Activities Of Daily Living Index Research Articles

Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh

To investigate the impact of nutritional status on self-reported as well as performance-based indicators of physical function in a rural elderly population in Bangladesh. A cross-sectional study conducted in Matlab, Bangladesh, included 457 randomly selected community-living elderly persons aged 60 years or more (60-92 years; 69 +/- 7 years). Mobility, activities of daily living (ADL), performance tests, handgrip strength, the Mini Nutritional Assessment (MNA) and a structured questionnaire were used to assess physical function, nutritional status, socioeconomic status and health status, respectively. Descriptive and linear hierarchical regression analyses were applied. Seven per cent of the participants reported limitations in mobility, and 8% reported limitations in ADL. However, more than half of the participants had difficulties in performing one or more items in the performance tests. According to the MNA, 26% of the participants were undernourished and 62% were at risk of malnutrition. More undernourished participants than well-nourished participants reported limited mobility, impaired ADL and difficulties in the performance tests. A corresponding reduction in grip strength was observed in the undernourished group. Accordingly, higher MNA scores, indicating better nutritional status, were significantly associated with higher mobility index, higher ADL index, higher performance tests index, and higher scores in handgrip strength. These associations remained after adjusting for demographic, socioeconomic and health status differences. Good nutritional status is important for the physical function of elderly people, even after controlling for possible confounders. Performance tests indicated a higher degree of functional impairment than that observed by self-reported estimation.

Predicting needs for nursing home admission – does sense of coherence delay nursing home admission in care dependent older people? A longitudinal study

Objectives. This study examined predisposing, enabling and need variables (Andersen's Behavioral Model) influencing the need for nursing home admission (NHA) in older people receiving home nursing care. In particular, the potential role of coping ability, measured as 'sense of coherence' (SOC), was studied. Design, sample, and measurements. A survey with baseline- and follow-up data after a 2-year period was undertaken with 208 patients aged 75+. The measures used were: gender, education, age, social visits, SOC, social provision scale (SPS), self-rated health (SRH), general health questionnaire (GHQ), clinical dementia rating (CDR), Barthel activities of daily living (ADL) index, and registered illnesses (RI). A Cox proportional model was used to examine factors that could explain risk of NHA. Results. Measures with predictive properties were Barthel ADL index, SPS, SRH, and gender. SOC, along with subjective health complaints, general health questionnaire, RI and social visits did not predict NHA. Conclusions. It is concluded that the patients' subjective evaluations of both their health and perceived social support were important predictors of future NHA needs, and should be seriously taken into consideration, along with the more commonly used objective measures of ADL and CDR.

Identificación de factores de predicción del incumplimiento terapéutico en adultos mayores hipertensos de una comunidad del sur de Chile

To identify the predictive factors associated with therapy nonadherence among hypertensive older adults, based on functional dependency, memory disorders, self-perceived wellbeing, abuse, and depression in an area of southern Chile. A quantitative, exploratory study of a sample of 211 hypertensive, older adults (29.1% of those being treated by the cardiovascular program at the Centro de Salud Familiar San Pedro, in the province of Concepción, del Bío Bío region, Chile). Seven instruments were applied: Pfeiffer's short mental status questionnaire, Yesavage's geriatric depression scale, the elder abuse screening scale, the morale scale of the Philadelphia Geriatric Center, the health behavior scale, the Lawton assessment of instrumental activities of daily living (ADL), and the Katz ADL index. Following an analysis of the important components, latent variables were identified. Two latent variables were identified: social connectedness-measured by the variables depression, abuse, and social satisfaction-and autonomy-measured by the variables mental health and ability to perform basic and instrumental ADLs. These latent variables accounted for 39.7% and 20.7% of nonadherence to therapy, respectively. The latent variables proposed here can be used as predictive factors for therapy nonadherence in elderly adults with arterial hypertension. Causes of nonadherence to therapy cannot be assessed solely at health care centers; but rather, an understanding of the home environment is needed and treatment should be adapted according to the needs that exist there.

Quality of life after carotid endarterectomy

BackgroundMost studies documenting beneficial outcomes after carotid endarterectomy (CE) are limited to mortality and morbidity rates, costs, and length of hospital stay (LOS). Few have examined the dependency of patients and how they perceive their own health changes after surgery. The aim of the present study was to evaluate quality of life and independence in activities of daily living (ADL) and to study its determinants.MethodsSixty-three patients admitted in the Post Anaesthesia Care Unit (PACU) after CE were eligible for this 14-month follow-up study. Patients were contacted 6 months after discharge to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in ADL evaluated.ResultsAmong 59 hospital survivors at 6 months follow-up, 43 completed the questionnaires. Sixty-three percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients had worse SF-36 scores for all domains except bodily pain than a general urban population, and comparison with a group of patients 6 months after surgical ICU discharge showed no differences. Six months after PACU discharge, the Lawton Instrumental Activities of ADL Scale and the Katz Index of ADL demonstrated higher dependency scores (5.9 ± 2.2 versus 4.3 ± 2.4 and 0.3 ± 0.8 versus 0.6 ± 0.9, p < 0.001 and p = 0.047). Sixty-five percent and 33% were dependent in at least one activity in instrumental and personal ADL, respectively. Patients dependent in at least one ADL task had higher Revised Cardiac Risk Index (RCRI) scores (1.0 versus 1.5, p = 0.017). After controlling for multiple comparisons, no significant differences were found.ConclusionPatients undergoing CE have improved self-perception of quality of life despite being more dependent. Almost all their scores are worse than those in an urban population. We could identify no predictors of greater dependency in ADL tasks six months after PACU discharge.

Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living persons

To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview. Comparative study of a convenience sample. Results in 36 persons with stroke >10 years previously. Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1-2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items). There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons. The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results.

Evaluating ADL Measures from an Occupational Therapy Perspective

Measures reflecting occupational therapy's conceptualization of occupational performance support the profession's contribution to evidence-based practice and fiscal accountability. This study compared measures of performance-based activities of daily living (ADL) with principles of occupational therapy practice and intended outcomes. Using an action research study design, occupational therapists and researchers (N= 13) systematically clarified the clinical problem, identified occupational therapy principles inherent to the assessment of daily living activity via nominal group technique; defined the key principles as constructs; and reframed these constructs as a questionnaire against which 18 published standardized ADL measures were evaluated. Participants identified six measures as most congruent with principles of occupational therapy practice: ADL Profile, Assessment of Motor and Process Skills, Functional Performance Measure, Rivermead ADL Assessment, Edmans ADL Index, and Melville-Nelson Self-Care Assessment. Findings guide occupational therapists' search and use of performance-based ADL measures that demonstrate the profession's distinct health care contribution.

Cognitive, Functional, and Quality‐of‐Life Outcomes of Patients Aged 80 and Older Who Survived at Least 1 Year After Planned or Unplanned Surgery or Medical Intensive Care Treatment

To investigate long-term cognitive, functional, and quality-of-life outcomes in very elderly survivors at least 1 year after planned or unplanned surgery or medical intensive care treatment. Retrospective cohort study. General, 1,024-bed, tertiary university teaching hospital in The Netherlands. Two hundred four survivors of a cohort of 578 patients admitted to the medical-surgical intensive care unit (ICU) between January 1997 and December 2002 and alive in December 2003. The majority of survivors underwent elective surgery. From December 2003 until February 2004, data were collected from 190 patients and 169 relatives. The measures were: Informant Questionnaire on Cognitive Decline short form (IQCODE-SF) (cognition), modified Katz index of activities of daily living (ADLs) (functional status), and EuroQol (EQ-5D) (health-related quality of life). The patients themselves completed the modified Katz ADL index and EQ-5D forms; their caregivers completed the ADL caregiver version and IQCODE-SF. The mean age at admission+/-standard deviation was 81.7+/-2.4, and the median time after discharge was 3.7 years (range 1-5.9 years). Of the ICU patients who had planned surgery, 57% survived, compared with 11% of the unplanned surgical admissions and 10% of the medical patients. Three-quarters (74.3%) of the patients who lived at home before ICU admission remained at home at follow-up. Eighty-three percent had no severe cognitive impairment, and 76% had no severe physical limitations (33% had moderate, 40% had mild, and 3% had no limitations). The perceived quality of life was similar to that of an age-matched general population. Long-term survivors of ICU treatment received at the age of 80 and older showed fair-to-good cognitive and physical functioning and quality of life, although few patients who underwent unplanned surgery or who were admitted to the ICU for medical reasons survived.

Assessing selected quality of life factors of nursing home residents in Turkey

As a result of improved public health and medical advances, not only has life expectancy among older people increased, but the importance of quality of life in terms of health in later life has also increased. The aim of this study was to investigate the relationship between socio-demographic factors, health-related behaviors, residents’ satisfaction, and functional disability levels among elderly people living in nursing homes in Turkey using the World Health Organization's Quality of Life-BREF (WHOQOL-BREF). Data regarding socio-demographic characteristics, chronic health problems, health-related behaviors (smoking, alcohol consumption, physical activity, etc.) were collected from the study group ( N = 107) by a structured questionnaire during face-to-face interviews. Dependencies in activities of daily living (ADL) of the study group were also assessed using Katz's ADL index. The mean WHOQOL-BREF scores were significantly higher in participants who had independence in performing ADL (bathing, dressing, toileting, transfer, continence, feeding) ( p < 0.0001, p < 0.0001, p < 0.0001, p < 0.001, p < 0.0001, and p < 0.001, respectively). It was found that WHOQOL-BREF scores were positively associated with having physical exercise habits and residents’ satisfaction with nursing homes; being dependent in dressing were significant predictors of in the study ( R 2: 0.38, p < 0.003, p < 0.0001, and p < 0.0001, respectively). Residents’ satisfaction from living nursing homes and participation in physical exercise were significant predictors of WHOQOL-BREF scores for those that participated in this study.

Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up

To compare changes in basic self-care activities in various cognitive groups of hip fracture patients by the Katz Index of Independence in activities of daily living (ADL). 117 community-dwelling elderly subjects with acute hip fracture (age 67-92 years), referred to the geriatric unit of Jyväskylä Central Hospital for rehabilitation, participated in the study. Basic self-care activities were evaluated by the Katz ADL Index and cognition by the Mini-Mental State Examination (MMSE). Prior to hip fracture, the patients in the lowest MMSE group had a significantly lower Katz Index than the other three groups (p<0.001). Disability increased in a statistically significantly way post-surgery in all four MMSE groups (p<0.001). In the two lower MMSE groups, the Katz Index remained at the lower level, and in the two higher groups it improved in a statistically significant way from 2 weeks to 3 months post-operatively, after which it deteriorated slightly. A significantly larger proportion of patients in the higher MMSE groups were independent in all basic ADLs, both before and after fracture (from p=0.023 to p<0.001), except in continence prior to fracture. Prior to hip fracture, patients with low MMSE scores had a significantly greater degree of basic ADL dependence than the other three groups. Despite similar post-operative multidisciplinary treatment, functional ability remained at the lower level in the two lower MMSE groups, whereas recovery was much better in the higher MMSE groups.

Lack of nutritional and functional effects of nutritional supervision by nurses: a quasi-experimental study in geriatric patients

BackgroundUndernutrition affects recovery from disease and regaining functional abilities; however, it frequently occurs in elderly hospitalized patients.ObjectiveTo study whether identification of geriatric patients at nutritional risk followed by individualized nursing care could improve their nutritional and activities of daily living (ADL) status.DesignThe design was quasi-experimental. In total, 345 rehabilitation patients (aged 84±7 years, 72% women) were allocated, according to bed availability, to either an intervention or a control ward. Nurses on the intervention ward attended a short class on nutrition and were supervised in nutritional care by trained nurses. In the intervention unit, the nursing staff identified patients at risk of undernutrition through systematic assessment of risk factors, e.g. body mass index (BMI) <24 kgm−2, and treated them according to individual care plans. On the control ward routine nutritional care was offered. Functional status was assessed by the Barthel ADL index.ResultsMean BMI was 24±5 on both wards. Fifty-five per cent of the patients had BMI <24. On average, patients were weight stable from admission to discharge, irrespective of allocation. No difference was found in ADL status as a result of the intervention. However, patients who gained weight improved more in ADL status than patients who remained stable or lost weight.ConclusionsIn this geriatric setting standard care and care by trained and supervised nurses were equally effective in maintaining weight stability and functionality in rehabilitation patients with a mean BMI of 24. Weight increase was associated with improved functionality.

Lack of nutritional and functional effects of nutritional supervision by nurses: a quasi-experimental study in geriatric patients

Background: Undernutrition affects recovery from disease and regaining functional abilities; however, it frequently occurs in elderly hospitalized patients. Objective: To study whether identification of geriatric patients at nutritional risk followed by individualized nursing care could improve their nutritional and activities of daily living (ADL) status. Design: The design was quasi-experimental. In total, 345 rehabilitation patients (aged 8497 years, 72% women) were allocated, according to bed availability, to either an intervention or a control ward. Nurses on the intervention ward attended a short class on nutrition and were supervised in nutritional care by trained nurses. In the intervention unit, the nursing staff identified patients at risk of undernutrition through systematic assessment of risk factors, e.g. body mass index (BMI) B24 kg m_2, and treated them according to individual care plans. On the control ward routine nutritional care was offered. Functional status was assessed by the Barthel ADL index. Results: Mean BMI was 2495 on both wards. Fifty-five per cent of the patients had BMI B24. On average, patients were weight stable from admission to discharge, irrespective of allocation. No difference was found in ADL status as a result of the intervention. However, patients who gained weight improved more in ADL status than patients who remained stable or lost weight. Conclusions: In this geriatric setting standard care and care by trained and supervised nurses were equally effective in maintaining weight stability and functionality in rehabilitation patients with a mean BMI of 24. Weight increase was associated with improved functionality. Keywords: ADL; elderly; hospitalized; undernutrition; weight gain

Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine

The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed. Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered. Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis. This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis.

Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition

Effects of combined nutritional treatment of patients at risk of protein-energy malnutrition (PEM) discharged from a geriatric service were evaluated. Patients (n=108, age 85+/-6 years) at risk of malnutrition according to the short form of the mini nutritional assessment were randomly allocated to dietary counseling, including liquid and multivitamin supplementation, i.e. intervention (I, n=51) and to controls (C, n=57). Body weight, biochemical indices (e.g. insulin-like growth factor I (IGF-I)), Katz activities of daily living (ADL) index, mini mental status examination (MMSE) and quality of life (QoL) by SF-36 were assessed at the start of the study and after 4 months. Statistical analyses were performed on "intention-to-treat" and on "treated-as-protocol" bases. Fifty-four patients, 29 in the I-group (86+/-7 years, 66% females) and 25 in the C-group (85+/-7 years, 72% females) completed the study according to the protocol. Both modes of analysis revealed a significant positive effect of the combined nutritional intervention on weight maintenance. Treated-as-protocol analyses showed that Katz ADL index improved in the I-group (p<0.001; p<0.05 between the groups). Serum IGF-I levels increased in the I-group (p<0.001), but were unchanged in the C-group (p=0.07 between the groups). QoL was assessed to be low and had not changed after nutritional treatment. Combined nutritional intervention prevented weight loss and improved ADL functions in discharged geriatric patients at risk of malnutrition.

Exercise Program for Nursing Home Residents with Alzheimer's Disease: A 1‐Year Randomized, Controlled Trial

To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). Randomized, controlled trial. Five nursing homes. One hundred thirty-four ambulatory patients with mild to severe AD. Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

地域在住高齢者における応用歩行予備能の有用性と生活機能との関連

The purpose of this study was to develop the index of functional gait reserve relative to gait endurance and gait conformability, and to examine the relationship between functional gait reserve and activities of daily living (ADL) in elderly individuals. Subjects comprised 107 community-dwelling elderly individuals (mean age, 72.5 +/-5.0 years). We evaluated gait function using the timed "Up and Go" test (TUG), 10-m walking time, 6-minute distance (6MD), physiological cost index (PCI) and ratings of perceived exertion (RPE), and investigated Tokyo Metropolitan Institute Gerontology-Index of Competence as an index of ADL. TUGs were performed at a comfortable speed (TUG(com)) and maximum speed (TUG(max)), and TUG Reserve (TUG-R) was derived from the ratio of the difference between TUG(max) and TUG(com) as an index of functional gait reserve. Intraday reliability of TUG-R was high (intraclass correlation coefficient (1, 2)=0.82), and TUG-R was correlated to 6MD, PCI and RPE, which was reflected in gait endurance and gait conformability. Scores for TUG-R were significantly lower in elderly individuals with ADL dependence than in independent elderly individuals. Multiple logistic regression analysis showed TUG-R as associated with performance of outdoor activities. TUG-R offers a reliable and useful index of functional gait reserve related to gait endurance and ADL in elderly individuals.

The association between patients' cognitive status and rehabilitation outcome in a geriatric day hospital

Purpose. To assess whether and to what extent cognitive status affects functional gain in mobility and extended activities of daily living (ADL) in patients admitted to a geriatric day hospital.Methods. During 2003, 135 older patients admitted to a rehabilitation day hospital were evaluated by the Mini Mental State Examination (MMSE) and the Cognitive Functional Independence Measure (FIM). On admission and at discharge, they were assessed by the Nottingham Extended ADL Index (NEAI) and the Timed Get Up and Go test (TUG).Results. Orthopedic and stroke patients achieved significant functional gain in mobility regardless of their cognitive status. Nevertheless, cognitively intact stroke patients achieved higher admission and discharge NEAI scores, manifesting greater absolute functional gain than cognitively impaired patients. The patients' ability to extract their rehabilitation potential was significantly better.Conclusions. Cognitively impaired patients can improve in mobility and performance of extended ADL during day hospital rehabilitation. Evaluation of the patients' cognitive status may enable the multidisciplinary team to develop suitable individual programs and better allocate resources. Cognitively intact stroke patients may benefit from extended rehabilitation treatment compared to impaired stroke patients as they are more capable of utilizing their potential to achieve independence in daily tasks.

Katz' ADL index assessed functional performance of Turkish, Moroccan, and Dutch elderly

Background and Objective We examined the reliability and validity of self-reported limitations encountered in the activities of daily living (ADL) as measure of functional performance, for Turkish, Moroccan, and indigenous Dutch elderly in the Netherlands. Methods We obtained data on self-reported ADL measured by Katz' ADL index and on five related health outcomes among a general population sample of 304 Dutch, 330 Turkish, and 299 Moroccan respondents aged 55–74 years, in Amsterdam, the Netherlands (response: 60%). Results Katz' ADL index demonstrated good internal consistencies for each ethnic group (Cronbach's alphas: 0.84–0.94). Regarding validity, the ADL index showed relatively strong associations with related outcomes, that is, long-term limitations in mobility and SF-36 physical functioning (rank correlations: 0.64 and −0.60, respectively). Associations with more general health outcomes, number of chronic disorders, Center for Epidemiologic Studies-Depression scale symptoms, and SF-36 role performance were weaker, as expected. Associations were stronger for Moroccans than for indigenous Dutch elderly regarding both SF-36 outcomes and depressive symptoms. Conclusion Katz' ADL index is valid to assess functional performance of Turkish, Moroccan, and Dutch elderly, but comparisons with Moroccan elderly should be handled with caution. The explanation of these findings and their generalizability to other ethnic groups deserve further study.

Co‐variation of tests commonly used in stroke rehabilitation

The aim of the present study was to analyse the co-variation of different tests commonly used in stroke rehabilitation, and specifically used in a recent randomized, controlled study of two different physiotherapy models in stroke rehabilitation. Correlations of the performed tests and recordings from previous work were studied. The test results from three-month, one-year and four-year follow-up were analysed in an SPSS Version 11 statistical package with Pearson and Spearman correlations. There was an expected high correlation between the motor function tests, both based on partial and total scores. The correlations between Nottingham Health Profile Part 1 and Motor Assessment Scale (MAS), Sødring Motor Evaluation Scale (SMES), the Berg Balance Scale (BBS) and Barthel Activities of Daily Living (ADL) index were low for all items except physical condition. The correlations between registered living conditions, assistive devices, recurrent stroke, motor function (MAS, SMES), ADL (Barthel ADL index) and balance (BBS) were high. The same variables showed weak or poor correlation to the Nottingham Health Profile (NHP). The co-variations of motor function tests and functional tests were high, but the co-variations of motor, functional and self-reported life-quality tests were poor. The patients rated themselves on a higher functional level in the self-reported tests than was observed objectively in the performance-based tests. A possible reason for this is that the patients may have been unaware they modified their performance to adjust for physical decline, and consequently overestimate their physical condition. This result underlines the importance of both performance-based and self-reported tests as complementary tools in a rehabilitation process.

A Multivariate Fall Risk Assessment Model for VHA Nursing Homes Using the Minimum Data Set

The purpose of this study was to develop a multivariate fall risk assessment model beyond the current fall Resident Assessment Protocol (RAP) triggers for nursing home residents using the Minimum Data Set (MDS). Retrospective, clustered secondary data analysis. National Veterans Health Administration (VHA) long-term care nursing homes (N = 136). The study population consisted of 6577 national VHA nursing home residents who had an annual assessment during FY 2005, identified from the MDS, as well as an earlier annual or admission assessment within a 1-year look-back period. A dichotomous multivariate model of nursing home residents coded with a fall on selected fall risk characteristics from the MDS, estimated with general estimation equations (GEE). There were 17 170 assessments corresponding to 6577 long-term care nursing home residents. The increased odds ratio (OR) of being classified as a faller relative to the omitted "dependent" category of activities of daily living (ADL) ranged from OR = 1.35 for "limited" ADL category up to OR = 1.57 for "extensive-2" ADL (P < .0001). Unsteady gait more than doubles the odds of being a faller (OR = 2.63, P < .0001). The use of assistive devices such as canes, walkers, or crutches, or the use of wheelchairs increases the odds of being a faller (OR = 1.17, P < .0005) or (OR = 1.19, P < .0002), respectively. Foot problems may also increase the odds of being a faller (OR = 1.26, P < .0016). Alzheimer's or other dementias also increase the odds of being classified as a faller (OR = 1.18, P < .0219) or (OR=1.22, P < .0001), respectively. In addition, anger (OR = 1.19, P < .0065); wandering (OR = 1.53, P < .0001); or use of antipsychotic medications (OR = 1.15, P < .0039), antianxiety medications (OR = 1.13, P < .0323), or antidepressant medications (OR = 1.39, P < .0001) was also associated with the odds of being a faller. This national study in one of the largest managed healthcare systems in the United States has empirically confirmed the relative importance of certain risk factors for falls in long-term care settings. The model incorporated an ADL index and adjusted for case mix by including only long-term care nursing home residents. The study offers clinicians practical estimates by combining multiple univariate MDS elements in an empirically based, multivariate fall risk assessment model.

Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation (p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators (p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores (r = -0.518 vs. r = -0.550) (p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.