Baseline Activities Of Daily Living Research Articles

Hospital Associated Disability among Older Adults with Plasma Cell Disorders Receiving Autologous Stem Cell Transplant

Background: Increasing number of older adults with Plasma Cell Disorders (PCDs) are receiving autologous stem cell transplant (ASCT) in the US. Hospital associated disability (HAD) is a common complication associated with acute care hospitalization among older adults. Objectives: To estimate the prevalence and prognostic significance of HAD among older adults with MM undergoing ASCT Study Design: This retrospective cohort study used consecutive adults ≥18y with PCD receiving ASCT at a single institution between 1/2013 and 5/2023. Trained nursing staff assessed Katz Activities of Daily Living (ADL) at admission and every 3 days thereafter under our Virtual Acute Care for Elders program. The primary outcome was development of HAD defined as ≥1 point decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. We examined the association between putative risk factors such as age, Karnofsky performance status (KPS), baseline ADL score, Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) and HAD using modified Poisson regression models with robust variance estimators. Subsequently, we studied the impact of HAD on downstream adverse events including 30-day readmission rates and long term survival. Results: We included 778 adults with a median age of 62y (QR 56-68y), with 56% males and 55% non-Hispanic Whites. In the overall population, 112 (14.4%) developed HAD, with much higher incidence among older adults ≥65y compared to those <65y at ASCT (22% vs. 9%, p value<0.01). In multivariable analysis, increasing age (RR 1.56; 95% CI 1.25-1.94, per 10y increase), female sex (RR 1.79; 95% CI 1.27-2.53) and KPS ≤70 (RR 2.55; 95% CI 1.32-4.94) were associated with an increased risk of developing HAD. As compared to those without, patients with HAD had a two-fold higher risk of 30-day readmission (95% CI 1.16-3.39) and a 3.7 fold increased risk of all-cause mortality (95% CI 2.15-6.22). Conclusions: Nearly one in 4 older adults ≥65y developed HAD while undergoing ASCT which was associated with a two-fold increased risk of 30-day readmission. Interventions to prevent HAD and its downstream consequences are critically needed.

Serum 25-Hydroxyvitamin D and Risk of Disability in Activities of Daily Living among the Oldest-Old: An Observational and Mendelian Randomization Study

BackgroundVitamin D deficiency and disability are both prevalent among older adults. However, the association between them has rarely been investigated in the oldest-old subjects (aged ≥80 y), and the causality remains unclear. ObjectiveThis study aimed to elucidate the causal effect of vitamin D on the incident risk of disability in activities of daily living (ADL) among Chinese oldest-old based on the 2012–2018 Chinese Healthy Ageing and Biomarkers Cohort Study. MethodsSerum 25-hydroxyvitamin D [25(OH)D] concentrations and ADL status at baseline and follow-up interviews were documented. Cox regression models were applied among 1427 oldest-old (mean age, 91.2 y) with normal baseline ADL status. One sample Mendelian randomization (MR) analyses were performed on a subset of 941 participants with qualified genetic data, using a 25(OH)D-associated genetic risk score as the genetic instrument. ResultsDuring a median follow-up of 3.4 y, 231 participants developed disability in ADL. Serum 25(OH)D concentration was inversely associated with the risk of disability in ADL [per 10 nmol/L increase hazard ratio (HR) 0.85; 95% CI: 0.75, 0.96]. Consistent results from MR analyses showed that a 10 nmol/L increment in genetically predicted 25(OH)D concentration corresponded to a 20% reduced risk of ADL disability (HR 0.80; 95% CI: 0.68, 0.94). Nonlinear MR demonstrated a monotonic declining curve, with the HRs exhibiting a more pronounced reduction among individuals with 25(OH)D concentrations below 50 nmol/L. Subgroup analyses showed that the associations were more distinct among females and those with poorer health conditions. ConclusionsOur study supports an inverse causal relationship between serum 25(OH)D concentration and the risk of disability in ADL among Chinese oldest-old. This protective effect was more distinct, especially for participants with vitamin D deficiency. Appropriate measures for improving vitamin D might help reduce the incidence of physical disability in this specific age group.

RACIAL–ETHNIC DISPARITIES IN STRESS EXPOSURE AND THE ONSET OF LATER-LIFE LIMITATIONS IN ACTIVITIES OF DAILY LIVING

Abstract This study investigates the relationship between stress exposure – including cumulative stress burden and domain-specific stressors – and the onset of activities of daily living (ADL) limitations in later life and examines whether there are racial-ethnic and nativity differences in this relationship. Examining data from the Health and Retirement study (HRS), we apply logistic regression and Weibull accelerated failure-time models to examine associations between stress and baseline ADL limitations as well as stress exposure and age of onset of ADL limitations over a decade. Interaction tests between stress and race-ethnicity and nativity were employed to understand how stress exposure uniquely influences ADL limitations among White, Black, US-born Hispanic, and foreign-born Hispanic older adults. Black, US-born Hispanic, and foreign-born Hispanic adults were more likely to develop an ADL limitation at a younger age compared to White adults (β = -0.06; β = -0.07; β = -0.09; respectively). Cumulative stress burden, childhood traumatic events, adult financial strain, everyday discrimination, and major lifetime discrimination were associated with an earlier onset of ADL limitation among White, Black, US-born Hispanic and foreign-born Hispanic adults. Further, US-born Hispanic adults that experienced the same amount of childhood traumatic events as White adults experienced an earlier transition to ADL limitation by a factor of 0.65 or in about 35% of the time. Reducing racial-ethnic and nativity disparities in ADL limitations in later-life will require efforts to adjudicate the long lasting historical and structural disadvantages that contribute to differential stress exposure across the life course.

Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia

Most older adults living with dementia ultimately need nursing home level of care (NHLOC). To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management. This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023. Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions. The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots). Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk. This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.

Bidirectional association between handgrip strength and ADLs disability: a prospective cohort study.

Decreased handgrip strength (HGS) and activities of daily living (ADL) disability are common in aging populations. No studies have evaluated the bidirectional associations between HGS and ADL disability. This study aimed to explore the bidirectional effects of HGS and ADL disability. This study analyzed data from two waves (2011 and 2015) of China Health and Retirement Longitudinal Study (CHARLS). Low HGS is defined by the Asian Working Group for Sarcopenia criteria. Meanwhile, disability was assessed by ADLs scale. The prospective bidirectional association between HGS and ADL disability was examined using binary logistic regression. Subgroup analysis were performed according to age and gender. A total of 4,902 and 5,243 participants were included in the Stage I and Stage II analyses, respectively. On the one hand, low HGS was significantly associated with subsequent ADL disability. The odds ratio (OR) value of developing BADL disability and IADL disability were 1.60 (95% confidence interval (CI): 1.23-2.08) and 1.40 (95% CI: 1.15-1.70), respectively, in participants with low HGS. On the other hand, baseline ADL disability was associated with an increased risk of developing low HGS. The OR value of developing low HGS were 1.84 (95% CI: 1.34-2.51) and 1.46 (95% CI: 1.19-1.79) for participants with BADL disability and participants with IADL disability, respectively. Lastly, the strength of the bidirectional associations varied among subgroups. A significant bidirectional associations were identified between HGS and ADL disability. Interventions should be developed to prevent the development or progression of both low HGS and ADL disability.

The Prognostic Utility of a Geriatric Assessment for Patients with Pancreatic Cancer Receiving Gemcitabine-based Chemotherapy: A Prospective Observational Study.

Objective To evaluate the effect of a pretreatment geriatric assessment on the clinical outcomes in older patients with unresectable or recurrent pancreatic ductal adenocarcinoma (PDAC) scheduled to receive gemcitabine (GEM)/GEM+nab-paclitaxel (GnP). Patients Older patients with unresectable PDAC scheduled to receive GEM/GnP who visited Kyorin University Hospital and cooperating institutions were enrolled and followed from April 2015 to March 2020. The maximum observation period was two years. All patients underwent a cancer-specific geriatric assessment (CSGA) and optional geriatric assessment (GA) before treatment initiation and two months after the start of treatment. The patients' background characteristics, tumor progression, tumor site, and regimen (GEM/GnP) were examined in a Cox proportional hazards model. The relationship between the overall survival (OS) and GA score was also determined. Eligible patients (age ≥70 years old with histopathologically confirmed unresectable or recurrent PDAC) were scheduled to receive first-line chemotherapy. Results The performance status (PS) and activities of daily living (ADL)/instrumental ADL (IADL) scores at baseline correlated with the OS. Furthermore, even in cases with normal baseline values, lower Frontal Assessment Battery scores and higher Geriatric Depression Scale-Short Form scores after treatment initiation were significantly correlated with OS. Conclusion The baseline PS, ADL, and IADL may be prognostic factors in older PDAC patients. In addition, a normal frontal lobe function and depression scores prior to treatment initiation that rapidly worsened during treatment were independently associated with a reduced OS. Selecting appropriate interventions and improving the therapeutic environment may prolong the OS in such patients.

Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia.

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.

Hospital-Associated Disability Associated With Delirium Among Older Adults

Hospital-associated disability (HAD), defined as a loss of activities of daily living (ADLs) occurring during hospitalization, is a common complication among older adults. Delirium is also a common complication during hospitalization and is associated with multiple long-term sequelae. We sought to determine the effect of delirium and known covariates on the risk of incident HAD in hospitalized older adults. We examined electronic health record (EHR) data for 35,201 older adults ≥ 65 years of age admitted to the general inpatient (non-ICU) units of UAB Hospital from January 1, 2015 to December 31, 2019. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission, and HAD defined as a decline on the Katz ADL scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations for individuals with multiple admissions. We found that 21.2% of older adults developed HAD during their hospitalization and experienced higher delirium rates as compared to those not developing HAD (25.2% vs. 16.3%). Presence of delirium, medical comorbidity score, baseline cognitive status, and baseline ADL function were associated (all p <0.001) with incident HAD. Mediation analyses also showed that 8% of the effect of comorbidity on incident HAD was due to delirium (p < 0.001). Reducing rates of delirium can be one component of a comprehensive approach to reduce rates of HAD in older adults.

Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit

This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). The total mBI improved from 40.7±33.0 to 63.1±34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change=0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change=0.014), impaired sitting balance (R2 change=0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change=0.006), and the presence of bladder incontinence (R2 change=0.006) assessed by physician upon rehabilitation admission (R2=0.53, p<0.05). Dependency in sitting up, impaired sitting balance, and the presence of urinary incontinence were negative prognostic factors of ADL independence at discharge (p<0.05). By contrast, the Brunnstrom stage of hemiplegic lower limb and baseline mBI scores at rehabilitation admission were positive prognostic factors of ADL independence at discharge (p<0.05). Baseline ADL function was the most important prognostic factor of functional independence in post-acute stroke. Moreover, the activity limitation of dependency on sitting up and motor function impairment of hemiplegic lower limb prognosticated functional independence.

Delirium and Functional Recovery in Patients Discharged to Skilled Nursing Facilities After Hospitalization for Heart Failure

A substantial number of patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization experience regression in function or do not improve. Delirium is one of few modifiable risk factors in this patient population. Therefore, understanding the role of delirium in functional recovery may be useful for improving outcomes. To assess the association of delirium with 30-day functional improvement in patients discharged to SNFs after HF hospitalization. This retrospective cohort study included patients hospitalized for HF in 129 US Department of Veterans Affairs hospitals who were discharged to SNFs from October 1, 2010, to September 30, 2015. Data were analyzed from June 14 to December 18, 2020. Delirium, as determined by the Minimum Data Set (MDS) 3.0 Confusion Assessment Method, with dementia as a covariate, determined via International Classification of Diseases, Ninth Revision (ICD-9) coding. The difference between admission and 30-day MDS 3.0 Activities of Daily Living (ADL) scores. A total of 20 495 patients (mean [SD] age, 78 [10.3] years; 78.9% White; and 97% male) were included in the analysis. Of the total sample, 882 patients (4.3%) had delirium on an SNF admission. The mean (SD) baseline ADL score on admission to SNF was significantly worse among patients with delirium than without (18.3 [4.7] vs 16.1 [5.2]; P < .001; d = 0.44.). On the 30-day repeated assessment, mean (SD) function (ADL scores) improved for both patients with delirium (0.6 [2.9]) and without delirium (1.8 [3.6]) (P < .001; d = -0.38). In the multivariate adjusted model, delirium was associated with statistically significant lower ADL improvement (difference in ADL score, -1.07; 95% CI, -1.31 to -0.83; P < .001). In this retrospective cohort study, patients with HF discharged to SNFs with delirium were less likely to show improvement in function compared with patients without delirium. Findings suggest a potential need to reexamine how and when health care professionals assess delirium in HF patients throughout their hospitalization and SNF course. Identifying and treating delirium for HF patients earlier in their care trajectory may play an important role in improving care and long-term functional outcomes in this population. Future research is warranted to further investigate the association between delirium and functional recovery for HF and other patient populations.

Nursing Home Residents’ Functional Trajectories and Mortality After a Transfer to the Emergency Department

ObjectiveTo describe nursing home residents’ (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED). DesignCase-control observational multicenter study. Setting and ParticipantsIn total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016. MethodsFinite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions. ResultsTrajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2‒time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness. Conclusions and ImplicationsIdentified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. Retrospective cohort study. Academic hospital with ambulatory follow-up. Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

Poor Activities of Daily Living Function Reflect Poor Quality of Life after Hip Fracture Surgery for Geriatric Patients

Introduction: With the aging of the population, hip fractures have become a major public health issue in the elderly. It is important to examine the loss of activities of daily living (ADL) and the quality of life (QoL) among the elderly after repair of hip fracture. The correlation between ADL and QoL over time after hip fracture surgery was also our major concern. Methods: A prospective study enrolling 117 geriatric patients undergoing hip fracture surgery in a tertiary medical center was conducted between 2017 and 2018. All participants were evaluated with the EuroQol-5D for assessing QoL and the Barthel index for measuring ADL function at baseline, 3-and 6-month follow-ups after hip fracture surgery. Results: The mortality rate among geriatric patients after hip fracture surgery was 5.5% at 3 months and 9.1% at 6 months. In addition, both ADL function and QoL significantly deteriorated after 6 months of follow-up without improvement with time. After the 6-month follow-up, only 20% of geriatric patients undergoing repair for hip fracture were able to recover baseline ADL. The QoL at the 6-month follow-up was correlated with both cross-sectional and longitudinal ADL function after repair for hip fracture among geriatric patients. Conclusion: Functional impairment is common among geriatric patients after hip fracture surgery. Poor ADL could predict and reflect poor QoL after the 6-month follow-up. More emphasis should be put on preventing functional loss after hip fracture surgery in order for better QoL among geriatric patients undergoing hip fracture surgery.

Subjective memory complaints and difficulty performing activities of daily living among older women in Australia.

Increased age and cognitive decline have been linked to difficulties with activities of daily living (ADL) and instrumental activities of daily living (IADL). Cognitive decline can often be signalled by complaints about one's cognition, such as memory. With older Australians living longer, there is an increasing proportion of the population at risk of declined performance in daily tasks. The aim of this study was to identify if subjective memory complaints in later life among older women predict changes in independence in performing ADL and IADL. Data were from 3721 women born 1921-1926, who completed Surveys 4-6 of the Australian Longitudinal Study on Women's Health. Memory complaints and difficulties on ADL were measured at each survey, using the Memory Complaint Questionnaire and 16 questions regarding specific ADL. Latent growth modelling examined correlations between initial scores on each measure, changes in measures, and the association between memory complaints and changes in ADL and IADL. There was a significant association between baseline scores for subjective memory difficulty and baseline ADL and IADL scores. Initial memory difficulty was also associated with increase in ADL and IADL difficulty. Subjective memory complaints may be a risk factor for decline in performance on ADL. Attention to these concerns may be important in identifying functional decline in older age.

Hospitalization-associated disability in older adults with valvular heart disease: incidence, risk factors and its association with care processes

Background: The aim of this study was to determine the incidence and recovery of hospitalisation-associated disability (HAD), the associated risk factors, and the link with care processes in patients aged 70 years or older hospitalised with valvular heart disease (VHD).Methods: Prospective cohort study performed on the cardiology and cardiac surgery units of University Hospitals Leuven, Belgium. HAD was defined as the loss of independence to complete one of the Activities of Daily Living (ADLs) between hospital admission and discharge. Recovery of HAD at 30 days post hospital discharge was achieved when patients recovered their baseline ADL status (2 weeks before hospital admission) (ClinicalTrials.gov: NCT02572999).Results: Eighty patients were enrolled in the study, 77 completed the assessment at discharge and 62 responded at 30 days follow-up. Forty patients (51.9%) developed HAD; 18 of them (45.0%) recovered their baseline ADL status. The risk of HAD increased when patients were physically restrained (relative risk (RR) 1.73, 95% confidence interval (CI) 1.20–2.49), had indwelling catheters (RR 1.80, 95% CI 0.85–3.80) and received preventive pressure ulcer measures (RR 1.71, 95% CI 1.07–2.74). Patients with HAD had longer hospital stays (+3 days, p = .011) and longer use of indwelling catheters (+2 days, p = .024).Conclusion: Half of the older adults with VHD developed HAD. The results indicate a potential association between HAD and care processes, which could be used as quality measures and intervention targets. Validation in larger cohort studies is recommended.

Perceived social support moderates the relationship between activities of daily living and depression after lower limb loss.

This study examined the moderating influence of perceived social support on the prospective relationship between baseline levels of activities of daily living (ADL) and depressive symptoms during the 1st year following amputation. Participants included 73 veterans with new/first unilateral lower extremity amputation due to vascular disease or diabetes. Baseline levels of perceived social support, ADL function, and mobility were assessed by retrospective recall 6 weeks after amputation. Depressive symptoms were measured at 6 weeks and 12 months following surgery. Perceived social support moderated the relationship between baseline ADL functioning and depressive symptoms at 12 months (β = -0.27, p < .001) after controlling for 6-week depressive symptoms and sociodemographic and physical/functional variables. Lower levels of baseline ADL function were associated with depressive symptoms at 12 months among those who reported lower levels of perceived social support. These data allowed us to identify those participants with both low ADL function at baseline and low social support as being at higher risk for depression symptoms postamputation. The findings support the stress buffering hypothesis and suggest that perceived social support may be an important modifiable target of intervention among individuals with lower levels of functioning. (PsycINFO Database Record

Survival, Functional Status, and Eating Ability After Percutaneous Endoscopic Gastrostomy Tube Placement for Acute Stroke.

To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement. Retrospective cohort study. A longitudinal nationally representative community-based sample of older adults. Individuals with stroke who had a PEG tube placed (N = 174, mean age 79, 51% female, 29% African American). Functional status before incident stroke was determined based on data from the Health and Retirement Study (HRS), a national longitudinal survey of community-dwelling older adults, from 1993 to 2012. Hospitalizations for stroke and PEG placement were determined according to Medicare claims. HRS participants were interviewed, and outcomes of survivors interviewed in the 2 years after hospitalization are described. Survival and functional and eating ability of the cohort were examined. Groups were compared according to age and prestroke functional disability in activities of daily living (ADLs) because it was hypothesized that ADL disability would predict worse outcomes. In the 2 years after hospitalization, overall mortality was 66%. Fifteen participants survived and regained independent ADL function (9%). Of those who survived to a follow-up interview, 33 (56%) could not eat independently, and 31 (53%) required assistance to walk across the room. Age of 85 and older was associated with worse outcomes (10% vs 29% at 2 years, P < .001), but baseline ADL disability was not. In this community-based sample, individuals who had had a stroke and a PEG tube placed had high mortality, and survivors were unlikely to be functional or mobile or to recover eating ability after hospitalization. A palliative care discussion including goals of care should occur before PEG tube placement is considered.

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

BackgroundPrediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk for poor outcomes. ObjectiveTo develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. DesignCohort study using data from the Medicare Current Beneficiary Survey (MCBS). SettingCommunity survey. ParticipantsThis study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001-2008 entry panels and were followed up for 2 years. MethodsThe index was derived in 60% and validated in the remaining 40%. β Coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. Main Outcome MeasureThe outcome was activity of daily living (ADL) stage transitions over 2 years following entry into the MCBS. Beneficiaries were categorized into 1 of 4 outcome categories: stable or improved function, functional deterioration, institutionalization, or death. ResultsOur model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (P < .05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death. ConclusionPredictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk for functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community. Level of EvidenceIII

P18.02 Prospective evaluation of quality of life in patients with recurrent high grade glioma treated with re-irradiation by tomotherapy based IMRT

Abstract Introduction: Prospective quality of life (QOL) evaluation in re-irradiation (reRT) for recurrent high grade glioma (HGG) is rare but an important endpoint. We report a prospective study of patient reported QOL and activities of daily living (ADL) as primary end point in patients treated with re-irradiation (reRT) for recurrent HGG. Materials and Methods: 34 patients of recurrent HGG with Karnofsky Performance Status (KPS) ≥60 planned for re-irradiation as per joint neuro-oncology meeting decision were included. Image guided intensity modulated radiotherapy (IG-IMRT) was delivered with helical tomotherapy at 1.8 Gy/fraction to 45-55 Gy. Serial QOL and ADL evaluation was done by a trained occupational therapist using validated Indian translations of EORTC QLQ30 + BN20 and Barthel’s ADL Index, before starting reRT and at 1,3,6,9 and 12 months follow up post reRT. Results: At recurrence, 56% HGG were grade 3 and 44% were grade 4 tumours. 65% patients had HGG transformed from a previous low grade glioma. Before reRT, 74% patients had undergone re-surgery and 59% had received salvage chemotherapy with either temozolomide or bevacizumab. Median interval from primary RT was 6.7 years. Planned reRT dose was completed by 91% patients, with 27% requiring treatment interruption. Concurrent chemotherapy was planned for 77% patients, of which 27% required early cessation due to poor tolerance. Concurrent corticosteroid support was required by 41% patients. QOL questionnaires were completed by patients themselves in 85% instances while 15% were filled in proxy by primary caregivers. Mean baseline global QOL score was 61/100, which remained stable up to 50.5/100 at 6 months post reRT. Global QOL was stable in 15/25 patients at 1 month, 13/20 at 3 months, 7/16 at 6 months and 4/10 patients at 1 year post RT. Mean physical and social function scores were stable till 6 months. Emotional, role and cognitive function scores remained stable till 9 months. Mean baseline ADL score was 16.5/20, declining to 14/20 at 9 months post reRT. Among symptom scores, appetite loss and seizures remained stable till 3 months while scores for fatigue, insomnia and weakness of legs were stable till 6 months. Scores for motor dysfunction, communication deficit, nausea and bladder control remained stable till 9 months. Remaining symptom scores showed no significant decline till 1 year post RT. Pseudo progression was seen in 9/34 patients. At the time of analysis, 17/34 patients are alive and on follow-up. Decline in QOL scores at 6 to 9 months coincided with a median progression free survival of 36.5 weeks. Median overall survival was 46.5 weeks. Serial QOL and ADL scores did not correlate significantly with age, sex, KPS, tumour location and grade. CONCLUSION: Clinical experience of re-irradiation in recurrent HGG with IG-IMRT has been encouraging in terms of tolerance and palliation, providing reasonably stable QOL till tumour progression.

MP96-03 FUNCTIONAL OUTCOMES AFTER “MINOR” UROLOGIC SURGERY AMONG NURSING HOME RESIDENTS; A NATIONAL STUDY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2017MP96-03 FUNCTIONAL OUTCOMES AFTER “MINOR” UROLOGIC SURGERY AMONG NURSING HOME RESIDENTS; A NATIONAL STUDY Anne M Suskind, Shoujun Zhao, Louise C Walter, and Emily Finlayson Anne M SuskindAnne M Suskind More articles by this author , Shoujun ZhaoShoujun Zhao More articles by this author , Louise C WalterLouise C Walter More articles by this author , and Emily FinlaysonEmily Finlayson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3026AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgery is commonly performed in frail older individuals seeking care for urologic conditions. While it is known that major urologic surgery is associated with increased morbidity and mortality, outcomes of minor urologic surgery among frail older adults remain unknown. The objective of this study is to explore the long-term functional outcomes associated with minor urologic surgery among nursing home residents. METHODS Using inpatient Medicare claims and the Minimum Data Set (MDS) for Nursing Homes, we identified all nursing home residents who underwent the following minor urologic procedures between 2004 and 2012: cystoscopy, cystoscopy with bladder biopsy, transurethral resection of bladder tumor (TURBT), prostate biopsy, transurethral resection of the prostate (TURP), removal of ureteral obstruction, and suprapubic tube placement. We examined changes in activities of daily living (ADL) and mortality up to 12 months after surgery and examined factors associated with ADL decline and mortality over this time period. RESULTS We identified 37,671 individuals residing in nursing homes who underwent minor urologic surgery during the study period. Mean age was 81.5 (±7.4) years, 63.7% were male and 78.2% of procedures were elective. At baseline, 29.2% experienced declines in ADLs in the past 6 months and 60.3% had cognitive impairment. Following surgery, 11.5% and 48.7% of individuals were dead within 1 and 12 months, respectively, while ADLs declined steadily over this time period (Figure). Poorer baseline ADL status and ADL decline at baseline were both predictors for death or ADL decline in the 12 months following surgery [adjusted HR 1.40 (95% CI 1.28-1.53) for worst quartile of ADL status compared to best quartile] and [adjusted HR 1.38 (95% CI 1.29-1.47)], respectively. CONCLUSIONS Patients undergoing relatively minor urologic surgery experience detriments in function and high rates of mortality in the year following surgery. This information is important to weigh the risks and benefits of any type of surgery, no matter how small, in this vulnerable population. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1295 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Anne M Suskind More articles by this author Shoujun Zhao More articles by this author Louise C Walter More articles by this author Emily Finlayson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...