Changes In Activities Of Daily Living Research Articles

Frequency of going outdoors predicts long-range functional change among ambulatory frail elders living at home

The purpose of the study was to investigate the relationships between frequency of going outdoors and subsequent functional and psychosocial changes over a 20-month period. Data were collected from community-dwelling 107 frail elders who could walk independently but who still needed some assistance to live on their own. Functional and psychosocial status at baseline and follow-up were compared among three groups defined by the frequency of going outdoors: (1) four or more times a week, (2) one to three times a week and (3) less than once a week. At baseline, elders going outdoors more often were less functionally impaired, more socially active, and less depressed than elders going outdoors less often. There was a significant difference in change over time of activities of daily living (ADLs) ( p = 0.002) among the three groups, even when controlling for baseline differences, and the scores of those who went outdoors almost daily were least likely to decline. More of those going outdoors four or more times a week at baseline were still living at home at follow-up than those in the other two groups ( p = 0.048). These results suggest that the frequency of going outdoors can predict changes in ADLs over at least a 20-month period.

胎児性水俣病患者の現在のActivity of Daily Living (ADL) 実態と15年前との比較およびコミュニケーション障害に関する研究

The main purposes of this study are to compare the current statuses and activities of daily living (ADL) scores with the same parameters 15 years ago in fetal-type Minamata disease patients and to identify the communication disorders in these patients. An interview survey was conducted on 31 fetal-type Minamata disease patients mainly in 2002 concerning family structure, present status of care, their demand for care, communication status, and ADLs. Changes in ADLs during the past 15 years were also studied in 22 of the patients. Their mean ages were 45.5+/-3.5 (n=20) for males, and 46.1+/-1.9 (n=ll) for females. The average numbers of family of the patients was 2, and 15 patients lived alone. An analysis of ADLs showed that about 50% of the patients could not walk or take a bath, and 30 to 40% of the patients could not eat, excrete, change their clothes, or wash their face alone. Approximately 80% of the patients could understand daily conversation to some degree. However, their ability to express their demands and thoughts, put an idea into action, remember events, and live like ordinary people were significantly worse than their ability to understand daily conversation. The changes in the ADLs of the 22 patients were not significant for the past 15 years. However, two patients showed a rapid decrease for ADL of movement and 2 other patients died after an interview before 50 years of age. Appropriate care in daily living is an important issue for fetal-type Minamata disease patients. Further, the individual health care of such patients is an urgent issue and can prevent their health from rapidly deteriorating.

ADCS Prevention Instrument Project: Assessment of Instrumental Activities of Daily Living for Community-dwelling Elderly Individuals in Dementia Prevention Clinical Trials

In primary prevention trials for Alzheimer disease, the inception cohort typically has normal or minimally impaired complex activities of daily living (ADL). ADL change during a trial could trigger detailed evaluation or serve as an outcome measure. A brief, easily administered, and reliable ADL rating scale would assist prevention studies. To develop an ADL scale for prevention trials that allows self-rating or completion by informants. The Activities of Daily Living-Prevention Instrument (ADL-PI) was developed, comprising 15 ADL and 5 physical function questions. Six hundred forty-four elderly subjects participating in the Prevention Instrument Project completed a self-rated version of the ADL-PI, and informants for 632 subjects completed an informant version. Informants also completed a Mild Cognitive Impairment (MCI) ADL questionnaire to allow comparisons. Subjects performed well on all ADL scales at baseline. Completion of the ADL-PI questionnaires at home or in-clinic yielded comparable information. Scores from baseline to 3 months had good reliability. The ADL-PI, obtained from either self-report or informants, discriminated between subjects rated as CDR 0 and CDR 0.5. Subjects with worse baseline cognitive performance also had slightly worse ADL-PI scores. Preliminary analysis indicates that subjects who triggered cognitive evaluations had slightly lower baseline ADL-PI scores by both self and informant reports. The ADL-PI can be completed at home or in clinic, and has adequate reliability. The utility of self-administered and informant versions and predictive value of reported deficits requires further follow-up.

Decreased activities of daily living and associations with bone loss among aged residents in a rural Japanese community: the Miyama Study

The present study aimed to clarify frequencies of decreased activities of daily living (ADL) and associations with rate of bone loss among inhabitants more than 60 years old in Miyama, a rural community in Japan. A cohort of 1543 inhabitants aged 40-79 years was established according to Miyama resident registrations in 1989. Men (n = 50) and women (n = 50) from each of two age strata between 60 and 79 years (N = 200) were selected from this cohort, and bone mineral density (BMD) of the lumbar spine and proximal femur was measured using dual-energy X-ray absorptiometry in 1990 (initial survey) and again in 1993, 1997, and 2000. Difficulties involving ADL were surveyed at every follow-up study. Of the 200 initial participants, 124 (57 men, 67 women; 62.0%) completed all BMD measurements and answered all items about ADL in the follow-up survey. The following items were investigated as a general indication of changes to ADL: reaching objects on a high shelf or cupboard (reaching); washing and drying the body (washing body); washing hair over a washbasin (washing hair); sitting for 1 h on a hard chair (sitting); raising the torso from a lying position in bed (raising); standing continuously for 30 min (standing); taking socks on and off the feet (taking socks); bending down from a seated position and picking up a small object at the side of the chair (bending); lifting heavy objects (lifting); and running 100 m without stopping (running). Among ADL items, the most frequent difficulties in men involved running (50.0%), followed by raising (30.6%), standing (27.1%), sitting (24.7%), and reaching (16.5%). In women, difficulties involved running (67.0%), followed by lifting (36.3%), standing (33.1%), reaching (30.8%), and sitting (23.6%). To evaluate relationships between decreased ADL and changes in BMD, annual rates of change for BMD at the lumbar spine and femoral neck were compared to changes for each ADL item (2 grade decrease; 1 grade decrease; or no change). Analysis of covariance (ANCOVA) was then performed on decreased ADL and annual bone changes after adjustment for age, concomitant disease (previous fractures, gastrectomy, diabetes mellitus, and renal dialysis at initial survey). In men, annual rates of change in BMD at the femoral neck over 10 years were significantly correlated with decreased abilities in bending (P = 0.046; R2 = 0.10). In women, annual rates of change in BMD at the lumbar spine over 10 years were significantly correlated with decreased abilities in reaching (P = 0.007; R2 = 0.25), and lifting (P = 0.014, R2 = 0.27), and those at the femoral neck were significantly correlated with decreased abilities in lifting (P = 0.001, R2 = 0.33).

Prevention of disability by exercise among the elderly: A population-based, randomized, controlled trial

Objective. To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population. Design. Randomized, controlled trial with intention-to-treat and subgroup analyses. Subjects and setting. All home-dwelling persons aged 85 years or older in the City of Oulu (n = 555, 67%), including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living (ADL) or mobility. Interventions. Programme consisting of home exercise, walking exercise, group exercise, and self-care exercise. Main outcome measures. Change in ADL and mobility during the intervention. Results. Change in ADL performance did not differ (p = 0.462) but a positive change was found in mobility performance (p = 0.013) in the intervention subjects (n = 243) compared with the controls (n = 243). At the end of the intervention period, severe mobility restrictions existed similarly in intervention and control subjects: 48 (34%) and 46 (31%) (p = 0.650) respectively. Frequency of admissions into long-term institutional care were similar in intervention and control groups: 15 (7%) and 13 (6%) (p = 0.669). Impaired balance existed in fewer intervention subjects (64, 45%) than controls (89, 59%) (p = 0.015). Frequency and times of home exercise activity reduced in control subjects (p < 0.001) but did not change in subjects assigned to home exercise intervention (p > 0.05). Conclusion. A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction. Positive effects were also found in balance performance.

Pattern of Functional Change During Rehabilitation of Patients With Hip Fracture

Latham NK, Jette DU, Warren RL, Wirtalla C. Pattern of functional change during rehabilitation of patients with hip fracture. Objective To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation. Design Retrospective analysis of data contained in an administrative dataset. Setting Seventy skilled nursing facilities (SNFs). Participants People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures. Interventions Not applicable. Main Outcome Measure Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation. Results The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43). Conclusions The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.

Minimal clinically important change on the unified Parkinson's disease rating scale

The Unified Parkinson's Disease Rating Scale (UPDRS) is the main outcome measure in clinical trials of Parkinson's disease (PD). The minimal change that represents a clinically meaningful improvement is unknown. The objective of this study was to determine the minimal change on the UPDRS that represents a clinically meaningful improvement in early PD after 6 months of treatment. Data from two independent randomized treatment trials over 6 months involving 603 patients with de novo PD were analyzed to determine the minimal clinically important change (MCIC), referred to the status before treatment, for the UPDRS motor, activities of daily living (ADL), and total scores. An anchor-based method using ratings on a seven-point global clinical improvement was used. A change of five points on the UPDRS motor part was found to be the most appropriate cutoff score for all Hoehn and Yahr stages I to III, and a change of eight points for the UDPRS total score. For the UDPRS ADL score, an MCIC of two points for Hoehn and Yahr stages I/I.5 and II and of three points for Hoehn and Yahr stage II.5/III was the most appropriate cutoff score. These data give the first estimate for cutoffs defining clinically important changes in UPDRS ADL and motor scores. Further studies using larger databases from more diverse study populations are encouraged to better define and solidify the MCIC for the UPDRS.

The effect of patient characteristics on variability in pain and function over two years in early knee osteoarthritis

BackgroundLarge variations in pain and function are seen over time in subjects at risk for and with radiographic knee osteoarthritis (OA). We hypothesized that this variation may be related not only to knee OA but also to patient characteristics. The objective of this study was to investigate the influence of age, gender, and body mass index (BMI) on clinically relevant change in pain and function over two years in subjects at high risk for or with knee OA.MethodsWe assessed 143 individuals (16% women, mean age 50 years [range 27–83]) twice; 14 and 16 years after isolated meniscectomy. Subjects completed one disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS) and one generic measure, the SF-36. Individuals with a BMI between 25 and 29.9 were considered overweight, while individuals with a BMI of 30 or more were considered obese.ResultsSubjects aged 46–56 (the middle tertile) were more likely to change (≥10 points on a 0–100 scale) in the KOOS subscale Activities of Daily Living (ADL) than younger subjects (odds ratio [OR] 4.5, 95% confidence interval [95% CI] 1.5–13.0). Essentially the same result was obtained after adjusting for baseline values. Overweight or obesity was a risk factor for clinically relevant change for knee pain (OR 2.4, 95% CI 1.0 – 5.8, OR 4.0, 95% CI 1.2 – 13.6) and obesity for change in ADL (OR 4.3, 95% CI 1.2 – 15.4). The results did not remain significant when adjusted for the respective baseline value. Being symptomatic was strongly associated with increased variation in pain and function while presence or absence of radiographic changes did not influence change over two years in this cohort.ConclusionIn a population highly enriched in early-stage and established knee OA, symptomatic, middle-aged, and overweight or obese subjects were more likely to vary in their knee function and pain over two years. The natural course of knee pain and function may be associated with subject characteristics such as age and BMI.

Cross-functional team processes and patient functional improvement.

To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

Associations between socio-economic status measures and functional change among older people in Taiwan

The major purpose of this study was to examine the effects of socio-economic status (SES) on changes in functional abilities, as measured by Activities of Daily Living (ADL) scales, among older people in Taiwan. A prospective longitudinal study design was used. A panel of 874 community-dwelling older people were followed over four years (1994 to 1998). Three SES indicators, education, having ‘extra’ money (more than required for basic necessities), and principal lifetime occupation were included in separate multiple logistic regression models of functional change in physical ADL (PADL) and in instrumental ADL (IADL). Over the four years, the study cohort experienced greater decreases in IADL functioning than in PADL functioning. Having ‘extra’ money was significantly and negatively associated with PADL decline, while level of education had a strong positive relationship with IADL functioning. In addition to SES, age was significantly associated with PADL and IADL functioning change. The paper also reports a comparison of similar findings from several eastern and western countries. This has established that among the available SES indicators, the level of education has most consistently been shown in both eastern and western population studies to be related to health and health change, and that self-perceived economic resource is also related to older people's health in Asian populations.

Short-term change in physical function and disability: the Women's Health and Aging Study.

Although measures of physical function are predictive of future disability, little is known about the short-term impact of changes in physical function on disability. Data from 93 of the 102 women who participated in the Weekly Substudy of the Women's Health and Aging Study (WHAS) were used to explore the association of changes in physical function with disability. The WHAS Substudy included 24 weekly assessments of three standard performance tests and self-reported disability in activities of daily living (ADLs) and basic mobility. Using random-effects models, we found small but significant (ps <.01) changes in ADL and mobility disability during weekly follow-up. Baseline performance scores were significantly associated with both ADL and mobility disability (ps <.001), accounting for 27% and 36% of the between-person variability in each type of disability, respectively. After adjustment for baseline scores, change in performance scores was significantly associated with ADL disability (beta = 0.08, p <.01) and mobility disability (beta = 0.12, p <.001), but accounted only for a small proportion (<10%) of the variability in the rate of change in disability outcomes. There was no evidence for an additional effect on either type of disability because of having a single episode of a higher or lower than usual performance score, or because of periods of at least 4 consecutive higher or lower than usual performance test scores. Basic physical functions account for a substantial proportion of the heterogeneity in ADL and mobility disability among older disabled women, but have a relatively small impact on short-term changes in either type of disability. Effective prevention of disability may require attention to a wider array of risk factors than just limitations in basic physical functions.

An evaluation of transition in functional states among the elderly in Beijing, China

The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change. Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management. The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends. Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.

The effects of acute illness on ADL decline over 1 year in frail older adults with and without cognitive impairment.

Acute illness may lead to long-term losses in older adults' ability to independently perform activities of daily living (ADLs). The magnitude of these losses may differ for patients with and without cognitive impairment. These relationships have not been described for the frailest of older adults whose high rates of acute illness and cognitive impairment put them at the greatest risk for loss of ADL functioning. We conducted a prospective study of 2593 patients enrolled in a nationwide medical and psychosocial program for frail, community-living, nursing home-eligible patients. We determined the independent and interactive effects of baseline cognitive impairment and admission for an acute illness on change in ADL functioning over 1 year. ADL decline over 1 year occurred in 53% of cognitively impaired patients who were admitted for an acute illness, 38% of cognitively impaired patients who were not admitted for an acute illness, 42% of noncognitively impaired patients who were admitted for an acute illness, and 25% of noncognitively impaired patients who were not admitted for an acute illness (p <.001). The amount of additional decline in ADLs associated with an admission for an acute illness was similar between patients with and without cognitive impairment (-.85 vs -.74; p for interaction =.86). Among patients who were admitted for an acute illness, significant decline in ADL functioning occurred only in the quarter surrounding the acute illness with no evidence of recovery in the months after the acute illness episode. Among frail older adults, loss of ADL functioning over 1 year is independently associated with both acute admission for an acute illness and cognitive impairment. Frail elders, especially those with cognitive impairment, are in need of interventions that reduce the long-term functional consequences of acute illness.

Demographic determinants for change in activities of daily living: a cohort study of the elderly people in Beijing.

To describe changes in activities of daily living (ADL) of community-dwelling Beijing elderly people, observed for 8 years, and to identify the demographic characteristics that predict the functional change. Four sets of interview data from 1992 to 2000 were used to evaluate changes among Beijing elderly aged 55 years and over. Results revealed that prevalence of disability increased from 3.9% to 7.1% during the 8 years of follow-up with the average increasing rate of disability was 0.41% per year. Meanwhile an increasing likelihood of recovery from disability is observed with age and time. Women, aged 75 or more, experienced higher disability than men though it was in the opposite for younger ages. In addition, certain demographic subgroups (such as women, unmarried, illiterate and living in non urban area) appeared to be at higher risk for ADL impaired. The patterns of ADL change is in both the direction of improvement and declination. Demographic variables emerged as a significant predictor in estimating functional outcomes. Furthermore, it is recommended that the demarcation factor for the evaluation of ADL should be 75 years of age.

Predicting cognitive decline in patients with hypoxaemic COPD

The objective was to identify predictors of cognitive decline in patients with hypoxaemic COPD on continuous oxygen therapy. Eighty-four consecutive ambulatory hypoxaemic COPD patients in stable clinical conditions were prospectively studied over the course of 2 yr. Baseline multidimensional assessment included respiratory function tests, blood gas analysis, Mini Mental Status (MMS) test, Geriatric Depression Scale (GDS), Activities of Daily Living (ADLs) and Charlson's index of comorbidity. Reassessments were made 1 yr and 2 yr thereafter. Sequential changes in MMS, GDS and ADLs were assessed by Friedman's ANOVA by rank test. Forty patients completed the study (group A), while 44 died or were lost to follow-up (group B). Group B was characterized by more severe respiratory function impairment and worse performances on ADLs and GDS. In group A, MMS deteriorated from baseline to the 1 yr and 2 yr reassessments (27 ± 2·9 vs. 25·8 ± 4·1 and 25·4 ± 4, P<0·005), whereas GDS and ADLs did not change significantly; the 23 patients experiencing a decline of MMS had baseline lower percentage predicted FVC (52·3 ± 17·1 vs. 66·9 ± 13·4, P<0·03) and FEV 1 (27·2 ± 8·6 vs. 44 ± 26·8, P<0·02) values and better affective status (GDS score: 11·9 ± 7·7 vs. 16·5 ± 5·6, P<0·04). Two-year changes in MMS and in GDS scores were inversely correlated (Spearman's ρ = −0·32, P = 0·04). Cognitive decline is faster in the presence of severe bronchial obstruction and parallels the worsening of the affective status in COPD patients on oxygen therapy. The onset of depression rather than baseline depressive symptoms seems to be a risk factor for cognitive decline.

Care dependence and activities of daily living in relation to ageing: results of a longitudinal study.

From 1990 to 1993, the University of Limburg and the Pepijn Centre, the Netherlands, have performed a prospective cohort study on ageing and intellectual disability. The key questions of the study were: "To what degree do the level of care dependence and activities of daily living (ADL) differ between age groups, and to what degree do these skills change during the study period (3 years)? Are the changes age related?'. Looking at the changes in time, the results show that the level of care dependence did not change substantially in the sample of 1602 residents of Dutch facilities for people with intellectual disability. Only the oldest residents (70+ years) showed a significant decline in independence. The results also show that the skills of young people with Down's syndrome (< 40 years) did not change substantially, whereas older people with Down's syndrome (40+ years) showed a substantial decrease in ADL-skills. The ADL-skills of the residents with other aetiological diagnoses younger than 60 years of age did not change substantially, while the older residents (60-69 and 70+ years) showed a significant decrease in ADL-functions. The trend between changes in ADL and age in both aetiological groups was statistically significant. Attention is paid to the implications of these findings in the discussion.

Strength Training Effects on Subjective Well-Being and Physical Function in the Elderly

The purpose of the present investigation was to examine (a) the effects of upper body high-intensity strength training on muscular strength, activities of daily living (ADLs), and subjective well-being within an aging population, and (b) whether changes in strength were related to subsequent changes in subjective well-being and ADLs. The main effects of the training program were significant for all five individual muscle groups examined, indicating that subjects who participated in the strength program had greater increases in muscular strength than did controls. There was limited support for the contention that strength training enhances subjective well-being and ADLs in older adults. Strength gains were related to moderate reductions in negative affect, greater satisfaction with life, and higher ADLs. Findings are discussed in terms of design and measurement improvements, the need to focus research efforts on multiple components of fitness in relation to subjective well-being, and relations among strength and ADLs in the elderly.

Functional decline in Alzheimer's disease: a longitudinal study.

To assess the reliability of activities of daily living (ADL) measures and determine the rate and pattern of longitudinal ADL change in patients with Alzheimer's disease (AD). Longitudinal study with evaluations every 6 months. Alzheimer's Disease Research Center Clinics at Mount Sinai Medical Center, New York, and the Veterans Affairs Medical Center, Bronx, New York. 104 patients meeting NINCDS-ADRDA criteria for probable AD were followed an average of 31 months. Physical Self-Maintenance Scale (PSMS) and Instrumental Activities of Daily Living Scale (IADLS) of Lawton and Brody and the Blessed Test of Information, Memory, and Concentration. For men there was inconsistency over time in the decision about whether or not some IADLS items such as "Laundry" were appropriate for a given patient. Test-retest and inter-rater reliabilities were high for all PSMS items and for IADLS items that were judged to be appropriate. IADLS scores changed an average of 2.06 (+/- 3.27) points annually, and change scores were smaller for patients with severe dementia. PSMS scores changed an average of 2.44 (+/- 3.87) points annually with virtually all change occurring in severely demented patients. There was a marked ceiling effect for the IADLS and a curvilinear relationship of PSMS annual change with PSMS baseline. Both PSMS and IADLS measures can be reliable in AD patients, but better IADLS items for males need to be developed. IADLS scores are sensitive to change in mild and moderately demented AD patients, while PSMS scores are sensitive to change in more severely demented patients.

Life activities and life quality of heroin addicts in and out of methadone treatment.

The focus of the present study was the daily life activities and self-perceived health and life quality of heroin addicts both in and out of methadone treatment, based on 219 addicts followed for 8 months after treatment entry. The majority of outcome evaluations of methadone treatment have focused on the "hard" outcome criteria of drug use levels, criminal activities, and employment. The present study, in contrast, addressed how heroin addicts live on a daily basis, and whether being chemically supported on methadone was associated with changes in daily life activities and perceived quality of life. A six-dimensional measurement model of daily life activities, perceived health, and life quality was established. Substantial changes on the dimensions in a positive direction were found in the 2 months just following treatment entry. Changes in daily life activities (e.g., spending more time with the family, attending to the home) may be early indicators of the impact of methadone treatment that precede changes on the usual "hard" criteria (e.g., obtaining legal employment).

Surgical results and complications in elderly patients with benign lesions of the spinal canal.

To describe the long-term outcome and complications of spinal surgery in a population of elderly patients. Retrospective chart review and clinical follow-up. A 700-bed tertiary care midwestern hospital. Patients 70 years of age or older who underwent elective surgical procedures for the treatment of benign lesions of the spinal canal. Data obtained from chart review included age, sex, nature and duration of neurological symptoms, activities of daily living (ADL), associated illnesses, length of hospitalization, type of surgery, and complications attributable to surgery. Outcome measurements included changes in neurological symptoms and ADL and a standardized scale obtained from consecutive outpatient visits, telephone interviews, or written responses. Seventy-eight patients with lumbar canal stenosis or soft disc herniations underwent laminectomies, foraminotomies or discectomies. Eleven patients underwent cervical laminectomies for multilevel spondylitic myelopathy. Limb and spine pain were the most common neurological symptoms in patients with lumbar lesions; diminished ADLs were present in eight patients with cervical myelopathies. Six patients died of unrelated causes, and 78 were followed for an average of 27.1 months. Twenty-three (85.2%) of 27 patients with lumbar disc herniations reported improvements or resolution of limb pain while 35 (81.4%) of 43 patients with lumbar canal stenosis reported fair or good results. Five of eight patients with multilevel cervical spondylosis reported improvements of myelopathic symptoms. Twenty-six (28.6%) complications were attributable to 91 surgical procedures including five severe complications and one fatality. Patients with three or more associated illnesses demonstrated a significantly higher incidence of postoperative complications. Elderly patients with benign lesions of the spinal canal may achieve significant reduction in limb pain and increases in ADL following appropriate surgery, with a tolerable rate of severe complications. The preoperative physical condition of the elderly patient served as an indicator for operative morbidity.