Basic Activities Of Daily Living Research Articles

Association between disability, social support and depressive symptoms in Chinese older adults: A national study.

ObjectiveDisability and social support can impact depressive symptoms of the elderly. Yet, studies infrequently discuss the moderating role of social support when evaluating the association between disability and depressive symptoms. The purpose of this study was to explore the association between disability, social support, and depressive symptoms among the Chinese elderly, and further examine the moderating effect of social support.Materials and methodsUsing the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) data set, we finally selected 9,231 Chinese elderly after screening. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depressive symptoms in the elderly. Disability was measured by basic activities of daily living (B-ADL) and instrumental activities of daily living (I-ADL). Social support included contact with family and friends, sick care, and money received, measured by five self-reported questions. We used multiple linear regression and moderating model to explore the association between disability, social support, and depressive symptoms.ResultsA total of 9,231 patients were included in this study, and approximately 26.75% of the elderly had depressive symptoms. Study found that depressive symptoms were associated with social support (βB−ADL = −0.108, 95% CI: −0.168– −0.047; βI−ADL = −0.098, 95% CI: −0.156– −0.039), βB−ADL (β = 0.296, 95% CI: 0.248−0.343) and I-ADL (β = 0.174, 95% CI: 0.152–0.195). Moreover, the result also showed that social support moderated the effects of B-ADL ( = 0.034, 95% CI: 0.014–0.053, F = 11.57, p = 0.001) and I-ADL ( = 0.025, 95% CI: 0.017–0.033) on depressive symptoms.ConclusionsThe study suggests that disability and social support can affect depressive symptoms, and social support moderates the effect of disability on depressive symptoms. Therefore, taking effective measures to reduce the elderly disability rate of disability and increase their social support are necessary condition for realizing mental health.

A-274 A Case Study of Progressive Supranuclear Palsy in a 68-year-old with Pronounced Frontal-Executive Deficits Complicated by Cerebrovascular Disease

Abstract Objective: Individuals with Progressive Supranuclear Palsy (PSP) often experience cognitive decline, repeated falls, restricted gaze, bradykinesia, and depression/behavioral changes. Despite having certain distinguishing features neuroanatomically and neurologically, PSP continues to be difficult to classify and distinguish from some other more well-known neurodegenerative and movement-related disorders. Method: A 68-year-old white male presented for a neuropsychological evaluation (2022) initially after his neurologist became suspicious of him having cerebellar degeneration or multisystem atrophy. He reported a progressive one-year decline in memory, motor abilities, and executive functions, along with having personality changes and a loss of independence in his activities of daily living (ADLs). To complicate the differential diagnosis, an MRI of his brain from six months prior simply concluded “age-related changes”. Upon revisiting this MRI and closer visual inspection, focal atrophy of the midbrain became apparent on a sagittal section, in addition to bilateral ischemic changes in the white matter. He was later diagnosed with PSP. Results: Despite demonstrating adequate performance on simple cognitive screening measures, he displayed marked behavioral disinhibition, executive/attention problems, visuospatial concerns, decreased motor abilities, and variable memory functioning that were found to impact his ability to carry out instrumental and even some basic ADLs. Conclusions: Cases such as this one requiring diagnostic clarification lend support to the “hummingbird sign” (midbrain atrophy) being a useful imaging marker in distinguishing PSP from other clinical disorders. Additionally, in contrast to other neurodegenerative disorders, frontal-executive deficits (e.g., disinhibition) were a particularly pronounced feature in his PSP neurocognitive profile, followed by milder difficulties in memory, language, and visuospatial functions.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country.

ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

A multicenter study to compare the effectiveness of the inpatient post acute care program versus traditional rehabilitation for stroke survivors

There is insufficient evidence to prove the effect of the Post-acute Care (PAC) program on post-stroke recovery. This study aimed to determine the effectiveness of the PAC versus traditional inpatient rehabilitation (non-PAC) for middle- and old-aged stroke survivors. This multicenter cohort study enrolled 334 stroke patients admitted for post-stroke rehabilitation. The outcome variables included the Barthel Index (BI), Functional Oral Intake Scale (FOIS), Mini Nutritional Assessment-Short Form (MNA-SF), EuroQoL-5D (EQ-5D), Lawton–Brody Instrumental Activities of Daily Living (ADL) Scale, and Mini-Mental State Examination (MMSE). The inverse-probability-of-treatment-weighting method was used to analyze the differences in outcomes between the PAC and non-PAC groups. The PAC group showed better improvements in BI, MNA-SF, EQ-5D, Instrumental ADL, and MMSE compared to the non-PAC group, with differences in effect sizes of 0.54 (95% confidence interval [CI] 0.38–0.71), 0.26 (95% CI 0.10–0.42), 0.50 (95% CI 0.33–0.66), 0.44 (95% CI 0.28–0.60) and 0.34 (95% CI 0.17–0.50), respectively. The PAC project showed more improvement in basic and instrumental ADL and status of swallowing, nutrition, and cognition than those of non-PAC, which had less length of stay restricted by the National Health Insurance. More studies are warranted to investigate the influence of hospital stay and duration from stroke onset on the PAC’s effectiveness.

Exploring human activity recognition using feature level fusion of inertial and electromyography data.

Wearables are objective tools for human activity recognition (HAR). Advances in wearables enable synchronized multi-sensing within a single device. This has resulted in studies investigating the use of single or multiple wearable sensor modalities for HAR. Some studies use inertial data, others use surface electromyography (sEMG) from multiple muscles and different post-processing approaches. Yet, questions remain about accuracies relating to e.g., multi-modal approaches, and sEMG post-processing. Here, we explored how inertial and sEMG could be efficiently combined with machine learning and used with post-processing methods for better HAR. This study aims recognition of four basic daily life activities; walking, standing, stair ascent and descent. Firstly, we created a new feature vector based on the domain knowledge gained from previous mobility studies. Then, a feature level data fusion approach was used to combine inertial and sEMG data. Finally, two supervised learning classifiers (Support Vector Machine, SVM, and the k-Nearest Neighbors, kNN) were tested with 5-fold cross-validation. Results show the use of inertial data with sEMG increased overall accuracy by 3.5% (SVM) and 6.3% (kNN). Extracting features from linear envelopes instead of bandpass filtered sEMG improves overall HAR accuracy in both classifiers. Clinical Relevance- Post-processing on sEMG signals can improve the performance of multimodal HAR.

Challenges in Basic and Instrumental Activities of Daily Living among Adults with Posttraumatic Stress Disorder: A Scoping Review

Participation is an important measure of disorder severity. Although posttraumatic stress disorder (PTSD) often causes functional impairment, the literature about challenges in basic and instrumental activities of daily living (ADL) among adults with PTSD appears limited. To describe the encountered challenges according to the existing literature, a systematic search identified 20 articles published between 1995 and 2021. These studies described various limitations on ADL among adults with PTSD, mostly (60%) in broad terms; thus, failing to identify the exact challenging domains. This review discusses the need for research and clinical practice to systematically evaluate basic and instrumental ADL in PTSD.

The relevance of geriatric assessments on the association between chronic kidney disease stages and mortality among older people: a secondary analysis of a multicentre cohort study.

Backgroundage-adapted definition of chronic kidney disease (CKD) does not take individual risk factors into account. We aimed at investigating whether functional impairments influence CKD stage at which mortality increases among older people.Methodsour series consisted of 2,372 outpatients aged 75 years or more enrolled in a multicentre international prospective cohort study. The study outcome was 24-month mortality. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Geriatric assessments included handgrip strength, short physical performance battery (SPPB), cognitive impairment, dependency in basic activities of daily living (BADL) and risk of malnutrition. Analysis was carried out by Cox regression, before and after stratification by individual functional impairments. Survival trees including kidney function and functional impairments were also investigated, and their predictivity assessed by C-index.Resultsoverall, mortality was found to increase starting from eGFR = 30–44.9 ml/min/1.73 m2 (hazard ratio [HR] = 3.28, 95% confidence interval [CI] = 1.81–5.95) to ACR = 30–300 mg/g (HR = 1.96, 95%CI = 1.23–3.10). However, in survival trees, an increased risk of mortality was observed among patients with impaired handgrip and eGFR = 45–59.9 ml/min/1.73 m2, as well as patients with ACR < 30 mg/g and impaired handgrip and SPPB. Survival tree leaf node membership had greater predictive accuracy (C-index = 0.81, 95%CI = 0.78–0.84 for the eGFR survival tree and C-index = 0.77, 95%CI = 0.71–0.81 for the ACR survival tree) in comparison with that of individual measures of kidney function.Conclusionsphysical performance helps to identify a proportion of patients at an increased risk of mortality despite a mild–moderate impairment in kidney function and improves predictive accuracy of individual measures of kidney function.

Resilience and Its Association With Activities of Daily Living 3 Months After Stroke.

Independence in basic activities of daily living (ADL) is an important outcome after stroke. Identifying factors associated with independence can contribute to improve post-stroke rehabilitation. Resilience, which is the ability of coping with a serious event, might be such a factor. Still, the impact of resilience and its role in rehabilitation after stroke is poorly investigated. Hence, the purpose of this study was to assess whether resilience assessed early after stroke can be associated with independence in basic ADL 3 months later. Hospitalized patients with a diagnosed acute stroke and a modified Rankin Scale score ≤ 4 were included. Bivariate and multivariate linear regression were applied to assess whether resilience as measured by the Brief Resilience Scale within the first 2 weeks after stroke was associated with basic ADL measured by Barthel Index at 3-month follow-up. Age, sex, fatigue, stroke severity at admission and pre-stroke disability were added as covariates. Sixty-four participants (35 (54.7%) male), aged 75.9 (SD 8.6) years were included 4.3 (SD 2.8) days after stroke. There was no significant change in resilience from baseline 3.1 (SD 0.3) to 3 months later 3.2 (SD 0.5). Resilience was not associated with basic ADL in neither the bivariate (b = 2.01, 95% CI −5.21, 9.23, p = 0.580) nor in the multivariate regression models (b = 0.50, 95% CI −4.87, 6.88, p = 0.853). Our results showed that resilience remained stable during follow-up. Early measurement of resilience was not associated with independence in basic activities of daily living 3 months after stroke. These results, indicate that resilience is a personal trait not associated with the outcome of physical adversity. However, future research should investigate whether resilience is related to the outcomes of psychosocial adversity after a stroke.

Indicators of frailty in newly diagnosed lung cancer patients: A retrospective review.

e24017 Background: Lung cancer is frequently diagnosed over the age of 70 years, in a population with increased risk factors for frailty. Frailty impacts cancer treatment selection, tolerance, and quality of life. We performed a retrospective study to determine whether there is a difference in the indicators of frailty in patients of different ages, and if this impacted treatment choice. Methods: Electronic records of patients who were discussed at the University Hospitals of Leicester Lung multidisciplinary team meeting (MDT) between January to December 2019 with a suspected diagnosis of lung cancer were reviewed. Populations below the age of 65 years and over the age of 65 years were compared. Results: 846 patient records were reviewed, and 80% were aged over 65 years. Baseline WHO performance status (PS) where recorded showed 35% were PS 0-1, and 28% were 3-4. Comparatively, in the under 65 population 46% were PS 0-1, and 10% were 3-4. The over 65s had a lower rate of independence with activities of daily living (ADLs) compared to the under 65s (54% vs 71%), assistance with basic ADLs was higher (10% vs 5%) and patients with unassisted mobility was also lower (48% vs 66%). The over 65s had an increased rate of multiple comorbidities compared to the younger group (no comorbidity 25% vs 30%, 3 or more comorbidities 27% vs 14% respectively.) Where curative intent was intended, in the under 65s, surgical review deemed 24% unsuitable and of these, 72% had a discussion regarding radiotherapy with 61% receiving treatment. Comparatively in the older population, 40% of patients were deemed unsuitable for surgery and 69% went for discussion regarding radiotherapy with 44% receiving treatment. Where systemic anti-cancer therapy (SACT) discussion was advised, more patients in the under 65 group saw a medical oncologist compared to the older group (73% vs 61%) and had a higher rate of subsequent SACT (80% vs 61%). There were similar rates of non-completion of SACT in the over 65s compared to the younger group (55% vs 54%) and number of dose reductions (18% vs 15%). 35% of the over 65s and 46% of the under 65s received immunotherapy. In the older population, 30% received monotherapy, compared to 17% in the younger population. 37% of the older patients having SACT were admitted with a median stay of 2 days (range 1-30) compared to 31% in the younger group, with a median stay of 1.5 days (range 1-2). Conclusions: Our review demonstrates that in the older population, PS is higher, with a lower independence rate for ADLs, a higher level of assisted mobility and increased comorbidity. These frailty indicators impacted treatment options; less older patients were suitable for treatment compared to the younger population. The older population displayed more indicators of frailty potentially impacting treatment options, and this highlights the need for active frailty assessment and rapid intervention in the lung cancer population to allow a full range of treatment options.

Secondary Gerstmann syndrome, a case report

IntroductionGerstmann syndrome is a rare neurological disorder that consist primarily of 4 neuropsychological signs that include acalculia (impairment in performing calcultaions), digital agnosia (dificulty discriminating their own fingers), agraphia (impairment or dificulty to write by hand); and left-right disorientation (impairment of distinguishing left from right.ObjectivesPresentation of a case report of a patient with Gertsmann syndrome secondary to breast cancer metastasis.MethodsWe analyze the case of a 79 years-old female with a history of breast cancer in remission, with a severe depressive episode of 8 months of evolution, dysphoria, apathy, decrease in the ability to carry out basic activities of daily life, acute personality changes and sleep disruption. 15 days previous to the first examination the patient suffers gait disturbances, falling from her own height, memory impairment, suicide ideation and nomination aphasia.ResultsAt the examination we encounter digital agnosia, acalculia, agraphia, right-left disorientation, right hemiparesis. MRI are taken founding 3 tumor lesions in the left and right frontal lobe, 2 solid lesions with a necrotic appearance in the right parietal lobe, one of them in the angular gyrus of the parietal cortex. CT scan found a solid tumor-like lesion in the left pulmonary apex. CA-125 antigen 429.5 U/mL. She was sent to continue her treatment with oncology, receiving radiotherapy.ConclusionsThe psychiatric abnormalities secondary to Gerstmann syndrome make the relatives of this patient seek psychiatric care, requiring multidisciplinary work to reach an accurate diagnosis. Gerstmann syndrome is a rare neurological condition that can mimic lots of other clinical pictures.DisclosureNo significant relationships.

Caregiving concerns and clinical characteristics across neurodegenerative and cerebrovascular disorders in the Ontario neurodegenerative disease research initiative.

Caregiving burdens are a substantial concern in the clinical care of persons with neurodegenerative disorders. In the Ontario Neurodegenerative Disease Research Initiative, we used the Zarit's Burden Interview (ZBI) to examine: (1) the types of burdens captured by the ZBI in a cross-disorder sample of neurodegenerative conditions (2) whether there are categorical or disorder-specific effects on caregiving burdens, and (3) which demographic, clinical, and cognitive measures are related to burden(s) in neurodegenerative disorders? N=504 participants and their study partners (e.g., family, friends) across: Alzheimer's disease/mild cognitive impairment (AD/MCI; n=120), Parkinson's disease (PD; n=136), amyotrophic lateral sclerosis (ALS; n=38), frontotemporal dementia (FTD; n=53), and cerebrovascular disease (CVD; n=157). Study partners provided information about themselves, and information about the clinical participants (e.g., activities of daily living (ADL)). We used Correspondence Analysis to identify types of caregiving concerns in the ZBI. We then identified relationships between those concerns and demographic and clinical measures, and a cognitive battery. We found three components in the ZBI. The first was "overall burden" and was (1) strongly related to increased neuropsychiatric symptoms (NPI severity r=0.586, NPI distress r=0.587) and decreased independence in ADL (instrumental ADLs r=-0.566, basic ADLs r=-0.43), (2) moderately related to cognition (MoCA r=-0.268), and (3) showed little-to-no differences between disorders. The second and third components together showed four types of caregiving concerns: current care of the person with the neurodegenerative disease, future care of the person with the neurodegenerative disease, personal concerns of study partners, and social concerns of study partners. Our results suggest that the experience of caregiving in neurodegenerative and cerebrovascular diseases is individualized and is not defined by diagnostic categories. Our findings highlight the importance of targeting ADL and neuropsychiatric symptoms with caregiver-personalized solutions.

Alzheimer Caregiving Problems According to ADLs: Evidence from Facebook Support Groups.

Background and study goal: Social media are a societal phenomenon today, including the oldest generation, yet they are seldom used in current health research to identify the needs of persons with Alzheimer’s disease (PADs) and their carers. There is an even bigger research gap in the analysis of caregivers’ communication in online support groups and its classification according to activities of daily living (ADLs). For this, the goal of this study is to identify real-life practices of informal caregivers who care for PADs based on the analysis of their communication in Facebook groups. Methods: A sample of 1603 contributions was obtained from support groups by keyword search, manual coding, and verification; thus, the contributions in the sample are relevant for the individual basic ADLs of PADs. Next, five main conversation topics were identified for each ADL. This was done using the topic extractor based on simple parallel threaded implementation of LDA with a sparse sampling scheme and data structure. Results: The qualitative dimension of research identified discussion topics as well as specific caregiver behavior patterns for each ADL. The quantitative dimension determining the level of engagement of group members in individual ADLs was also measured. The highest engagement was found in activities of feeding and drinking, followed by bathing. In contrast, the activities of dressing, continence, and toileting attract the lowest interest. Moreover, the causal links between the topics discussed within the areas of ADLs were identified. Conclusions: The acquired knowledge can help further research focus on the most problematic areas relevant for people with AD in order to increase their quality of life and at the same time reduce the caregiver burden. The study expands the information of the demands posed by the individual caregiver activities, specifically in the context of activity-based costing or time-based activity costing.

Severe functional impairment increases the risk of major morbidity and mortality in older patients after digestive tract surgery: a retrospective cohort study.

The relationship between the severity of impairment in basic activities of daily living (ADLs) function and postoperative outcomes in older surgical patients remains unclear. This study aimed to clarify the association between the severity of preoperative functional impairment and the composite postoperative outcome of major morbidity and mortality in older patients undergoing digestive tract surgery. This was a retrospective cohort study. We collected perioperative data of older patients (age ≥ 65years) who underwent digestive tract surgery in our institution. The severity of functional impairment was assessed using the Barthel Index scale before surgery. The major morbidity and mortality were defined as Clavien-Dindo grade III or greater postoperative complications during hospital stay. The association between the severity of functional impairment and the major morbidity and mortality was assessed using a multivariable logistic regression model. 131 of 1076 patients (12.2%) developed major morbidity and mortality. After controlling for confounding factors, high Barthel Index scores were correlated with decreased risk of major morbidity and mortality (OR 0.986, 95% CI 0.976-0.997, P = 0.011); preoperative severe (OR 2.862, 95% CI 1.172-6.989, P = 0.021), but not mild or moderate (OR 1.019, 95% CI 0.602-1.726, P = 0.943) functional impairment was independently associated with an increased risk of major morbidity and mortality, when compared with independent functional status. Preoperative severe functional impairment in basic ADLs was independently associated with a higher risk of major postoperative morbidity and mortality in older patients undergoing digestive tract surgery.

A systematic literature review and meta-analysis on digital health interventions for people living with dementia and Mild Cognitive Impairment.

ObjectivesDigital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI.Methods/DesignSearches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta‐analyses were performed to pool data on intervention effectiveness.ResultsTwenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = −0.03 to 0.76; I 2 = 61%), and a negative moderate effect on basic ADLs (SMD = −0.40; 95% CI = −0.86 to 0.05; I 2 = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions.ConclusionSupervised intervention delivery is linked to greatest benefits. A mix of remote and face‐to‐face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end‐users must be pre‐requisites for the development of future successful services.

Many Paths to Recovery: Comparing Basic Function and Participation in High-Functioning Older Adults After Acute Hospitalization.

Function after acute hospitalization is mostly operationalized by Basic Activities of Daily Living (BADL), a limited concept that overshadows a wide range of instrumental, social, and recreational activities, otherwise referred to as participation. Participation is important for patients' health and quality of life after hospitalization. This study focuses on high-functioning older adults, examining functional recovery after hospitalization by comparing BADL assessment with assessment of participation at one and three months following discharge relative to pre-hospitalization. Quantitative data were collected from 72 participants divided into two age groups of hospitalized older adults (age 65-74, n = 38; age ≥75, n = 34), followed by home visits after 1 month and telephone interviews 3 months after discharge. Both groups experienced a significantly greater decline in participation, compared with BADL, which were mostly preserved. A comprehensive assessment of participation better captures functional changes in high-functioning older adults. Early identification of participation withdrawal is crucial for preventing disability.

Social support moderates the association of functional difficulty with major depression among community-dwelling older adults: evidence from LASI, 2017–18

BackgroundThis study aimed to examine the potential independent association of functional disability with major depression and moderating effects of social support variables including marital status, living arrangement and social participation in such associations.MethodsData for the study were drawn from the Longitudinal Ageing Study in India (LASI) wave 1 that was collected during 2017–18 including a sample of 31,464 individuals aged 60 years and above. Descriptive statistics and results from bivariate analysis have been reported. Further, moderated multivariable logistic regression models were used to fulfil the study objective. Major depressive disorder was assessed using the scale of the Short Form Composite International Diagnostic Interview (CIDI-SF).ResultsIt was found that 8.67% of older participants were depressed in this study. Older adults who had difficulty in basic activities of daily living (BADL) (15.34%), difficulty in instrumental activities of daily living (IADL) (12.06%), unmarried (10.13%), separate living (9.67%) and socially inactive (10.09) were having higher prevalence of major depression compared to their respective counterparts. The adjusted model-1 revealed that older adults who had difficulty in BADL and IADL were 2.53 times [AOR: 2.53, CI: 2.17—2.95] and 2.27 times [AOR: 2.27, CI: 1.97—2.64] more likely to have major depression than those with no difficulty in BADL and IADL respectively. Further, interaction analyses found that currently unmarried status, separate living and being socially inactive have moderation effects in the observed associations and exacerbate the likelihood of major depression among older adults who are functionally impaired.ConclusionsThe findings highlight the importance of integrating social participation in the daily life of older adults and developing initiatives that promote a healthy surrounding such as social connectedness, co-residential living and special care for those who are physically disabled to protect against late-life depression.

Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers

IntroductionOropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatricpopulation. Meeting the needs of these patients can lead to an overload of their caregivers. ObjectivesTo describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQL). Material and methodsDescriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQoL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. Results103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend towards improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. ConclusionsThe monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.

Effectiveness of caregiver-mediated exercise interventions on activities of daily living, anxiety and depression post-stroke rehabilitation: A systematic review and meta-analysis.

This review aims to examine updated evidence to evaluate the effectiveness of caregiver-mediated exercise interventions on basic and extended activities of daily living (ADL), anxiety and depression of post-stroke rehabilitation individuals. A systematic review and meta-analysis. Six electronic databases, including CINAHL, CENTRAL, Embase, PubMed, PsycINFO and Scopus, grey literature and trial registry were searched from inception until February 2021. Only randomized controlled trials written in English were included. Meta-analyses were conducted for basic and extended ADL, anxiety and depression outcomes using RevMan software. Overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation framework. A total of 11 randomized controlled trials comprising 2120 participants were identified, with 10 trials meta-analysed. Meta-analyses indicated statistically significant effects favouring caregiver-mediated exercise interventions for basic ADL. Subgroup analyses revealed significant effects for exercise-only interventions mediated by caregivers for basic ADL. No significant effects were found for extended ADL, anxiety and depression for stroke survivors. Caregiver-mediated exercise interventions appear to have beneficial impacts on basic ADL for stroke survivors, suggesting caregiver-mediated exercise interventions as a potentially feasible way to improve functional independence. Caregiver-mediated intervention with exercises as a major component could be a promising approach to augment stroke rehabilitation. Future research should include high-quality studies with focus on specific intervention components or to explore caregiver outcomes.

Long-Term High Dietary Diversity Maintains Good Physical Function in Chinese Elderly: A Cohort Study Based on CLHLS from 2011 to 2018.

(1) Objective: This study aimed to explore the correlation between dietary factors and physical function in Chinese elderly. (2) Methods: A cohort study was conducted on the association of long-term dietary intake status with physical function in older people based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. The physical function of the subjects was judged according to the scores of basic activities of daily living (BADL) and instrumental activities of daily living (IADL). The dietary diversity score was established according to the intake frequency of the food groups, and the dietary pattern score was obtained by factor analysis. The associations between dietary factors and functional impairment was investigated by logistic regressions. (3) Results: A total of 2282 subjects were included in our cohort study, 458 and 1439 of whom had BADL limitation and IADL limitation, respectively. The risk of functional impairment decreased in the consistent high dietary diversity groups compared with the consistent low dietary diversity group (p < 0.05). The fruit-egg-milk pattern, vegetable-meat-fish pattern, and condiment and tea pattern reduced the risk of functional impairment (p < 0.05). (4) Conclusions: Long-term maintenance of high dietary diversity and increasing total dietary intake can help maintain good physical function of Chinese elderly.

Effect of Cluster Needling of Scalp Acupuncture Combined with Walking Training on Walking Ability of Stroke Patients under Different Task

<bold>Objective</bold> To observe the effect of cluster needling of scalp acupuncture combined with walking training on walking ability of stroke patients under single-task walking (STW) and dual-task walking (DTW) paradigm. <bold>Methods</bold> A total of 78 inpatients with non-acute stroke who were treated in the the Third Affiliated Hospital of Zhejiang Chinese Medicine University from September 2019 to April 2021, which were divided into the control group and the observation group according to the random number table method, with 39 cases in each group. Both groups received conventional treatment for cerebrovascular disease, the control group received walking training on the basis of conventional treatment, 40 minutes a time, once a day, five days a week, continuous treatment for four weeks, including antigravity muscle training, lower limb weight-bearing support training, lower limb step training of affect side and standing center of gravity transfer training, etc. The observation group received cluster needling of scalp acupuncture on the basis of the control group, once a day, five days a week, continuous treatment for four weeks. The parietal area, anterior parietal area and frontal area of the head were selected for cluster needling of scalp acupuncture, the needles were kept for six hours, routine walking training was performed during needle retention. Before and after treatment, the gait parameters (stride, step length, step speed, stride frequency, stride time, support time, swing time) under STW and DTW paradigms were evaluated by the gait detection evaluation and training system; activities of daily living (ADL) were used to assess patients' activities of daily living, including basic activities of daily living (BADL) and instrumental activities of daily living (IADL). <bold>Results</bold> ① Gait parameters: compared with the STW paradigm, stride, step length, stride speed, stride frequency and swing time of the stroke patients were significantly decreased under the DTW paradigm, while stride time and support time were significantly increased, the differences were statistically significant (<italic>P</italic>&lt;0.05). Under the STW and DTW paradigm, compared with before treatment, stride,step length, step speed, stride frequency and swing time of the two groups after treatment were significantly increased (<italic>P</italic>&lt;0.05), while stride time and support time were significantly decreased (<italic>P</italic>&lt;0.05). Under the STW paradigm, compared with the control group, the stride,step length, step speed, stride frequency and support time of the observation group were significantly increased (<italic>P</italic>&lt;0.05), and the stride time was significantly decreased (<italic>P</italic>&lt;0.05). Under the DTW paradigm, compared with the control group, stride,step length, step speed, stride frequency of the observation group were significantly increased, while the stride time was significantly decreased (<italic>P</italic>&lt;0.05). ② ADL scores: compared with before treatment, the ADL total score and BADL score of the two groups after treatment were significantly decreased, and the IADL score in the observation group after treatment was significantly decreased (<italic>P</italic>&lt;0.05). Compared with the control group, the ADL total score and IADL score in the observation group were significantly decreased (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> The walking ability of stroke patients with dual-task walking is lower than that of single-task walking; cluster needling of scalp acupuncture combined with walking training can effectively improve the walking ability of dual-task and activities of daily living.