Activities Of Daily Living Index Research Articles

Nonspecific stress biomarkers for mortality prediction in older emergency department patients presenting with falls: a prospective multicenter observational study.

Older patients presenting to the emergency department (ED) after falling are increasingly prevalent. Falls are associated with functional decline and death. Biomarkers predicting short-term mortality might facilitate decisions regarding resource allocation and disposition. D-dimer levels are used to rule out thromboembolic disease, while copeptin and adrenomedullin (MR-proADM) may be used as measures of the patient`s stress level. These nonspecific biomarkers were selected as potential predictors for mortality. Prospective, international, multicenter, cross-sectional observation was performed in two tertiary and two regional hospitals in Germany and Switzerland. Patients aged 65years or older presenting to the ED after a fall were enrolled. Demographic data, Activities of Daily Living (ADL), and D-dimers were collected upon presentation. Copeptin and MR-proADM levels were determined from frozen samples. Primary outcome was 30-day mortality; and secondary outcomes were mortality at 90, 180, and 365days. Five hundred and seventy-two patients were included. Median age was 83 [IQR 78, 89] years, 236 (67.7%) were female. Mortality overall was 3.1% (30d), 5.4% (90d), 7.5% (180d), and 13.8% (365d), respectively. Non-survivors were older, had a lower ADL index and higher levels of all three biomarkers. Elevated levels of MR-proADM and D-dimer were associated with higher risk of mortality. MR-proADM and D-dimer showed high sensitivity and low negative likelihood ratio regarding short-term mortality, whereas copeptin did not. D-dimer and MR-proADM levels might be useful as prognostic markers in older patients presenting to the ED after a fall, by identifying patients at low risk of short-term mortality. ClinicalTrials.gov Identifier: NCT02244983.

#1874 Comparative analysis of rehabilitation outcomes in hospitalized hemodialysis vs. non-hemodialysis patients: a retrospective cohort study

Abstract Background and Aims The hospitalization rate of patients undergoing hemodialysis (HD) is high, due to complications related to renal failure and hemodialysis treatment. Therefore, it is crucial to provide rehabilitation for hospitalized HD patients to improve their activities of daily living (ADL) and physical functions, so as to enable them to be discharged home, resume outpatient dialysis, and avoid re-hospitalization. However, the effectiveness of rehabilitation to improve the ADL and physical functions may differ between hospitalized patients undergoing HD (HD patients) and hospitalized patients not undergoing HD (non-HD patients), depending on their pathological conditions and influence of the HD treatment. The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD patients and non-HD patients. Method This was a retrospective cohort study. The inclusion criteria were hospitalized patients who received rehabilitation between April 2017 and February 2023. The exclusion criteria were patients who discontinued rehabilitation, were transferred to other hospitals, or died during the rehabilitation period. Rehabilitation consisted of physical therapy and/or occupational therapy provided six times a week, for both hospitalized HD and non-HD patients. The rehabilitation program comprised balance training, aerobic exercises, resistance training, and ADL training to prepare the patients for discharge to their homes. We measured several outcomes in the study, including the daily duration of rehabilitation (min/day), length of hospital stay (days), Barthel index (BI), as the ADL index, at the time of admission and discharge, grip strength and isometric knee extension strength (IKES) as muscle strength indices, and the 10-meter walking speed, timed up and go test (TUG), and short physical performance battery (SPPB) as mobility function indices. For the statistical analysis, missing values were completed by using multiple imputation methods. The inverse probability weighting (IPTW) method was used to match the HD group and non-HD group to adjust for confounding factors. The outcomes between the groups were then compared using a generalized linear model analysis. All procedures in the present study were conducted with the approval of the ethics committee of Seirei Christopher University. Results Of 1002 patients who were registered for the study, 100 patients who discontinued rehabilitation, were transferred to other hospitals, or died were excluded, and the data of the remaining 902 patients (765 of the non-HD group and 137 of the HD group) were included in the analysis in this study. The results of the generalized linear model analysis revealed a lower daily duration of rehabilitation [43.3(0.6) vs. 38.8(1.2) min/day, p=0.0003] and longer length of hospital stay [48.5(0.5) vs. 58.1(2.3) days, p=0.0108] in the HD group. In addition, the 10-meter walking speed [0.75(0.02) vs. 0.66(0.03) m/s, p=0.003] and scores on the TUG [20.8(0.7) vs. 24.3(1.0) sec, p=0.0021] and SPPB [6.3(4.57) vs. 4.7(0.6) points, p=0.0415] at discharge were also significantly lower in the HD group as compared with the non-HD group. There was no difference in the ability for ADL or muscle strength at discharge between the two groups. Conclusion This study was the first to demonstrate a lower daily duration of rehabilitation and longer hospital stay in hospitalized HD patients. Furthermore, rehabilitation had a lower impact on the mobility indices in HD patients as compared with non-HD patients. Although there was no difference in the ability for ADL or muscle strength at discharge between the two groups, HD patients exhibited a significantly lower ability for mobility functions, including a lower gait speed and lower scores on the TUG, and SPPB assessments. Therefore, rehabilitation efforts in HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement.

#2303 Evaluating symptom burden and decision making in older people with advanced chronic kidney disease (CKD): a cross-sectional service evaluation

Abstract Background and Aims The benefits of dialysis compared with conservative management (CM) are less certain in older people with advanced chronic kidney disease (CKD) living with frailty and multimorbidity. Symptom burden and quality of life can worsen following dialysis initiation; studies have reported that patients can experience dialysis decisional regret. We conducted a cross-sectional service evaluation to understand symptom burden, experience of shared decision making and decisional regret for older people receiving haemodialysis (HD) and CM at our trust. Method People from our trust aged 65 and older receiving HD (for 3 to 12 months) or CM were recruited between April and May 2023. Patients were approached on HD units or via telephone. Baseline demographic and clinical characteristic data were obtained from electronic patient records. A Clinical Frailty Scale (CFS) assessment was performed for each patient using the CFS app. Patients with a CFS score ≥5 were categorized as frail. Activities of daily living (ADL) were assessed using the KATZ ADL index. Patients completed questionnaires evaluating symptom burden (IPOS-Renal), experience of shared decision making (SHARED questionnaire) and decisional regret (Decision Regret Scale). Information about advance care planning (ACP) was recorded. Mann-Whitney U, independent samples T-tests, Chi-squared, and Pearson's correlation coefficient were calculated using Statistical Package for Social Scientists (SPSS). Results Twenty-five HD and 25 CM patients were included with mean age of 74.7 (SD=5.9) and 83.2 (SD=5.2) years old, respectively. Eleven (44%) HD patients and 9 (36%) CM patients were female. The most common co-morbidities were hypertension (n=32, 64%), diabetes (n=16, 32%) and ischaemic heart disease (n=14, 28%). There was no significant difference in frailty (HD n=15 [60%], CM n=17 [74%], p=0.307) or KATZ ADL score between the two groups (p=0.124) There was no significant difference between mean total IPOS-renal scores (HD 13 [SD=8.5], CM 15 [SD=8], p=0.395). CM patients were significantly more affected by dyspnoea (p=0.014) and drowsiness (p=0.036). HD patients experienced more wasted time for appointments (p=0.001), mostly related to transportation issues. CM patients had more discussions about other treatment options aside from the one chosen (p=0.036), had their opinions sought more (p=0.038) and felt welcome to consider different options (p=0.018). HD patients felt more informed that there was a preferred medical treatment for their advanced CKD (p=0.006). HD patients regretted their treatment option more than CM patients (p=0.028). A moderately-negative correlation was found between shared decision making and regret (r=-0.455, p<0.001). Finally, CM patients had more ACP decisions documented than HD patients (CM n=14 [58%], HD n=6 [26%], p=0.025). Conclusion Symptom burden was similar between CM and HD patients (see Fig. 1). HD patients felt less involved during decision making than CM patients and experienced more regret about their treatment choice. It is vital that all treatment options, including CM, are openly and impartially discussed with patients to truly ensure shared decision making and minimise the likelihood of decisional regret.

Limitations and determinants of Activities of Daily Living among older adults in Assam: LASI (Wave-1) analysis

BackgroundThe entire concept of aging gracefully involves maintaining the independence and quality of life among the older adults, with a particular emphasis on the ability to perform Activities of Daily Living (ADL). The number of older adults in the country has grown subsequently, with their dependence on care-givers which has also increased. ObjectivesThe study attempts to understand the prevalence and determinants of the limitations of Activities of Daily Living (ADL) among older adults aged 60 and over living in Indian state of Assam. MethodsThe study use the Longitudinal Ageing Study in India (LASI, 2017–18) Assam data, and information was sought from 816 older adults aged 60 years and above. An index of ADL was created on a scale of two levels, having no levels of ADL and having ADL limitation. ResultsAround 18 % of the older adults reported ADL disability. Females had higher prevalence of ADL than males (22 % v/s 14 %). Those aged 70 plus were also more likely to have ADL functional limitation (OR = 1.78, CI = 1.61–1.96) than those aged 60–69 years. Older adults not involved in any physical activity were more likely to report ADL limitation (OR = 1.50, CI = 1.34–1.68) than their counterparts. ConclusionThe findings of the study call for action to have geriatric care centres as the need of the hour, to promote exercise and other recreational activities that will help the old keep physically active and increase social-participation.

Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study.

Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

ADL/IADL limitations and related factors in older adults in 3 Northern provinces Vietnam

This cross-sectional study aimed to identify the prevalence and factors related to the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) among elderly people in Ha Noi, Ninh Binh, and Quang Binh in 2018. In total, 2448 participants were interviewed and measured using an adapted short version of Katz ADL Index and Lawton IADL Scale. The study showed a high prevalence of ADL and IADL disability (29.1% and 33.1%, respectively) in older adults. The risks of ADL and IADL limitations increased with age, gender ( higher in females), individuals withlower incomes, who had a history of chronic diseases, who self-rated poor health status, reported a moderate or severe somatic pain and who had weak grip strength. People who were still employed and regularly performed heavy physical activities had a lower chance of ADL and/or IADL limitations. We suggest that ADL/IADL limitations should be taken in account for any potential health care strategies and interventions for elderly population.

Efficacy and Safety of 6-Month High Dietary Protein Intake in Hospitalized Adults Aged 75 or Older at Nutritional Risk: An Exploratory, Randomized, Controlled Study

The aim of this study was to investigate the effects of increased dietary protein in daily-life settings in Japan for 6 months on the activities of daily living (ADL) in adults aged 75 or older at nutritional risk. The study was an open-label, exploratory, randomized controlled trial conducted at seven hospitals in Japan. The study participants were adults aged 75 or older who were hospitalized for treatable cancer, pneumonia, fractures, and/or urinary-tract infection at nutritional risk. The primary outcome was change in grip strength, skeletal muscle, and ADL indices (Barthel index, Lawton score). One hundred sixty-nine patients were randomly assigned to the intensive care (IC) or standard care (SC) group; the protein intake goals (g/kgw/day) were 1.5 for IC and 1.0 for SC. There was a significant improvement in grip strength only in the IC group (1.1 kg: 95% CI 0.1 to 2.1) (p = 0.02). While the skeletal muscle index and ADL indices were not significantly improved in either group, the improvement ratio tended to be greater in the IC group. There was no decrease in renal function in either group. Thus, intervention of increased dietary protein in daily-life settings for 6 months in adults aged 75 or older with treatable cancer, pneumonia, fractures, and/or urinary-tract infection and at nutritional risk may be effective in ameliorating loss of muscle strength.

Risk factors of poor sleep quality in older adults: an analysis based on comprehensive geriatric assessment

Objectives Sleep quality is associated with many diseases and conditions that affect individuals’ health in various ways. We aimed to investigate the association between sleep quality and common geriatric conditions in older adults. Methods The study included 237 older adults admitted to the geriatric outpatient clinic of a university hospital. All patients underwent comprehensive geriatric assessment (CGA). The Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life (EQ-5D), Pittsburgh Sleep Quality Index (PSQI), Katz Index of Independence in Activities of Daily Living (ADL) and Lawton and Brody Instrumental Activities of Daily Living (IADL) questionnaires, Tinetti Balance and Gait Assessment (TBGA), and Mini Nutritional Assessment (MNA) were performed on the participants. Results Participants had a mean age of 72.2 ± 6.3 years, and 146 (61.6%) of them had poor sleep quality. Of the participants, 61.2% were female. In the poor sleep quality group, GDS and BAI scores were higher while ADL, IADL, MNA, and EQ-5D index scores were lower. PSQI score had a negative correlation with ADL (r = −.207, p = .01), EQ-5D index (r = −.372, p = .00), MNA (r = −.277, p = .00), and TBGA (r = −.263, p = .41) scores and a positive correlation with GDS (r = .426, p = .00) and BAI (r = .450, p = .00) scores according to the results of correlation analysis. Multivariate logistic regression analysis showed that the presence of diabetes mellitus (DM) and higher GDS and BAI scores were independent variables for poor sleep quality [(p = .48, OR = 1.92; p = .20, OR = 1.11; and p <.01, OR = 1.11, respectively)]. Conclusions We found that DM and depressive and anxiety symptoms were the risks of poor sleep quality. In addition, participants with poor sleep quality had a worse quality-of-life and nutritional status. Improving sleep quality may be helpful in the management of geriatric syndromes and that sleep quality assessment should be part of CGA.

Intertrochanteric Femoral Fractures: A Comparison of Clinical and Radiographic Results with the Proximal Femoral Intramedullary Nail (PROFIN), the Anti-Rotation Proximal Femoral Nail (A-PFN), and the InterTAN Nail

Background and Objectives: The aim of this study was to evaluate retrospectively the radiological and functional outcomes of closed reduction and internal fixation for intertrochanteric femoral fractures (IFF) using three different proximal femoral nails (PFN). Materials and Methods: In total, 309 individuals (143 males and 166 females) who underwent surgery for IFF using a PFN between January 2018 and January 2021 were included in the study. Our surgical team conducted osteosynthesis using the A-PFN® (TST, Istanbul, Turkey) nail, the PROFIN® (TST, Istanbul, Turkey), and the Trigen InterTAN (Smith & Nephew, Memphis, TN, USA) nail. The PFNs were compared based on age, gender, body mass index (BMI), length of stay (LOS) in intensive care, whether to be admitted to intensive care, mortality in the first year, amount of transfusion, preoperative time to surgery, hospitalisation time, duration of surgery and fluoroscopy, fracture type and reduction quality, complication ratio, and clinical and radiological outcomes. The patients' function was measured with the Harris Hip Score (HHS) and the Katz Index of Independence in Activities of Daily Living (ADL). Results: Pain in the hip and thigh is the most common complication, followed by the V-effect. The Z-effect was seen in 5.7% of PROFIN patients. A-PFN was shown to have longer surgical and fluoroscopy durations, lower HHS values, and much lower Katz ADL Index values compared to the other two PFNs. The V-effect occurrence was significantly higher in the A-PFN group (36.7%) than in the InterTAN group. The V-effect was seen in 33.1% of 31A2-type fractures but in none of the 31A3-type fractures. Conclusions: InterTAN nails are the best choice for IFFs because they have high clinical scores after surgery, there is no chance of Z-effect, and the rate of V-effect is low.

Drug Burden Index in Older Adults with Psychiatric Illnesses: A Cross-Sectional Study.

Medications with anticholinergic and/or sedative properties are commonly used in the management of psychiatric illnesses. The burden of anticholinergic and sedative medication use has been measured by the Drug Burden Index (DBI) score tool. A higher DBI score has been associated with increased risk of falls, bone and hip fractures, and functional and cognitive impairment, among other serious health outcomes, especially in older adults. We aimed to describe the drug burden in older adults with psychiatric illnesses using DBI, determine the factors that are associated with the drug burden measured by DBI, and examine the association between DBI score and Katz for activities of daily living (ADL) index. A cross-sectional study was conducted in the psychogeriatric division of an aged-care home. The study sample comprised all inpatients, aged ≥ 65 years, diagnosed with psychiatric illness. The data obtained included demographic characteristics, duration of hospital stay, primary psychiatric diagnosis and comorbidities, functional status using the Katz ADL index, and cognitive status using the Mini-Mental State Examination (MMSE) score. DBI score was calculated for each anticholinergic and sedative medication used. Of the 200 patients eligible for analysis, 106 (53.1%) were females and the mean age was 76 ± 9 years. The most commonly encountered chronic disorders were hypertension 102 (51%) and schizophrenia 94 (47%). The use of drugs with anticholinergic and/or sedative effects was seen in 163 (81.5%) patients; the mean DBI score was 1.25 ± 1. The results of the multinomial logistic regression showed that schizophrenia (odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.57-4.45), p = 0.01), level of dependency (OR = 3.50 (95% CI 1.38-5.70), p = 0.001), and polypharmacy (OR = 2.99 (95% CI 2.15-4.29), p = 0.003) were significantly associated with DBI score ≥ 1 compared to DBI score 0. The study showed that anticholinergic and sedative medication exposure measured by DBI was associated with higher levels of dependency on the Katz ADL index in a sample of older adults with psychiatric illnesses from an aged-care home.

COVID-19 Accelerated Cognitive Decline in Elderly Patients with Pre-Existing Dementia Followed up in an Outpatient Memory Care Facility.

Coronavirus disease 2019 (COVID-19) may affect the cognitive function and activities of daily living (ADL) of elderly patients. This study aimed to establish the COVID-19 effect on cognitive decline and the velocity of cognitive function and ADL changes in elderly patients with dementia followed up in an outpatient memory care facility. In total, 111 consecutive patients (age 82 ± 5 years, 32% males) with a baseline visit before infection were divided into those who had or did not have COVID-19. Cognitive decline was defined as a five-point loss of Mini-Mental State Examination (MMSE) score and ADL comprising basic and instrumental ADL indexes (BADL and IADL, respectively). COVID-19 effect on cognitive decline was weighted for confounding variables by the propensity score, whereas the effect on change in the MMSE score and ADL indexes was analyzed using multivariate mixed-effect linear regression. COVID-19 occurred in 31 patients and a cognitive decline in 44. Cognitive decline was about three and a half times more frequent in patients who had COVID-19 (weighted hazard ratio 3.56, 95% confidence interval 1.50-8.59, p = 0.004). The MMSE score lowered on average by 1.7 points/year, independently of COVID-19, but it lowered twice faster in those who had COVID-19 (3.3 vs. 1.7 points/year, respectively, p < 0.050). BADL and IADL indexes lowered on average less than 1 point/year, independently of COVID-19 occurrence. Patients who had COVID-19 had a higher incidence of new institutionalization than those who did not have the disease (45% versus 20%, p = 0.016, respectively). COVID-19 had a significant impact on cognitive decline and accelerated MMSE reduction in elderly patients with dementia.

488: DELIRIUM PREDICTS MORTALITY AND LENGTH OF STAY BUT NOT FUNCTIONAL INDEPENDENCE POST-ICU DISCHARGE

Introduction: Delirium is common in the intensive care unit (ICU) and can complicate the existing critical illness. Yet, there is a paucity of information about delirium incidence and its effect on patient’s outcomes in the developing countries where it can be misdiagnosed or undetected. The aim of this study was to determine the incidence, predictors, and the association of delirium with short-term (ICU length of stay, hospital length of stay, and in-hospital mortality) and long-term (activities of daily living and mortality at 4 months after discharge) outcomes among ICU patients. Methods: This was a prospective cohort study of 111 patients who were conscious, > 18 years old, and admitted to the ICU for ≥ 8 hours. Untestable patients (Richmond agitation score of -4 or -5, mental disability, receptive aphasia, and/or visual or auditory impairment) were excluded. The Confusion Assessment Method for the ICU (CAM-ICU) was utilized to assess delirium while Katz Activities of Daily Living index was used to assess functional independence at 4 months after discharge. Delirium was assessed daily during ICU stay and continued until death or ICU discharge. Multivariable logistic regression and student’s t-test were used in the analyses. Results: Delirium was found in 32% of patients. The severity of illness measured by APACHE II (OR 1.28, p<.001) score was an independent predictor of delirium in multivariable analysis controlling age, sex, and sedation. Patients with delirium had significantly longer ICU and hospital stay (12.4±11.9 and 22.2±19.4 respectively) compared to those without delirium (6.4±5.8 and 14.7±17.4, respectively), p<.05. Delirium was associated with increased in-hospital and 4-month mortality (OR 12.1 and 7.1, p<.05) but not with activities of daily living (OR=1.4, p=.69). Conclusions: Delirium has a substantial effect on ICU and hospital length of stay and both in-hospital and post discharge mortality. The mechanistic link between delirium and mortality remains unclear. This warrants further investigation to better understand how delirium contributes to mortality, and to determine whether the current interventions to manage delirium affect mortality among ICU patients.

Dental Criteria Could Alert for Malnutrition Risk and Inappropriate Choice of Food Texture in Older Subjects with Dementia: An Analytical Cross-Sectional Study.

Oral health indicators are usually collected to alert for the presence of infectious diseases, but the impact of poor oral health on the nutritional status of older people with dementia is often neglected. This study aims to explore the relationship between the number of posterior dental functional units (PFUs) and the anthropometric measure of malnutrition, the mid-upper arm circumference (MUAC), in older people with dementia while controlling for other variables, and to analyze whether the number of PFUs is considered when adjusting the texture of the food provided at mealtimes. A total of 103 individuals who were 70 years or older with dementia were recruited from seven institutions. Cognitive impairment was assessed using the Mini Mental State Examination. Data were collected from medical records (sociodemographic characteristics, presence of chronic diseases, prescribed medications, results of serum albumin level), as well as questionnaires (type of feeding routes, type of food texture, supplements intake, Activity of Daily Living index), clinical examinations (MUAC), and oral health parameters (PFUs, oral dryness, oral hygiene). MUAC was the dependent outcome variable. MUAC was associated with the number of PFUs (p = 0.032); participants with PFU ≤ 4 were 7.5 times more likely to have MUAC &lt; 21 cm than others. Other associations were found between MUAC and albumin level (OR = 12.5; p = 0.001), modified food texture (OR = 4.2; p = 0.035), and length of institutional stay (OR = 5.2; p = 0.033); however, the type of oral feeding was not significantly related to the number of PFUs (p = 0.487) so there is an inadequate correlation between food texture and oral health status. Similar to MUAC, the number of PFUs could be an oral anthropometric criterion that is recorded during routine hygiene care to alert for the risk of malnutrition and the inappropriate choice of food texture in older individuals with dementia.

Determinants of Health-Related Quality of Life Among Community-Dwelling Thai Older Adults in Chiang Mai, Northern Thailand.

BackgroundPopulation aging has been growing worldwide and Thailand has become an aged society with 20% of its population aged 60 and over. Age-related decline in physical and mental health impacts the health-related quality of life (HRQOL) of older adults.PurposeWe aimed to describe the HRQOL of Thai older adults, residing in the community.MethodsThis cross-sectional survey was part of a Community-Integrated Intermediary Care project (CIIC), TCTR20190412004. A total of 1509 participants from an intervention arm of a cluster randomized controlled trial were included. A Thai version of the Euro-Qol questionnaire (EQ-5D-5L) was used to determine the HRQOL and associated sociodemographic background, health behaviors and underlying diseases of a representative sample from Maehia, Chiang Mai, Thailand. SPSS version 24 was used to analyze data via descriptive analysis and binary logistic regression.ResultsThe mean age of the participants was 69.31±7.10 years, and nearly a quarter (23.8%) was older than 75 years. The mean EQ index score was 0.81±0.23 and older age, lower educational attainment, unemployment, lack of exercise habits, current smokers, having history of a fall in the last 6 months, diabetes, hyperlipidemia, dependency assessed using Barthel’s Activity of Daily Living (ADL) Index, and depression using the Geriatric Depression Scale (GDS) were more likely to represent HRQOL-related problems.ConclusionOur findings have highlighted the factors affecting the HRQOL of community-dwelling older adults which could be of importance in preparing for active and healthy aging communities. The routine dependency assessment using the ADL index will be useful in estimating the HRQOL of the aging population. Fall prevention programs are also recommended to reduce dependency. Moreover, the association of having diabetes and hyperlipidemia with problems in HRQOL dimensions highlight the need for public health intervention not only to prevent the increasing burden of non-communicable diseases but also to improve the HRQOL of older adults.

The Relationship Between Vitamin D and Activity of Daily Living in the Elderly.

ObjectiveTo analyze the association between vitamin D and the performance of activity of daily living in the elderly.MethodsA total of 94 patients over the age of 65 were eligible to participate if they had undergone a bone mineral density test and if they were in a stable health condition. Subjects were further divided into two groups according to activity of daily living (ADL): the score over 40 of the patients as the high ADL group and the below as the low ADL group.ResultsAccording to univariate analysis, the mean of total hip T score, serum creatinine/cystatin C ratio (CCR), and vitamin D were significantly different between the two groups (P=0.024, 0.008, 0.010). Multivariate ORs showed that the CCR (OR: 0.948; 95%CI: 0.910–0.989; P=0.013) and vitamin D (OR: 865; 95%CI: 0.752–0.994; P=0.047) were inversely associated with having low ADL. Furthermore, on multiple linear regression analysis, the Barthel ADL index was related to geriatric nutritional risk index (GNRI), CCR and vitamin D but independent of patients’ age with the slope of 0.732, 0.539, and 0.689 separately, reflected the stronger relative within the variables.ConclusionWe demonstrated that there is a negative correlation of CCR and vitamin D with having low ADL in elderly population. Monitoring the trend of serum vitamin D and CCR, may have a role in the early detection of low ADL with loss of muscle mass and strength in the population of the elderly.

Factors of independent of activities of daily living among osteoarthritis elderly

&lt;p&gt;The aim of this cross-sectional study was to determine the relationship between ability to carry out activities of daily living (ADL) independently and functional ability, mental status, exercise habits, and other factors, among elderly people with osteoarthritis (OA) at Pleret Bantul, Indonesia. Measures included Katz Index of Independence in ADL, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short portable mental status questionnaire (SPMSQ). Chi-square analyses odds ratios (OR) were calculated. The study results showed that the ADL independence among the sample was associated with younger age OR=.347; 95% CI =.253-.477), exercise habit OR=7.07; 95% CI=2.86-17.47) and functional ability (OR=2.34; 95% CI=1.82-3.01). There was no relationship between living situation or mental status and ADL. These findings can be used as information to design programs to support independence in ADLs among elderly persons with OA in Indonesia.&lt;/p&gt;

Effects of the Robot-Assisted Gait Training Device Plus Physiotherapy in Improving Ambulatory Functions in Patients With Subacute Stroke With Hemiplegia: An Assessor-Blinded, Randomized Controlled Trial

ObjectiveTo investigate the effects of the robot-assisted gait training (RAGT) device plus physiotherapy vs physiotherapy alone in improving ambulatory functions in patients with subacute stroke with hemiplegia. DesignA prospective, assessor-blinded, randomized controlled trial. SettingPatients with subacute stroke with hemiplegia admitted at the Rehabilitation Center. ParticipantsTwenty-six patients with subacute stroke with hemiplegia (N=26). InterventionAll patients received 30 training sessions (5 d/wk for 6 wk), which included conventional physiotherapy training (60 minutes) and ambulation training (60 minutes). In the ambulation training session, the RAGT device group received robotic training (40 minutes) and ground ambulation training (20 minutes). The control group received only ground ambulation training (60 minutes). The outcomes were assessed at the initial session and at the end of the 15th and 30th sessions. Comparisons within groups and between groups were conducted. Main Outcome MeasuresPrimary outcome variables were the FIM-walk score and the efficacy of FIM-walk. ResultsThe RAGT device group showed greater improvements from baseline than control in (1) the FIM-walk score at the end of the 15th session (P=.012), (2) the efficacy of FIM-walk at the end of the 15th session (P=.008), (3) walking distance in the 6-minute walk test at the end of the 15th session (P=.018), (4) the Barthel Index for Activities of Daily Living (ADL) at the end of the 30th session (P<.001), and (5) gait symmetry ratio at the end of the 30th session (P=.044). Other gait parameters showed tendencies of improvement in the RAGT device group, but there were no significant differences. ConclusionsRAGT devices plus physiotherapy showed early improvements in walking ability and Barthel ADL index compared with the ground level training plus physiotherapy in patients with subacute stroke with hemiplegia.

Sociodemographic Determinants, Health Conditions, and Mental Status as Predictors of the Functional Status of Older Saudi People

The increasing population of Saudi elderly demands adequate assessment of their functional health status and mental status to improve their health and quality of life. This study aimed to determine the functional status of older Saudi people in performing basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and its influencing factors. This quantitative, descriptive-correlational study surveyed a total of 203 participants using the Mini-Mental State Examination, Katz Index of ADL, and Lawton IADL. Overall, the participants had moderate cognitive impairment and were able to perform basic ADLs and IADLs independently, but they needed assistance in doing housework. Functional status was sensitive to their sociodemographic characteristics, presence of health problems, and mental status. Mental status, education, employment, marital status, and source of support were significantly associated with their ability to perform basic ADLs and IADLs. This study suggests that more efforts are needed to understand the sociodemographic characteristics, presence of health problems, and mental status that support the development of evidence-based public health policy on the functional status among older Saudi people. The findings can be utilized by hospital and nursing administrators to initiate educational and training programs for healthcare professionals including nurses and to create healthcare policies so that the health concerns and functional difficulties of older patients are adequately addressed.

Geography matters to disability: regional disparity of bathing difficulty among older adults in China

Bathing is a major type of disability among older adults. While studies on bathing difficulties have recently started to go beyond the limitations of the human body to examine bathroom amenities; researchers have rarely considered the environment beyond the bathroom. This study explored the regional disparities in bathing disability among older adults in China. Using data from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018, random-effects logistic regressions were performed to examine how bathing difficulties differed across regions among older adults in China. We found that older adults residing in the northern regions were significantly more likely to experience bathing disability compared to those from the South after controlling for confounding variables. Women and the oldest-old were also the most likely to experience bathing disabilities. Within the Northern regions itself, individuals from the Northeast stood out for having the highest likelihood of experiencing bathing disability. Interestingly, this regional disparity only existed for bathing disability and not the other Activities of Daily Living (ADL) items. It is concluded that the large regional disparity could be due to both climate differences and uneven economic development across the different regions in China. As bathing is a highly environment-dependent activity, this study highlights the potential for policy interventions to reduce the prevalence of bathing disability among older adults through improving the bathing environment. Additionally, we aim to put forth the notion that disability research should move towards analyses of specific disability items rather than an undifferentiated ADL index.

Safety of an inactivated SARS-CoV-2 vaccine in elderly persons

Introduction. Brazil has the 2nd highest number of COVID-19 deaths (more than 530,000) and the 3rd highest number of confirmed cases (more than 19 million) worldwide. COVID-19 vaccination is the most effective strategy to prevent new cases and illness, reducing hospitalizations and deaths. The 1st vaccine used in Brazil was the Sinovac/Instituto Butantan CoronaVac, an inactivated SARS-CoV-2 vaccine. Elderly persons (EP) were among the first groups eligible for immunization, after healthcare workers, indigenous people and quilombolas. Objective. To evaluate adverse events following immunization (AEFI) with CoronaVac in EP. Methods. This observational retrospective study was conducted at the Reference Center for Special Immunobiologicals (CRIE) of the Hospital das Clínicas (HC-FMUSP), a tertiary/quaternary hospital attached to the University of São Paulo Medical School (FMUSP), in São Paulo city, from February to April 2021. EP, who searched or were referred to CRIE to receive the COVID-19 vaccine were asked for authorization for follow-up calls to evaluate AEFI. The on phone follow up was made by healthcare workers who conducted AEFI forms on day 4 and day 8 after the first and second vaccine doses; a sociodemographic questionnaire; and a modified functionality scale for EP based on the Independence in Activities of Daily Living index (ADLi), Instrumental Activities of Daily Living scale (IADLs) and Study of Osteoporotic Fractures index (SOFi). Results. During the study period, CoronaVac was used; 159 EP received the first dose and 155 EP were fully vaccinated at CRIE; 152 participants were contacted after the first dose and 142 participants were contacted after the second dose. The participants’ age ranged from 53 to 101 years (mean, 84 years), 65.4% were females, and 73.7% were white. 148 (93.1%) participants have at least one comorbidity, the most common was hypertension (59.8%) followed by heart disease (30.2%) and dyslipidemia (25.2%). 70/152 (46.1%) participants were classified as independent in IADLs, 117/152 (77.0%) in ADLi and 66/152 (43.4%) according to SOFi. 47 participants (30.2%) reported at least one AEFI at first dose. The most common local AEFI was pain at the injection site (13, 8.6%) and the most common systemic AEFI was fatigue (8, 6.0%), followed by headache (6, 4.0%). Thirty participants (21.1%) reported at least one AEFI at the second dose. The most common local AEFI was pain at the injection site (6, 4.3%) and the most common systemic AEFI was myalgia (11, 7.9%), followed by fatigue (9, 6.5%). Most AEFI were mild and had no or little interference in daily activities. There were five severe AEFI: two deaths after the first dose (a sudden death and another following a hemorrhagic stroke) and three hospitalizations (one after the first dose and two after the second dose). None of them were considered related to the vaccine. Discussion and conclusion. This unique studied population was composed of EP with comorbidities and some level of dependency. The participants reported few and mild AEFI, suggesting CoronaVac is safe in EP.