Activities Of Daily Living Dependence Research Articles

The Impact of Intrinsic Capacity on Adverse Outcomes in Older Hospitalized Patients: A One-Year Follow-Up Study

Background: Intrinsic capacity (IC) is a novel view focusing on healthy aging. The effect of IC on adverse outcomes in older hospitalized Chinese adults is rarely studied. Objectives: This study focused on investigating the impact of IC domains on the adverse health outcomes including new activities of daily living (ADL) dependency, new instrumental activities of daily living (IADL) dependency, and mortality over a 1-year follow-up. Methods: In a retrospective observational population-based study, a total of 329 older hospitalized patients from Zhejiang Hospital in China were enrolled and completed 1-year follow-up. The 5 domains of IC including cognition, locomotion, sensory, vitality, and psychological capacity were assessed at admission. The IC composite score was calculated based on these domains, and the higher IC composite score indicated the greater amount of functional capacities reserved. Multivariate logistic regression models were used to explore the association between IC at baseline and 1-year adverse outcomes. Results: During the 1-year follow-up, 69 patients (22.5%) experienced new ADL dependency, 103 patients (33.6%) suffered from new IADL dependency, and 22 patients (6.7%) died. After adjusting for age, sex, education level, comorbidities, and polypharmacy, low Mini-Mental State Examination (MMSE) scores at admission predicted 1-year new ADL dependency (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.12–4.78) and new IADL dependency (OR = 2.15, 95% CI: 1.14–4.04) among older hospitalized patients, but no significance was obtained between IC domains and mortality. Higher IC composite score at admission was associated with decreased risks of 1-year new ADL dependency (OR = 0.53, 95% CI: 0.40–0.70) and new IADL dependency (OR = 0.76, 95% CI: 0.61–0.95), and 1-year mortality (OR = 0.48, 95% CI: 0.31–0.74) after adjustment for the possible confounders. Conclusions: Loss of ICs at admission predicted adverse health outcomes including new ADL and IADL dependency and mortality 1 year after discharge among older hospitalized patients.

Análisis del estado cognitivo y su relación con la dependencia en las actividades de la vida diaria: un estudio transversal en pacientes con accidente cerebrovascular

ObjectiveTo analyse cognitive status in relation to activities of daily living (ADL) dependency in stroke patients. MethodsA cross-sectional study was carried out. The Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Barthel index were used to assess cognitive status and ADL, respectively. A Pearson and Spearman correlation was used considering the normality of the data in cognitive status. Results62 patients were evaluated. The most impaired domains were associated with writing and drawing in the MMSE (mean = 24.9 ± 4.1) and language, visuospatial/executive function, and memory in the MoCA (mean = 18.3 ± 5.6). The ADLs with most dependency on the Barthel index (mean = 78.1 ± 14.0) were eating, dressing/undressing, bathing, and going up and down stairs. On the other hand, the ADL dependency showed a correlation with the MMSE (Rho = .3) and the MoCA (r = .2). In addition, MMSE was correlated with activities including dressing/undressing (Rho = .3) and bathing (Rho = .3) and MoCA with transfer from chair to bed (r = .2). ConclusionsThe domains with the highest cognitive impairment were related to memory and visuospatial/executive function. The correlations reflect that stroke survivors with greater cognitive impairment show greater ADL dependency.

Persistent Symptoms and Disability After COVID-19 Hospitalization: Data From a Comprehensive Telerehabilitation Program

ObjectiveTo report symptoms, disability, and rehabilitation referral rates after coronavirus disease 2019 (COVID-19) hospitalization in a large, predominantly older population. DesignCross-sectional study, with postdischarge telemonitoring of individuals hospitalized with confirmed COVID-19 at the first month after hospital discharge, as part of a comprehensive telerehabilitation program. SettingPrivate verticalized health care network specialized in the older population. ParticipantsIndividuals hospitalized because of COVID-19. We included 1696 consecutive patients, aged 71.8±13.0 years old and 56.1% female. Comorbidities were present in 82.3% of the cases (N=1696). InterventionsNot applicable. Main Outcome MeasuresDependence for basic activities of daily living (ADL) and instrumental activities of daily living (IADL) using the Barthel Index and Lawton's Scale. We compared the outcomes between participants admitted to the intensive care unit (ICU) vs those admitted to the ward. ResultsParticipant were followed up for 21.8±11.7 days after discharge. During postdischarge assessment, independence for ADL was found to be lower in the group admitted to the ICU than the ward group (61.1% [95% confidence interval (CI), 55.8%-66.2%] vs 72.7% [95% CI, 70.3%-75.1%], P<.001). Dependence for IADL was also more frequent in the ICU group (84.6% [95% CI, 80.4%-88.2%] vs 74.5%, [95% CI, 72.0%-76.8%], P<.001). Individuals admitted to ICU required more oxygen therapy (25.5% vs 12.6%, P<.001), presented more shortness of breath during routine (45.2% vs 34.5%, P<.001) and nonroutine activities (66.3% vs 48.2%, P<.001), and had more difficulty standing up for 10 minutes (49.3% vs 37.9% P<.001). The rehabilitation treatment plan consisted mostly of exercise booklets, which were offered to 65.5% of participants. The most referred rehabilitation professionals were psychologists (11.8%), physical therapists (8.0%), dietitians (6.8%), and speech-language pathologists (4.6%). ConclusionsIndividuals hospitalized because of COVID-19 present high levels of disability, dyspnea, dysphagia, and dependence for both ADL and IADL. Those admitted to the ICU presented more advanced disability parameters.

Long-term individual and population functional outcomes in older adults with atrial fibrillation.

Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability have not been previously characterized. Our objective was to determine long-term function among older adults with AF and the relative contribution of stroke. We used data from the nationally representative Health and Retirement Study (1992-2014) with participants ≥65 years with incident AF. We examined the association of incident stroke with three outcomes: independence with activities of daily living (ADL), instrumental activities of daily living (IADL), and residence outside a nursing home (community-dwelling). We fit logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimated the contribution of strokes to the overall population burden of disability using the method of recycled predictions. Among 3530 participants (median age 79 years, 53% women), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for comorbidities, annually, ADL independence decreased by 4.4%, IADL independence decreased by 3.9%, and community dwelling decreased by 1.2% (p< 0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p< 0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4 years. Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant functional decline and increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of disability, stroke was not the dominant determinant of population-level disability in older adults with AF.

General practitioners\u2019 deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

BackgroundGeneral practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries.MethodsIn this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions.ResultsOf 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57).InterpretationThe majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients.

ABSTRACTObjectives:The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)—a score based on the level and duration of rehabilitation activities—of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge.Methods:This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low- and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors.Results:The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047).Conclusions:ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.

Association Between Sarcopenia and Its Components and Dependency in Activities of Daily Living in Patients on Hemodialysis

To investigate the association of sarcopenia and its components (muscle mass, muscle strength, and physical performance) with dependency in activities of daily living (ADLs) in maintaining patients on hemodialysis. This is a cross-sectional study. Sarcopenia was identified according to the Asian Working Group for Sarcopenia 2019 criteria. Basic ADLs (BADLs) and instrumental ADLs (IADLs) were assessed. Logistic regression was used to estimate the association of sarcopenia and its components with dependency. Area under the receiver-operating characteristic curve of gait speed corresponding with dependency was calculated. A total of 238 patients on hemodialysis were included. The proportion of enrolled male candidates was 67.6%, and the average age was 60.9years. In all, 49.2% (n=117) and 30.7% (n=73) of patients on dialysis were diagnosed with sarcopenia and severe sarcopenia, respectively. Dependency in BADLs was 21.0% (n=50), and dependency in IADLs was 41.2% (n=98). Severe sarcopenia was significantly associated with dependency in BADLs and IADLs after adjustment of clinical covariables (odds ratio [OR], 4.68 [95% confidence interval (CI): 2.11-10.40]; OR, 3.24 [95% CI: 1.61-6.53], respectively), whereas those effects for sarcopenia were not significant. With all three sarcopenia components in the analysis model, high gait speed remained strongly associated with low function dependency in BADLs and IADLs (per 0.1m/s increase of gait speed: OR, 0.52 [95% CI: 0.41-0.66]; and 0.46 [95% CI: 0.35-0.59], respectively). Area under the receiver-operating characteristic curve of gait speed corresponding with dependency in BADLs and IADLs was 0.827 (0.759, 0.896) and 0.878 (0.832, 0.925), respectively. Severe sarcopenia was closely related to dependency in ADL in patients on hemodialysis. Gait speed was the most important factor affecting dependency in sarcopenia and had good diagnostic accuracy for screening dependency in ADL.

Nursing home residents’ ADL status, institution-dwelling and association with outdoor activity: a cross-sectional study

IntroductionThe Norwegian regulations for nursing homes consider access to meaningful activities to be an indicator for the quality of nursing homes. Activities of daily living (ADL) provide important basic self-care skills for nursing home residents. Due to the physical changes caused by ageing and comorbidities, nursing home residents may experience functional decline over time, which may affect their ability to perform meaningful ADL, such as outdoor activity, which is considered a valuable and meaningful activity in Norwegian culture. This study aimed to investigate the association between ADL status, institution-dwelling and outdoor activity among nursing home residents.MethodsThis cross-sectional study included 784 residents aged >67 years living in 21 nursing homes in 15 Norwegian municipalities between November 2016 and May 2018. The Barthel Index was used to assess the nursing home residents’ ADL status. Other variables collected were age, gender, body weight and height, visits per month, institution, ward, and participation in weekly outdoor activities. Descriptive statistics were used to provide an overview of the residents’ characteristics. A Poisson regression model was used to test the association between the outdoor activity level as the dependent variable and ADL score, institution, and other control variables as independent variables.ResultsMore than half (57%) of the nursing home residents in this sample did not go outdoors. More than 50% of the residents had an ADL score <10, which indicates low performance status. Further, we found that residents’ ADL status, institution, ward, and number of visits had an impact on how often the residents went outdoors.DiscussionThe nursing home residents in this study rarely went outdoors, which is interesting because Norwegians appreciate this activity. Differences in the number of visits might explain why some residents went outdoors more often than other residents did. Our findings also highlight that the institutions impact the outdoor activity. How the institutions are organized and how important this activity is considered to be in the institutions determine how often the activity is performed.ConclusionThe low frequency of the outdoor activities might be explained by a low ADL score. More than 50% of the residents had an ADL score <10, which indicates low performance status. Despite regulations for nursing home quality in Norway, this result suggests that organizational differences matter, which is an important implication for further research, health policy and practice.

Functional dependence among older adults: a cross-sectional study with a rural population of southern Brazil.

Brazil has a rapidly aging population, yet little is known about the occurrence of functional dependence in the rural older adult population. The objective of this study was to estimate the prevalence of functional dependence and its associated factors among community-dwelling older adults in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. This was a cross-sectional, population-based study. A systematic random sampling of households was used. Eighty percent of households in the rural area were selected, which included 1131 older adults. The outcome analyzed in this study was functional dependence. This was measured by and data were collected using the Katz Index for Activities of Daily Living (ADL) and Lawton and Brody's Scale for Instrumental Activities of Daily Living (IADL). Descriptive analysis was used to estimate the prevalence of functional dependence in ADL and IADL and to describe the sample. Crude and adjusted analysis was performed by Poisson regression with robust adjustment of variance. Prevalence ratios (PRs) and 95% confidence intervals (95%CIs) were reported. A total of 1029 older adults took part in this study, corresponding to an 8.9% rate of losses and refusals. Prevalence of functional dependence in ADL was 8.1% (95%CI 6.4-9.7), while prevalence of functional dependence in IADL was 32.4% (95%CI 29.5-35.2). The occurrence of functional dependence in one or more of ADL or IADL was 6.7% (95%CI 5.2-8.2). The following categories were associated with functional dependence in ADL: female sex (PR=1.70; 95%CI 1.10-2.62), age group 80 years or more (PR=3.68; 95%CI 2.20-6.16), no schooling (PR=2.61; 95%CI 1.26-5.37) and 1-4 years of schooling (PR=2.49; 95%CI 1.28-4.84), having diabetes (PR=1.85; 95%CI 1.21-2.83), depression in the previous year (PR=1.90; 95%CI 1.09-3.31), urinary incontinence (PR=3.26; 95%CI 2.06-5.16), history of stroke (PR=2.26; 95%CI 1.35-3.76) and poor/very poor self-rated health (PR=2.36; 95%CI 1.29-4.32). The following categories were associated with functional dependence in IADL: female sex (PR=1.40; 95%CI 1.19-1.65), age groups of 70-79 years (PR=1.92; 95%CI 1.51-2.43) and 80 years or more (PR=3.80; 95%CI 3.07-4.72), no schooling (PR=1.87; 95%CI 1.46-2.41) and 1-4 years of schooling (PR=1.55; 95%CI 1.22-1.96), medical diagnosis of diabetes (PR=1.33; 95%CI 1.10-1.60), urinary incontinence (PR=1.40; 95%CI 1.17-1.68), history of stroke (PR=1.41; 95%CI 1.10-1.81) and regular self-rated health (PR=1.27; 95%CI 1.06-1.52) or poor/very poor self-rated health (PR=1.80; 95%CI 1.41-2.30). Older adults in rural areas have a high prevalence of functional dependence. Knowledge of functional dependence and associated factors in rural populations is necessary for the planning and developing actions, especially in the routine of primary care, which promote health and prevent or postpone the decline in functional capacity.

Development and Validation of Machine Learning-Based Prediction for Dependence in the Activities of Daily Living after Stroke Inpatient Rehabilitation: A Decision-Tree Analysis

Background and PurposeAccurate prediction using simple and changeable variables is clinically meaningful because some known-predictors, such as stroke severity and patients age cannot be modified with rehabilitative treatment. There are limited clinical prediction rules (CPRs) that have been established using only changeable variables to predict the activities of daily living (ADL) dependence of stroke patients. This study aimed to develop and assess the CPRs using machine learning-based methods to identify ADL dependence in stroke patients. MethodsIn total, 1125 stroke patients were investigated. We used a maintained database of all stroke patients who were admitted to the convalescence rehabilitation ward of our facility. The classification and regression tree (CART) methodology with only the FIM subscores was used to predict the ADL dependence. ResultsThe CART method identified FIM transfer (bed, chair, and wheelchair) (score ≤ 4.0 or > 4.0) as the best single discriminator for ADL dependence. Among those with FIM transfer (bed, chair, and wheelchair) score > 4.0, the next best predictor was FIM bathing (score ≤ 2.0 or > 2.0). Among those with FIM transfer (bed, chair, and wheelchair) score ≤ 4.0, the next predictor was FIM transfer toilet (score ≤ 3 or > 3). The accuracy of the CART model was 0.830 (95% confidence interval, 0.804–0.856). ConclusionMachine learning-based CPRs with moderate predictive ability for the identification of ADL dependence in the stroke patients were developed.

Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans.

Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA2 DS2 -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]). In this study of 779 participants with AF (median age = 80 years; median CHA2 DS2 -VASc score = 4), 82% had one or more geriatric syndromes. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairments, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7%; 95% confidence interval = -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia. Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia - A Subgroup Analysis of a Randomized Controlled Trial.

PurposeTo investigate if the effects of geriatric interdisciplinary home rehabilitation after hip fracture were different among people with dementia compared to those without dementia and to describe the overall outcome after hip fracture in people with dementia.Patients and MethodsA post hoc subgroup analysis of a randomized controlled trial was conducted including 205 people with hip fracture, aged ≥70, living in ordinary housing or residential care facilities. Early discharge followed by individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks was compared to in-hospital geriatric care according to a multifactorial rehabilitation program. Outcomes were hospital length of stay (LOS), readmissions, falls, mortality, performance in activities of daily living (ADL), and walking ability.ResultsInterdisciplinary home rehabilitation vs in-hospital care had comparable effects on falls and mortality between discharge and 12 months and on ADL and walking ability at 3 and 12 months regardless of whether the participants had dementia or not (P≥0.05 for all). Among participants with dementia, postoperative LOS was a median of 18 days (interquartile range [IQR] 14–30) in the home rehabilitation group vs 23 days (IQR 15–30) in the control group (P=0.254) with comparable numbers of readmissions after discharge. Dementia was associated with increased risk of falling (odds ratio [OR] 3.86; 95% confidence interval [CI]: 2.05–7.27; P<0.001) and increased mortality (OR 4.20; 95% CI 1.79–9.92, P=0.001) between discharge and 12 months and with greater dependence in ADL and walking at 3 and 12 months compared to participants without dementia (P<0.001 for all).ConclusionThe effects of geriatric interdisciplinary home rehabilitation vs in-hospital geriatric care did not differ in participants with and without dementia. However, the statistical power of this subgroup analysis was likely insufficient to detect differences between the groups. Dementia was associated with a substantial negative impact on the outcomes following the hip fracture. Our findings support offering interdisciplinary home rehabilitation after hip fracture to people with dementia.

Prevalence of Comorbid Spasticity and Urinary Incontinence in Residents of a Long-Term Care Facility.

The current study evaluated the prevalence of comorbid spasticity and urinary incontinence (UI) in a long-term care facility. Medical history, presence of UI, and activities of daily living (ADL) dependency were obtained from medical records and Minimum Data Set 3.0. Quality of life was assessed with the EuroQoL-5D-5L (EQ-5D). Comorbid spasticity and UI presented in 29% of participants (14 of 49). Participants with spasticity and UI had higher ADL dependency and lower EQ-5D than participants without both conditions (4.9, 95% confidence interval [CI] [1.6, 80.], p = 0.003; -0.17, 95% CI [-0.33, 0.00], p = 0.044; respectively). More than one half of participants with lower limb spasticity had severe UI, compared to only 10% without lower limb spasticity (relative risk = 5.5; 95% CI [1.9, 15.9]; p = 0.006). Comorbid spasticity and UI may be common in the long-term care setting and negatively associated with ADL and quality of life. Further investigation is needed to confirm these findings. [Journal of Gerontological Nursing, 46(10), 35-42.].

Characteristics of Long-Term Care Residents That Predict Adverse Events after Hospitalization.

Adverse events (AEs) occur frequently in long-term care (LTC) residents transitioning from the hospital back to an LTC facility. Measuring the association between resident characteristics and AEs can inform AE risk reduction strategies. Prospective cohort analysis. A total of 32 nursing homes from six New England states. A total of 555 LTC residents contributing 762 transitions from the hospital back to LTC. We measured the association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC and demographic variables, hospital length of stay (LOS), Charlson Comorbidity Index (CCI) (0-1, 2-3, 4-5 and ≥6), dependency in activities of daily living (ADLs) using the Minimum Data Set Long Form Scale (in quintiles 0-12, 13-15, 16, 17-18, and ≥19), and number of regularly scheduled medications (0-9, 10-13, 14-17, and ≥18). To understand the independent association of each resident characteristic with AEs and preventable AEs, we constructed multiple Cox proportional hazards models. There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of an AE included hospital LOS 9 or more days (hazard ratio [HR] = 1.49; 95% confidence interval [CI] = 1.02-2.17); CCI of 4 to 5 (HR = 1.74; 95% CI = 1.13-2.67) or 6 or higher (HR = 1.58; 95% CI = 1.01-2.46); 18 or more regularly scheduled medications (HR = 1.53; 95% CI = 1.07-2.18); and 19 and above on ADL dependency (HR = 1.78; 95% CI = 1.21-2.62). Results from models with preventable AEs were similar to those with all AEs. Increased LOS, higher comorbidity burden, greater dependency in ADLs, and polypharmacy were the resident characteristics most strongly associated with risk of AEs and preventable AEs. We recommend heightened vigilance in the care of LTC residents with these characteristics transitioning back to LTC. We also recommend research to assess strategies to reduce the risk of AEs.

Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico.

Background: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonetheless, these studies were not specifically designed to estimate the economic impact of dependence. Our aim was to estimate the total adjusted annual OOP healthcare expenditures in dependent older adults compared to independent ones. Additionally, we explore the potential combined effect of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) dependence on OOP healthcare expenditures.Methods: Data comes from the cross-sectional study “Economic impact of physical dependence in older adults and the burden of informal care” conducted in 2018 with a sample of 735 community-dwelling older Mexican adults ages 60 and older. We used direct (medical and non-medical) and indirect costs to estimate the OOP healthcare expenditures associated with dependence. We applied the Katz scale to assess dependence in ADL and the Lawton scale to assess dependence in IADL. Two-Part regression models were used to analyze the relationship between dependence and OOP health expenditures.Results: Presence of ADL dependence represented a higher level of expenditure, 107% compared to non-dependent OA (β = 1.07, CI95%: 0.43–1.71), and 97% for IADL dependence (β = 0.97, CI95%: 0.49–1.45). The combined effect of ADL and IADL dependence (132%) was greater (β = 1.32, CI95%: 0.74–1.90) than the effect of ADL or IADL dependence alone. In monetary terms, OA with ADL dependence had a total annualized mean OOP healthcare expenditure of $31,865 (Mexican pesos), OA with IADL $26,912, and combined ADL and IADL $39,520.Conclusions: ADL and IADL dependence are associated with the total annualized OOP healthcare expenditures. This association is even higher when both conditions are present together. These findings highlight the economic implications of the dependence for individuals, their families, and the health system. Given that current evidence on effective interventions to prevent dependence in OA is insufficient, future studies should be conducted to estimate their costs and determine what interventions work, as well as their effectiveness and cost-effectiveness in different sub-groups of the population, and how these might be appropriately implemented.

Adverse Childhood Experiences, Depressive Symptoms, Functional Dependence, and Physical Activity: A Moderated Mediation Model.

Adverse childhood experiences, depressive symptoms, and functional dependence are interrelated. However, the mechanisms underlying these associations remain unclear. The authors investigated the potential of depressive symptoms to mediate the effect of adverse childhood experiences on functional dependence in older age and whether physical activity moderated this mediation. Data from 25,775 adults aged 62 (9)years from the Survey of Health Ageing and Retirement in Europe were used in adjusted linear mixed-effects models to test whether depressive symptoms mediated the associations between adverse childhood experiences and functional dependence in activities of daily living (ADL) and instrumental ADL (IADL) and whether physical activity moderated these mediations. The results showed a graded association between the number of adverse childhood experiences (0 vs 1 and 0 vs ≥2) and the number of functional limitations in both ADL (bs = 0.040 and 0.067) and IADL (bs = 0.046 and 0.076). These associations were mediated by depressive symptoms. Physical activity reduced the effect of adverse childhood experiences on depressive symptoms (bs = -0.179 and -0.515) and tempered the effect of depressive symptoms on functional dependence both in ADL (b = -0.073) and IADL (b = -0.100). As a result of these reductions, the effect of adverse childhood experiences and depressive symptoms on functional dependence in ADL (Ps > .081) and IADL (Ps > .528) was nonsignificant in physically active participants. These findings suggest that, after age 50, engaging in physical activity more than once a week protects functional independence from the detrimental effects of adverse childhood experiences and depression. In inactive individuals, the detrimental effects of adverse childhood experiences on functional dependence are mediated by depressive symptoms.

Occupational and leisure-time physical activity decreases the odds of disability in older adults: Prospective study

Aging decreases physical function which can increase dependence in activities of daily living (ADL) and disability. However, physical activity (PA) may improve physical function and prevent disability in older adults. In addition, it is important to emphasize that research concerning the domains in which PA is practiced and the benefits for physical function of older adults is also important for the elaboration of preventative health measures for this population. Thus, the aim of this study was to analyse the association of total PA and PA in different domains and odds of disability in older adults in a 24-month follow-up. The study included 211 older adults, aged ≥60 years (72 ± 7 years, 72% women). Handgrip strength was measured using a digital dynamometer, gait speed and chair stand by functional tests. PA and dependence in ADL were self-reported. Older adults who remained sufficiently active in the occupational (OR:0.11;CI95%:0.01–0.93, OR:0.21;CI95%:0.07–0.69, and OR:0.13;CI95%:0.05–0.34) domain presented protection for high dependence in basic (BADL), instrumental (IADL) and advanced (AADL), respectively, as well as in total ADL (OR:0.25;CI95%:0.07–0.92). Older adults who remained sufficiently active in the leisure-time exercise (OR:0.28;CI95%:0.11–0.72, OR:0.44;CI95%:0.20–0.93 and OR:0.15;CI95%:0.04–0.49) domain presented protection for high dependence in IADL, AADL and total ADL, respectively. Moreover, older adults who remained sufficiently active in total PA (OR:0.11;CI95%:0.01–0.94, OR:0.30;CI95%:0.11–0.80 and OR:0.21CI95%:0.10–0.46) presented protection for high dependence in BADL, IADL and AADL, respectively, as well as in total ADL (OR:0.28;CI95%:0.09–0.86). The odds of disability are lower in older adults who are sufficiently active, especially in occupational and leisure-time exercise domains.

Dynamic Balance Performance In Relation To the Dependence in Activities of Daily Living: A Cross-Sectional Study in Stroke Patients

Aim: to determine if dynamic balance is related to activities of daily living (ADL) dependence in stroke patients. Methods: a cross-sectional study was carried out. The Barthel index (BI) was used to assess ADL dependence. The Timed Up and Go Test (TUG) and the Four Square Step Test (FSST) were used to evaluate dynamic balance. A Spearman correlation was used assuming a data abnormality in the performance of TUG and FSST and considering a significance of p&lt;0.05. Results: 62 stroke patients were evaluated. The BI showed correlations with the performance of the TUG and the FSST. These correlations were also found between performance of both balance tests and ADLs, such as bathing, moving, and going up and down stairs. In contrast to TUG, correlations were estimated between the ADL related to dressing and the performance of the FSST. Conclusion: dynamic balance evaluated by the TUG and the FSST showed correlations with the ADL dependency in stroke patients.

The Prevalence of Physical Disability in Elderly SAMPLE in Primary Health Care Centers (PHCs) in AL-Resafa Sector /Baghdad/2018

Background&#x0D; The proportion of older population throughout the world is continuously increasing, and becomes a challenge worldwide, since it may lead to an increasing number of disabled populations, and to a rise of the national health burden, and so there is greater need to look into their physical disability aspects, which is otherwise neglected.&#x0D; Objectives&#x0D; To estimate the prevalence of Activity of Daily Living dependency(ADL) in primary health care centers(PHCs) in AL Resafa health sector in Baghdad, and to find association between dependency and some sociodemographic factors.&#x0D; Method&#x0D; A Descriptive cross- sectional study was carried out in all PHCs in AL Resafa health sector in Baghdad and 250 elderly were interviewed using pretested questionnaire which covered some Sociodemographic factors and Barthal index scale( a 10 item instrument measuring functional independence in personal Activities of Daily Living).&#x0D; Results&#x0D; 250 participants all of them are aged 60 year and older, those aged 60 to 69 years were 47.6%, minority aged 80 years and older , elderly female were slightly more than male (51.6%,48.4% ), Most of participants 97.6% were living in company with their families, 82.0% were not currently employed, 48% overweight , According to Barthal index scale score: 78.0% were independent while ADL with assistance observed in 15.2% and those of ADL with severity 6.8%. There was a significant association between increase in age, Female gender, low education and obesity with decrease in ADL.&#x0D; Conclusion&#x0D; Preserving functional capacity of elderly is a great challenge to public health, subjects categorization on the basis of Barthel index to correlates functional disability will be of value for a better quality of life.

Factors associated with the overlap of frailty and nutrition in institutionalized older adults: A multicenter study

ObjectivesThis multicenter cross-sectional study aimed to investigate the factors associated with the overlap of frailty and nutrition in older adults residing in nursing homes. MethodOlder adults (n = 344, mean age ± SD = 77.7 ± 9.1) were selected from 17 nursing homes, 10 in Piracicaba and seven in João Pessoa, Brazil. The modified Fried’s questionnaire and the Mini Nutrition Assessment Short-Form (MNA-SF) were used for screening frailty phenotypes and nutritional status, respectively. These variables overlapped into (1) frail and malnourished; (2) nonfrail and malnourished or frail and nourished; and (3) nonfrail and nourished. The independent variables were sex, age, mobility, number of medications, dependence for activities of daily living (ADL), maximal grip strength, muscle mass, body fat and body mass index (BMI). Spearman’s correlation and Poisson regression were used to analyze the data (α = 0.05). ResultsThe Spearman’s test demonstrated a moderate correlation (r2=-0.441) between frailty (mean ± SD = 2.8 ± 1.7) and nutritional status (mean ± SD = 10.5 ± 2.9). Regarding the overlap of frailty and nutrition, 139 participants (40.5 %) were frail and malnourished, 121 (35.3 %) were nonfrail and malnourished or frail and nourished, and 83 (24.2 %) were nonfrail and nourished. The Poisson regression showed association of the coexistence of frailty and malnutrition with age (PR = 1.009, 95 % CI = 1.003−1.016), number of medications (PR = 1.016, 95 % CI = 1.006−1.027), dependence for ADL (PR = 1.061, 95 % CI = 1.016−1.108), maximal grip strength (PR = 0.992, 95 % CI = 0.986−0.998) and BMI (PR = 0.997, 95 % CI = 0.996−0.998). ConclusionsThe findings showed that frailty and malnutrition were prevalent in institutionalized older adults and associated with advanced age, greater use of medicines, dependence for ADL, lower maximal grip strength and lower BMI.