through home visits reduced caregiver burden.

Improvements in activities of daily living among patients with brain tumors are associated with age, baseline physical function, duration of rehabilitation, and tumor recurrence but not type.

Genetic testing has improved the accuracy of diagnosis of brain tumors, and treatment is now tailored to the type of brain tumor. In contrast, the factors that influence the improvement in independence in activities of daily living (ADLs) following rehabilitation have not been clarified, particularly the role of tumor type. In this retrospective cohort study of 358 participants, we analyzed changes in the Functional Independence Measure (FIM) from pre-rehabilitation to post-rehabilitation provided in an acute care hospital. Multiple regression was used to determine whether FIM gain is associated with age, gender, preadmission Karnofsky Performance Status (KPS), number of rehabilitation days, average duration of daily therapy (min/day), and tumor recurrence and type (WHO grade 1, 2, 3, and 4 gliomas; primary central nervous system lymphomas; and metastatic brain tumors). The results showed that older age ( β -0.183), tumor recurrence ( β -0.137), preadmission KPS < 80 ( β -0.180), and higher baseline total FIM score ( β -0.470) were associated with lower FIM gain whereas the average duration of daily therapy ( β 0.153) was associated with higher FIM gain. Brain tumor type was not associated with FIM gain. Improved independence in ADLs is more influenced by demographic, functional status, and treatment factors than differences in brain tumor type.

Coexistence of low body mass index and poor oral health negatively affects activities of daily living, swallowing, and cognition after stroke.

Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post-stroke older patients. A retrospective cohort study was conducted on 708 hospitalized post-stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure-motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure-cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest. The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023-0.718), worse swallowing level (B = -0.878, 95% CI -1.280 to -0.476), and poorer cognitive status (B = -1.872, 95% CI -2.960 to -0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone. The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 24: 1045-1052.

Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson's disease in Singapore.

Subthalamic nucleus deep brain stimulation (STN-DBS) is a proven treatment modality for Parkinson's disease (PD), reducing dyskinesia and time spent in the "OFF" state. This study evaluates the long-term outcomes of STN-DBS in PD patients up to 10 years post-surgery in Singapore. We conducted a retrospective review of Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scores, activities of daily living (ADLs), disease milestones, dopaminergic drug prescriptions, and adverse events in patients before and after STN-DBS surgery. A total of 94 PD patients who underwent bilateral STN-DBS were included. STN-DBS reduced time in the "OFF" state by 36.9% at 1 year (P=0.034) and 40.9% at 5 years (P=0.006). Time with dyskinesia did not significantly change. Levodopa equivalent daily dose was reduced by 35.1% by 5 years (P<0.001). MDS-UPDRS-II and III scores increased from 5 years post-DBS by 40.5% and 35.4%, respectively. Independence in ADLs decreased, though not significantly. The prevalence of frequent falls increased at 5 years. Surgery- and device-related adverse events were uncommon and generally mild. STN-DBS provides sustained relief from motor complications and reduced medication requirements in PD patients in Singapore. This study highlights STN-DBS as an effective treatment option, significantly enhancing the quality of life for those with PD.

Long-term outcomes of subthalamic nucleus deep brain stimulation for Parkinson’s disease in Singapore

Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS) is a proven treatment modality for Parkinson’s disease (PD), reducing dyskinesia and time spent in the “OFF” state. This study evaluates the long-term outcomes of STN-DBS in PD patients up to 10 years post-surgery in Singapore. Method: We conducted a retrospective review of Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) scores, activities of daily living (ADLs), disease milestones, dopaminergic drug prescriptions, and adverse events in patients before and after STN-DBS surgery. Results: A total of 94 PD patients who underwent bilateral STN-DBS were included. STN-DBS reduced time in the “OFF” state by 36.9% at 1 year (P=0.034) and 40.9% at 5 years (P=0.006). Time with dyskinesia did not significantly change. Levodopa equivalent daily dose was reduced by 35.1% by 5 years (P&lt;0.001). MDS-UPDRS-II and III scores increased from 5 years post-DBS by 40.5% and 35.4%, respectively. Independence in ADLs decreased, though not significantly. The prevalence of frequent falls increased at 5 years. Surgery- and device-related adverse events were uncommon and generally mild. Conclusion: STN-DBS provides sustained relief from motor complications and reduced medication requirements in PD patients in Singapore. This study highlights STN-DBS as an effective treatment option, significantly enhancing the quality of life for those with PD.

Leveraging independence and mental fitness - keys to reducing in-hospital mortality among geriatric COVID-19 patients in the intensive care unit: A cross-sectional study in Poland.

Coronavirus disease 2019 (COVID-19) quickly reached the pandemic status, with 765.22 million confirmed cases of COVID-19 and 6.92 million COVID-19 deaths reported worldwide by May 2023. Due to its sudden and global nature, the COVID-19 pandemic has had a significant impact on the emotional and mental health of many people. A group of COVID-19 patients who frequently require intensive care are geriatric patients. The cognitive performance of these patients and their independence in instrumental activities of daily living (IADL) may be crucial to their prognosis and risk of in-hospital death. The present study aimed to assess the level of independence in activities of daily living (ADL), mental fitness, the level of fear of COVID-19, and cognitive functions to determine their impact on in-hospital mortality in geriatric COVID-19 patients. A total of 300 intensive care unit (ICU) patients with COVID-19 were included in the cross-sectional study, using the following questionnaires: the Lawton IADL scale, the Katz ADL index of independence, the fear of COVID-19 scale (FCV-19S), the abbreviated mental test score (AMTS), and the 15-item geriatric depression scale (GDS15). Patients aged 64 or below reported significantly greater independence on the IADL scale and the basic ADL scale, and showed a significantly higher level of mental fitness (Mann-Whitney U test; p = 0.001). Patient survival and in-hospital mortality were influenced by independence in basic and complex ADL. The level of independence is an important prognostic indicator for in-hospital mortality in geriatric COVID-19 patients. The higher the level of mental fitness, the higher the level of independence in basic and instrumental activities of daily living. Patients aged ≥65 years are less independent in basic and instrumental activities of daily living. Moreover, they show a significantly lower level of cognitive functions.

Overview of the Level of Activity Daily Living of the elderly who have chronic diseases in the Geriatric Polyclinic of the State General Hospital

Introduction: The increase in the elderly population will of course be accompanied by an increase in the risk of suffering from chronic diseases which can accelerate functional decline and reduce the ability of the elderly to carry out important activities in daily living Activities of Daily Living (ADL Objectives: The aim of this study was to obtain a more comprehensive picture of the level of ADL independence in elderly people with chronic diseases Methods: This type of research is descriptive with a cross-sectional study design. The research sample of elderly people who had chronic diseases was 63 elderly people selected using consecutive sampling. The research instrument uses the Barthel Index. Results: The results of the study showed that of the 63 elderly people, the majority of the 39 elderly people (61.9%) who had chronic diseases experienced a mild level of dependence in carrying out daily living activities Conclusions: Chronic diseases can affect the functional abilities of elderly people in living their daily lives. The importance of educating the elderly and their families about chronic disease management, providing support to increase independence, as well as developing intervention programs that can improve the elderly's ability to carry out Activities of Daily Living (ADL).

Tingkat Kemandirian Pasien Dengan Gangguan Mobilitas Fisik Dengan Berbagai Macam Penyakit

In Indonesia, 22.5 million people experience disabilities with the highest incidence occurring in those aged 60 years and over (elderly). Meanwhile, the most common impairment or limitation of function experienced by persons with disabilities in Indonesia is impaired walking (immobility). This mobility impairment can affect a person's independence in fulfilling their daily activities.This study aims to determine the level of independence of activity of daily living (ADL) in patients who experience impaired physical mobility. This research is quantitative research with a descriptive survey design. The sampling technique used purposive sampling technique with a total sample of 102 patients who experienced impaired physical mobility aged ≥ 60 years and domiciled in the Sukra Health Center work area. Measurement of ADL independence using the Katz Index questionnaire, which has been back translated and tested for construct validity with a calculated r value of 0.580-0.740 &gt; r table 0.361 which means it is valid. Data were analyzed univariately and cross-tabulated. The results showed that the majority of patients with impaired physical mobility experienced total dependence in performing ADL (23.5%). Total dependence was more experienced by patients aged &gt; 90 years (24.7%), female (26.1%), suffered a stroke (42.6%), lived with family (27.1%), usually assisted by other people (nurses/neighbors/helpers) (50%), and had been hospitalized less than 1 year ago (35%). Patients with impaired physical mobility are expected to be able to fulfill all activities daily living either independently or with the help of others.