Assessment Of Older Adults Research Articles

Relative Validity and Reliability of Isometric Lower Extremity Strength Assessment in Older Adults by Using a Handheld Dynamometer.

Handheld dynamometry (HHD) is a practical alternative to traditional testing of lower extremity strength. However, its reliability and validity across different populations and settings are not clear. We hypothesize that HHD is a valid and reliable device to assess lower extremity strength in a population of older adults. Cross-sectional/cohort. Level 3. This study included 258 older adults (≥65 years). Isometric knee extension and flexion force were measured by 1 examiner, using an HHD (n = 222), including 3 repetitions to calculate within-day intrarater reliability. These measurements were repeated by the examiner in a subgroup (n = 23) to analyze intrarater reliability over a test-retest period of on average 8 weeks. In addition, HHD force measures were performed by a second examiner (n = 29) to analyze interrater reliability. In another subgroup (n = 77), isometric knee extension and flexion torque were measured by 1 examiner using both the HHD and Biodex System 4 to assess relative validity. HHD and Biodex measurements were highly correlated and showed excellent concurrent validity. HHD systematically overestimated torque as compared with Biodex by 8 N·m on average. Same-day intrarater intraclass correlation coefficients (ICCs) ranged from 0.97 to 0.98. Interrater reliability ICCs ranged from 0.83 to 0.95. HHD represents a reliable and valid alternative to Biodex to rank individuals on leg strength, or to assess within-person changes in leg strength over time, because of the high validity and reliability. The HHD is less suited for absolute strength assessment because of significant systematic overestimations. Clinicians are encouraged to use HHD to rank older adults on leg strength, or to assess within-person changes in leg strength over time, but not to compare readings with cut-offs or normative values.

Assessing moderate-to-vigorous physical activity in hip and knee osteoarthritis using accelerometers: Implications of different patterns and cut-points for health and well-being

ABSTRACT Objective This cross-sectional study explored how using age-specific and non-age-specific cut-points to assess moderate-to-vigorous physical activity (MVPA) measured by GT3X accelerometers affected bouted and total volume MVPA associations with health and well-being. Methods MVPA correlations with physical function, BMI, joint pain, quality of life, anxiety and depression were tested. Steiger’s z compared the strength of these correlations for each pair of cut-points. Results A total of 109 adults with hip/knee osteoarthritis [M= 63.8 years (±10.58), 63.3% women] participated. Applying age-specific cut-points resulted in significantly more time classified as MVPA (76/9.5min total volume/bouted) compared to non-age-specific (38.8/7min total volume/bouted). Only total volume MVPA correlations differed significantly as a function of cut-points for self-reported function, quality of life, anxiety and depression (p ≤ .05). For age-specific cut-points, more time spent in MVPA was associated with a worse psychological profile. Discussion Applying age-specific cut-points for MVPA assessment in older adults with lower limb OA had implications for MVPA associations with health and well-being when total volume, but not bouted, MVPA was considered. Age-specific total volume MVPA needs further understanding regarding patterns and affective responses it comprises. Bouted MVPA is an important pattern for MVPA accrual, but probably not an applicable PA target for many patients.

Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses.

To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05). These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.

Supplemental Material for The Complementary Utility of Cognitive Testing and the Medication Management Ability Assessment in Older Adults

Supplemental Material for The Complementary Utility of Cognitive Testing and the Medication Management Ability Assessment in Older Adults

Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults

Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p<.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

Social Participation and Elder Mistreatment in a National Sample of Older Adults

Little is known about how social participation influences older adults' susceptibility to elder mistreatment. We conducted a cross-sectional analysis of a national probability sample of community-dwelling U.S. adults from 2015-2016 (1,268 women and 973 men; mean age 75 and 76 years, respectively; 82% non-Hispanic white). Frequency of participation in formal activities (community meetings, religious services, and volunteering) and informal social activities (socializing with friends and family) was assessed by questionnaire. Additional measures assessed emotional, physical, and financial mistreatment since age 60. Multivariable logistic regression examined associations between social participation and elder mistreatment, adjusting for age, race/ethnicity, education, and comorbidity. Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly formal social participation were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.57, 95% confidence interval (CI) 1.08-2.29) and financial mistreatment (AOR 1.56, 95% CI 1.02-2.38) than women with less frequent engagement. Older women who socialized at least weekly were more likely to report emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85). These associations were not seen among older men. Frequent social engagement in the community does not preclude risk for elder mistreatment, and informal socializing may be associated with decreased exposure to certain forms of mistreatment. Assessment of older adults’ social activities may help guide strategies for detecting and mitigating elder mistreatment in the community.

How Has COVID-19 Impacted Older Adults and Their Needs for Services?

COVID-19 has had profound effects on older adults and will have lasting impacts on their preferences and needs for services, including those offered by Meals on Wheels and other community organizations. Organizations serving older adults would benefit from insights about how to prioritize resources and services to address older adults’ needs during the pandemic and beyond. On behalf of Meals on Wheels America, NORC at the University of Chicago conducted a study to explore COVID-19’s impacts on older adults and older adults’ needs during the pandemic. We conducted two data collection activities with adults age 60 and older: a nationally representative survey with 1,535 respondents and 24 interviews. Results indicated that COVID-19 has affected older adults’ physical and mental health, social connectedness, employment, and use of services and technology. Informal networks of family members and friends are a source of assistance for 50% of older adults during the pandemic. Impacts of COVID-19 differed by income, rurality, disability status, and living situation. Findings documented the extent to which older adults had unmet needs during the pandemic, such as activities to help keep busy at home and affordable food to meet dietary needs. Survey respondents who have a lower income, are 75 and older, live alone, and who are Black were more likely to have unmet needs. Findings suggested a need to strengthen partnerships among organizations that serve older adults to address diverse needs, conduct ongoing assessments of older adults’ needs and preferences, and enhance assistance for informal support networks.

Age Differences in Personality Structure

Most investigations in the structure of personality traits do not adequately address age, as few studies look at the structure of personality traits a-theoretically, instead presupposing a theoretical structure e.g., Big Five. As a result, the relationship among indicators within a trait (coherence) are often highlighted but relationships across traits (differentiation) are not thoroughly examined. Using a large-scale sample of 369,151 individuals ranging in age from 14 to 90, the present study examines whether personality indicators show differential relationships as a function of age. Results indicate that coherence shows few changes across the lifespan, while differentiation weakens across adulthood into old age. These finding suggest that Big Five indicators only parallel the Big Five structure among young but not older adults. Thus, using standard Big Five personality trait assessments in older adults may, at best, not reflect reality and, at worse, undermine the predictive utility of personality traits.

Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018)

Protein plays a critical role in healthy aging. Little research exists regarding the association between meal program participation and protein consumption among individuals 65 and older. The objective of this research is to provide health professionals with a better understanding of how meal program participation through delivery services or congregate sites may relate to nutritional status. We analyzed cross-sectional data on 2845 individuals ≥65 years old who participated in the National Health and Nutrition Examination Survey (NHANES) during 2013-2018. Using linear regression models, we explored relationships between meal participation and covariates ( sex, race, marital status, income, and age) on protein intake. Protein intake did not differ significantly between individuals who participated in meal programs and those who did not. However, among individuals who answered whether or not they participated in meal programs, race was significantly associated with decreased protein intake. Non-Hispanic Blacks experienced a two-day average 8.82 grams lower [SE:1.48; p<.0001] that their white counterparts. Similarly, Hispanic/Latinos’ two-day protein average was 4.29 grams lower [SE:2.05; p=0.0426]. The association between earning an income of <$20,000 per year and protein intake was also statistically significant [β: -8.44. SE:2.4, p=0.0014]. Understanding protein intake among older adults who utilize meal programs is a gap in current literature. Results from this research may inform questions that health professionals should include in their assessments of older adults and provide guidance for nutrition policies and meal programs for people over 65.

Geriatric Oncology in the Instagram Era: PhotoVoice to Enable Patient-Centered Care and Shared Decision Making

Evidence shows that multidimensional assessment of older adults with cancer yields more holistic care and results in better communication about age-related concerns; as well as enables personalised, patient-centered supportive care. Geriatric assessment (GA) captures clinical, physical and psychological factors, with limited opportunity to gather information about the patient’s environment, personal contexts and priorities. We trialed the feasibility and acceptability of geriatric assessment (GA)-guided enhanced supportive care (ESC) among 20 adults aged over 70 years in a regional cancer center. We then studied the impact of the integration of four patient-derived photographs (with PhotoVoice analysis) to this ESC on patient satisfaction with communication with the oncologist regarding age-related concerns and on facilitating empowerment, patient-centered care and shared decision making. The use of PhotoVoice analysis of patient-derived photographs is a novel strategy that can facilitate gathering patient-centered information during the assessment process.

Short-Term Fluctuation of Subjective Age and its Correlates: An Ecological Momentary Assessment of Older Adults

We examined short-term fluctuations of subjective age with data obtained from 123 young-old (Mage = 67.19 years) and 47 old-old adults (Mage = 86.59 years) who reported their momentary subjective age six times a day over seven consecutive days as they were going about their everyday lives. Participants felt younger on a large majority of occasions, and 25% of the total variability in subjective age could be attributed to within-person variation. Those with younger trait subjective ages exhibited larger moment-to-moment variation, while chronological age did not impact variability. Furthermore, we investigated relationships between within-day fluctuations of subjective age and daily cortisol fluctuations. Our findings extend the literature on subjective age by showing that how old people feel can vary on a momentary basis, that state and trait components of subjective age are related, and that fluctuations in subjective age are related to biomarkers of stress.

Gait Speed and Grip Strength Are Predictors of Cognitive Decline and Dementia in Older Individuals.

Lower gait speed and grip strength are common in older adults. However, the results of lower motor function on cognitive outcomes have been mixed. We examined the longitudinal association between baseline slow gait speed and weak grip strength, alone and in combination, with risk of incident dementia or cognitive decline in a cohort of older adults. Participants (n=19,114) aged 70 and over (65 if U.S. minority) without documented evidence of dementia, significant cognitive impairment, physical disability or previous cardiovascular disease at baseline, were recruited from community settings. Incident dementia was adjudicated by an expert panel using DSM-IV criteria. Incident cognitive decline was defined as a persistent intra-individual decline in score of >1.5 SD from baseline on any of the cognitive tests. Using cox proportional hazard models, slow gait speed at baseline was associated with an increased risk of dementia (63%) and cognitive decline (43%), over a median 4.7 years. Weak grip strength was not as strong a predictor, but was also associated with risk (43% and 11%, respectively). Both outcomes showed higher risk for dementia than cognitive decline. There was no gender-specific interaction. When considered together (adjusted for one another), gait speed and grip strength were both independently associated with cognitive decline and dementia. The synergistic association of these physical measures, each of which is readily administered in the clinic or home, serve as effective early markers of increasing risk of cognitive decline and incident dementia and thus, should be considered for routine health assessments for older adults.

Feasibility and Acceptability of the Technology-Based Fall Risk Assessments for Older Adults

Promising technologies, which are simple, portable, quick, non-invasive, and inexpensive, may open new horizons on fall risk assessments and provide important information for older adults. We used a mixed-methods approach to examine the feasibility and acceptability of technology-based fall risk assessments, including the BTrackS Balance System, Bioelectrical Impedance Analysis, and activity monitoring devices among older adults. Data were collected via a Qualtrics survey and interviews. The acceptability was measured by the Senior Technology Acceptance (STA) and semi-structured interviews with 15 participants. The STA consists of four domains with 14 items, and the semi-structured interview includes three main questions related to experiences about balance performance tests, body composition, and activity monitoring. One hundred twenty-four community-dwelling older adults completed the online survey, and 15 older adults participated in the interviews. The majority of participants were female, and 72% had no history of falls. Race and ethnicity were 17% Hispanic, 7% African Americans, and 3% Asian Americans. About 7% had COVID-19 positive, 31% reported fear of COVID, and 14.5% were afraid of losing their life to COVID. The word-of-mouth strategy and key person approach were used and had an incredible impact on the recruitment process. None of the participants had ever had their fall risk and fear of falling assessed before agreeing to participate in this study. The technology-based fall risk assessments were feasible and acceptable. About 78% of participants liked the idea of using technology to assess falls risk, and 79% agreed that using technology would enhance their effectiveness in daily activities.

Telehealth‐based assessment of cognition in older adults during COVID‐19 and beyond

BackgroundEvidence supporting the use of telehealth techniques in the assessment and diagnosis of dementia has been growing steadily. This began with the use of telephone‐based cognitive screening in the 1980s and televideoconference‐based assessments in the 2000s. The COVID19 pandemic brought telehealth suddenly to the forefront of healthcare, particularly for aging and at‐risk populations, as well as for clinical providers and researchers. While clinicians have been challenged to continue to provide patient care in a safe manner, researchers have been faced with the challenge of maintaining study protocols and continuing to advance the science of dementia. Fortunately, a growing body of research has demonstrated the feasibility, reliability, validity, and consumer acceptability of telehealth‐based assessment procedures, including teleneuropsychological (teleNP) techniques.MethodWe first reported results from a study of 202 adults age 50‐85 using a brief battery of common neuropsychological tests administered via teleNP vs in‐person in counterbalanced fashion which showed generally strong intraclass correlations (Cullum et al., 2014). Additional studies have since examined the validity and consumer acceptability of teleNP assessment in older adults, including recent reviews and findings from surveys and observations using teleNP during the COVID19 pandemic.ResultOur initial investigation revealed essentially equivalent results across teleNP vs traditional in‐person test conditions, with intraclass correlations around .80 and high levels of satisfaction with the procedures. Additional findings revealed validity by the discrimination of impaired and non‐impaired older adults with and without cognitive impairment similar to traditional in‐person assessment. Subsequent studies and reviews have added to this growing body of literature supporting the use of teleNP in older adults.ConclusionIn this presentation, the literature supporting the evidence for telehealth applications in the assessment and diagnosis of dementia will be reviewed, along with commonly used assessment instruments. A critical review of the strengths and limitations of remote clinical/cognitive evaluations as applied to aging individuals with and without cognitive impairment will be provided, along with practical recommendations for application of these procedures, including in‐home and computerized evaluations. Last, needs, opportunities, and future directions for remote cognitive assessment in clinical and research settings, including large‐scale surveillance and treatment studies, will be discussed.

Web-based software applications for frailty assessment in older adults: a scoping review of current status with insights into future development

BackgroundA crucial aspect of continued senior care is the early detection and management of frailty. Developing reliable and secure electronic frailty assessment tools can benefit virtual appointments, a need especially relevant in the context of the COVID-19 pandemic. An emerging effort has targeted web-based software applications to improve accessibility and usage. The objectives of this scoping review are to identify and evaluate web-based frailty assessment tools currently available and to identify challenges and opportunities for future development.MethodsWe conducted a review with literature (e.g., using MEDLINE databases) and Google searches (last updated on October 10, 2021). Each of the identified web applications were assessed based on eight featured categories and assigned a rating score accordingly.ResultsTwelve web-based frailty assessment applications were found, chiefly provided by the USA (50%) or European countries (41%) and focused on frailty grading and outcome prediction for specific patient groups (59%). Categories that scored well among the applications included the User Interface (2.8/3) and the Cost (2.7/3). Other categories had a mean score of 1.6/3 or lower. The least developed feature was Data Saving.ConclusionsWeb-based applications represent a viable option for remote frailty assessments and multidisciplinary integrated care of older adults. Despite the available web-based frailty assessments on the Internet, many missed certain needed features for professional use in healthcare settings. This situation calls for fully comprehensive web-based applications, taking into consideration a number of key functions linking graphical user interface and functionalities, and paying special attention to secure data management.

Can Virtual Assistants Perform Cognitive Assessment in Older Adults? A Review.

Community-dwelling older adults have raised the scientific community’s interest during the COVID-19 era as their chronic conditions might be aggravated by the consequences of confinement. Digital devices in this field to monitor cognitive impairment are an emerging reality of an innovative nature. However, some groups may not have benefited from these developments as much as, for example, younger people. The aim of this manuscript is to carry out a review on the development of digital devices, and specifically virtual assistants, for the detection of cognitive impairment in older adults. After a screening process, eight studies were found under the given criteria, and this number was even smaller for those using virtual assistants. Given the opportunities offered by virtual assistants through techniques such as natural language processing, it seems imperative to take advantage of this opportunity for groups such as older adults.

Minimal Clinically Important Difference of Executive Function Performance in Older Adults Who Fall: A Secondary Analysis of a Randomized Controlled Trial

Introduction: Executive function is responsive to exercise and predictive of subsequent falls. Minimal clinically important differences (MCIDs) are critical for understanding whether observed changes are meaningful. However, MCIDs of many cognitive measures are not established. We aimed to determine MCIDs of the Digit Symbol Substitution Test ([DSST] processing speed measure), Stroop (inhibition measure), and Trail Making Test B-A (TMT; set-shifting measure), using anchor- and distribution-based approaches in older adults who have fallen and received the Otago Exercise Program (OEP) relative to usual care only (CON). Our secondary aim was to establish construct (convergent and divergent) validity of these measures. Methods: Complete case analyses of cognitive outcomes (DSST, Stroop, TMT, and Montreal Cognitive Assessment [MoCA]) were acquired at baseline and 1 year (NCT01029171; NCT003235960); participants were randomized to the OEP (n = 114/172; Age: 80.6 ± 6.1 years; 64.9% Female) or CON (n = 128/172; Age: 82.3 ± 5.8 years; 71.9% Female)]. The MoCA was used as the anchor. We estimated MCIDs using anchor- and distribution-based approaches. Anchor-based executive function change differences ([CD] 1 year minus baseline) observed in participants with meaningful changes in the MoCA (≥3 or ≤ −3 points) receiving the OEP were subtracted from the CON. An anchor-based receiver operator characteristic (ROC) curve was employed to identify optimal cut-off scores of the 3 executive function measures. The distribution-based approach (DA) accounted for variability in baseline and follow-up data. MCID ranges were estimated using these approaches. We used Spearman’s correlations to explore convergent validity between executive function measures and other measures involving the same construct (DSST, Stroop, TMT, MoCA, and Mini-Mental State Examination), and divergent validity between executive function measures and variables reflecting different constructs (Geriatric Depression Scale, Instrumental Activities of Daily Living, sex, and body mass index). Results: Based on the 3 approaches, MCID improvement ranges were 3–5 symbols for the DSST (CD = 5; ROC = 2.5; DA = 3.3 symbols), and −11.5 to −26.0 s for the Stroop (CD = −26.0; ROC = −11.5; DA = −20.6 s). MCID decline ranges were −3 to −6 symbols for the DSST (CD = −5.2; ROC = −2.5; DA = −3.3 symbols) and 5.4–30.6 s for the Stroop (CD = 30.6; ROC = 5.4; DA = 20.6 s). MCIDs for the TMT were not meaningful due to high variability (Improvement: CD = −106.6; ROC = −18.4; DA = −69.1 s; Decline: CD = 69.1; ROC = 14.5; DA = 69.1 s). The executive function measures exhibited good convergent (r = −0.22 to r = 0.42) and divergent (r < −0.01 to r = 0.16) validity. Conclusions: These established MCIDs will allow clinicians to interpret meaningful changes in executive function following exercise amongst older adults who have fallen. The DSST, Stroop, and TMT demonstrated good construct validity, supporting their use in comprehensive fall-risk assessments in older adults who fall.

Advancement in the medicolegal requirement for testamentary capacity assessment in older adults: the dilemmas in Hong Kong

Medical and legal professionals are increasingly involved in probate disputes in which the validity of a will due to a lack of testamentary capacity in older adults is frequently challenged. The legal test for testamentary capacity under common-law jurisdiction was established in the famous case of Banks v Goodfellow (1870). The High Court of Hong Kong recently issued new practice guidance for legal professionals on the preparation of a will for older adults. This paper discusses the dilemmas and competing issues among different parties on this medicolegal interface based on recent literature and local examples. We recommend a risk-based pragmatic framework for legal and medical professionals to minimise potential disputes in testamentary capacity assessment.

Telephone Administration of the Automated Self-Administered 24-hour Dietary Assessment in Older Adults: Lessons Learned.

Automated Self-Administered 24-hour Dietary Assessment (ASA24) is an economical method of estimating dietary intake as nutrient analysis is automated, but its use in older adults is limited. The purpose of this work was to guide dietitians and future researchers on how to use the ASA24 with older adults, considering potential barriers encountered and strategies used to support completion based on our experience using this tool in a pilot clinical trial. ASA24 was completed by phone interview with 39 older adults. Challenges included: recalling food intake in detail, recording frequent eating occasions and complicated recipes, and general problems with communication. Strategies to support collection included making morning phone calls and suggesting that seniors write down the food consumed. Phone interviews were acceptable to older adults, but sufficient time was required. Dietitians and future researchers can use these findings to obtain dietary intake data from this hard-to-reach group.

Assessment of older adults' decision-making capacity in relation to independent living: A scoping review.

With a growing global ageing population, approaches to assess and support decision-making are becoming more pertinent. This scoping review aimed to identify and map current knowledge on assessment of older adults' decision-making capacity in relation to independent living. A five-stage scoping review framework was followed. Inclusion criteria were papers on assessment approaches used to evaluate decision-making capacity of older adults, aged 60years and over for independent living, including studies involving people with cognitive impairment and dementia. Five databases were searched for publications with eligibility criteria from January 2000 to December 2020; 4,118 results were retrieved from sources, resulting in 29 publications being analysed, eight of which were research reports. Publication characteristics and methodologies varied; however, many common components of decision-making capacity assessment for independent living were identified including cognitive, functional, environmental and risk assessment. Overall, a multidisciplinary approach was recommended, and consideration of the person's values and preferences is noted in many publications. Decision-making capacity assessment for independent living of older adults requires multicomponent, multidisciplinary assessment. Future work is needed to examine this from the perspective of older adults and their caregivers.