Activities Of Daily Living Dependence Research Articles

Gait speed moderates the adverse effect of obesity on dependency in older Colombian adult.

Gait speed worsens with the presence of obesity, and is a powerful marker of functional dependence. Accordingly, gait speed could be a factor that improves or worsens the relationship between obesity and dependence in activities of daily living (ADL). However, to date this potential role has not been examined and the minimum gait speed threshold in the relationship between obesity and ADL is not known. The aim of this study was to determine whether speed moderates the association between obesity and dependence in ADL, and also define the gait speed threshold of this relationship. A total of 20,507 community-dwelling older adults from a cross-sectional analysis of national survey data - the Colombian Health, Well-being and Aging study (SABE, 2015) - were surveyed. The research data were collected using structured questionnaires, including basic information, ADL measured using the Barthel Index, body mass index, and gait speed (3 m). The Johnson-Neyman technique was applied to determine the gait speed threshold adjusted for age, sex and comorbidities. Regression analysis showed a significant detrimental effect of obesity on dependence in ADL, which was moderated by gait speed (β = 0.081; 95%CI: 0.045 to 0.117; p < 0.001). Adjusted for major covariates, the Johnson-Neyman technique defined two gait speed thresholds: < 0.77 m/s, indicating an aggravated adverse effect; and >1.06 m/s, indicating a positive effect. The adverse effect of obesity on dependence in ADL is moderated by gait speed. Considering these thresholds, the distribution of older adults in each of the proposed areas of significance were: below 0.77 (m/s) = 14,324 (70.0%), above 1.06 (m/s) = 1553 older adults (7.5%) and between areas = 4630 older adults (22.5%).

Prognostic value of a rapid sarcopenia measure in acutely ill older adults.

Current recommendations to assess sarcopenia requiring specialized equipment hinder its use as a prognostic tool in busy acute settings. To investigate the prognostic value of a rapid sarcopenia measure in acutely ill older outpatients for 1-year adverse outcomes. Prospective study with 665 acutely ill older adults (mean age 78.7±8.3 years; 63% women) in need of intensive management to avoid hospital admission. Sarcopenia was screened upon admission, defined as the presence of both low muscle strength and low muscle mass. Low muscle strength was determined by handgrip strength according to the cutoffs of the Foundation for the National Institutes of Health (<16kg for women and <26kg for men). Low muscle mass was assessed by calf circumference, a validated surrogate measure of skeletal muscle mass, using previously established thresholds (≤33cm for women and ≤34cm for men). Outcomes were time to hospitalization, new dependence in basic activities of daily living (ADL), worsening walking ability, and death. To investigate the association of sarcopenia and its components with outcomes we used hazard models, considering death as a competing risk, adjusted for sociodemographic factors, Charlson comorbidity index, cognitive impairment, depressive symptoms, and weight loss. On admission, 203 (31%) patients had sarcopenia. Comparing 1-year adverse outcomes between older adults with and without sarcopenia, respectively, cumulative incidences for hospitalization were 46% vs 32% (adjusted sub-hazard ratio [sHR]=1.53; 95% CI=1.16-2.04), for new ADL dependence, 47% vs 24% (adjusted sHR=1.78; 95% CI=1.31-2.42), for worsening walking ability, 28% vs 13% (adjusted sHR=1.93; 95% CI=1.28-2.90), and for death, 22% vs 10% (adjusted HR=1.69; 95% CI=1.05-2.73). Low muscle strength alone was associated with all outcomes, and low muscle mass was associated with all outcomes except mortality. Sarcopenia was a strong predictor of 1-year adverse outcomes among acutely ill older outpatients. Combining handgrip strength with calf circumference may be a practical and efficient approach to screen for sarcopenia, and thereby identify high-risk older adults in busy clinical settings.

Influence of Cognition on Length of Stay and Rehospitalization in Older Veterans Admitted for Post-Acute Care.

Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes. Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke's Cognitive Examination-Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC. Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% (n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%). Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.

Dependency in Activities of Daily Living Is Associated with Household Food Insecurity Among Mexican Older Adults (P04-070-19)

ObjectivesTo analyze the association between dependency in activities of daily living (DADL) among Mexican older adults and the presence of household food insecurity. MethodsData on 6674 Mexican adults aged ≥60 years and their households were drawn from the 2012 Mexican National Health and Nutrition Survey (ENSANUT). DADL dependency, measured under the Katz Index (1983), was determined when respondents indicated needing assistance from another person in order to perform at least one DADL. Food insecurity (FI) was measured according to the Latinoamerican and Caribbean Food Security Scale (ELCSA). We used Path Analysis to examine the structure of the association of FI with DADL and other socio-demographic variables. Results22.6% of older adults analyzed were ADL-dependent, and 72.9% lived in households marked by a FI category. We found that DADL (P = 0.001) exerted a significant impact on moderate and severe FI in households not benefiting from a food aid program (P = 0.000) or retirement pension plan (P = 0.000). ConclusionsFew studies have explored this issue. DADL are intimately linked to household FI in that they affect the productivity of working adults and their caregivers. The findings from this study support the creation of nutritional policies and programs which address the unique needs of low income elderly people who have functional limitations. Funding SourcesN/A.

Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living.

BackgroundSarcopenia in older adults is strongly associated with an increase in dependency in activities of daily living (ADL) and with a decline in gait speed. Interestingly, gait speed has been shown to independently predict mortality. In this context, our study aimed to explore the mediator role of gait speed on the relationship between sarcopenia and dependency in ADL.MethodsA cross‐sectional study was conducted in Colombia, 19 705 older adults with a mean age of 70 years, 55.6% women, 16.1% with sarcopenia, and 14.7% mild, moderate, or severe dependency in ADL, according to ‘SABE Survey 2015’. Sarcopenia was assessed by calf circumference and ADL dependence through the Barthel Index. Gait speed was measured over a distance of 3 m. The association between sarcopenia condition and gait speed and dependency level was analysed by linear regression adjusted by covariates. To examine whether gait speed mediated the association between sarcopenia and dependence components of physical function, simple mediation models were generated using ordinary least squares with the macro PROCESS version 3.2, adjusted for age, sex, and body mass index (BMI).ResultsSignificant differences (P < 0.05) were found in gait speed and dependency in ADL between the sarcopenia and non‐sarcopenia groups after adjusting for age, sex, and BMI. BMI was significantly higher in the non‐sarcopenia group whereas dependency was significantly higher in the sarcopenia group (19.6% vs. 13.8%). Results from mediation model regression analysis indicated a significant and direct detrimental effect of sarcopenia on dependency in ADL (β = −0.05; P < 0.001), and a significant indirect effect of gait speed on the direct effect (−0.009 to −0.004).ConclusionsThe negative effect of sarcopenia on functional dependence was mediated by the gait speed. Therefore, gait speed may positively influence the detrimental effect of sarcopenia for dependency, after adjusting for age, gender, and BMI. Consequently, physical exercise should be promoted and focused to circumvent the gait speed decline associated with age in older people with sarcopenia.

Changes in functional outcome over five years after stroke.

ObjectivesData on the long‐term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort.Materials and MethodsConsecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed‐up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility.ResultsThe proportions of survivors who reported ADL dependency remained stable throughout follow‐up (19%–22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08–1.13), diabetes (HR 1.65; 95% CI 1.12–2.44), NIHSS score (HR 1.07; 95% CI 1.04–1.10), and self‐perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44–2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19–0.91), NIHSS score (HR 0.90; 95% CI 0.86–0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17–0.89.ConclusionTransitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.

Activities of Daily Living of Home Healthcare Patients

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.

Acute inflammation is associated with lower muscle strength, muscle mass and functional dependency in male hospitalised older patients

BackgroundHospitalisation is associated with adverse health outcomes including loss of muscle strength, muscle mass and functional decline, which might be further aggravated by acute inflammation. This study aimed to determine whether acute inflammation, as denoted by C-reactive protein (CRP), is associated with muscle strength, muscle mass and functional dependency in hospitalised older patients.MethodsThe observational, prospective EMPOWER study included 378 hospitalised patients aged 70 years and older. As part of the hospital assessment, 191 patients (50.5%) had CRP measured. Muscle strength and mass were measured using handheld dynamometry and bioelectrical impedance analysis respectively. Activities of Daily Living (ADL) were assessed using Katz score and Instrumental ADL (IADL) by Lawton and Brody score. Linear regression analyses and logistic regression analyses were performed stratified by sex and adjusted for age and comorbidities.ResultsMean age was 79.7 years (SD 6.4) and 50.8% were males. On admission and discharge, males with elevated CRP had significantly lower handgrip strength and lower absolute muscle mass compared with males with normal CRP and those with no CRP measured. At three months post-discharge, males with elevated CRP were more likely to be ADL dependent than those with normal CRP and with no CRP measured. In females, no associations were found between CRP and muscle strength, muscle mass, ADL or IADL.ConclusionsHospitalised older male patients with acute inflammation had lower muscle strength at admission and discharge and lower absolute muscle mass at admission and higher ADL dependency at three months post-discharge.

Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies.

Cancer-focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute-care utilization in populations of older adults with different hematologic malignancies. Prospective cohort study. A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA. Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations). Subjects were a mean age of 79.7 years and had a mean follow-up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46-3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30-5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37-6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency. These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute-care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889-897, 2019.

Crossed Cerebellar Diaschisis Has an Adverse Effect on Functional Outcome in the Subacute Rehabilitation Phase of Stroke: A Case-Control Study

ObjectiveTo investigate whether crossed cerebellar diaschisis (CCD) is associated with functional outcome in the subacute rehabilitation phase of stroke. DesignRetrospective case-control study. SettingHospital-based cohort. ParticipantsThe study enrolled participants who underwent brain single-photon emission computed tomography (N=48). Patients with CCD were identified (n=24). Twenty-four controls were selected for each case-patient by matching age, stroke type (ischemic or hemorrhagic), lesion laterality, and lesion location. InterventionNot applicable. Main Outcome MeasuresThe functional ambulation category (FAC), modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE) were administered at the initial (initiation of rehabilitation therapy) and the follow-up (4wk after rehabilitation therapy) assessments. ResultsThe CCD group had lower MMSE, FAC, MBI, and MMSE scores at the initial assessment (P=.032, .016, and .001, respectively) and lower FAC and MBI scores at the follow-up assessment, than the non-CCD group (P=.001 and .036, respectively). Although CCD was not associated with cognitive impairment, nonambulatory status, and dependent activities of daily living (ADL) at the initial assessment (P=.538, .083, and >.99, respectively), the CCD group had a higher risk of cognitive impairment (adjusted odds ratio [aOR]=4.044; 95% confidence interval [CI], 1.071-15.270; P=.039), nonambulatory status (aOR=7.000; 95% CI, 1.641-29.854; P=.009) and dependent ADL (aOR=13.500; 95% CI, 1.535-118.692; P=.019) at the follow-up assessment. ConclusionsCCD is associated with severe functional impairment and may have an adverse effect on functional outcomes related to cognition, ambulatory function, and ADL during the subacute rehabilitation phase of stroke. This suggests that CCD may be a valuable predictor of functional outcome in the subacute rehabilitation phase of stroke.

Association of Handgrip Strength and Muscle Mass with Dependency in (Instrumental) Activities of Daily Living in Hospitalized Older Adults -The EMPOWER Study

ObjectivesHandgrip strength (HGS) and muscle mass are strong predictors for dependency in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in community dwelling older adults. Whether this also applies to older hospitalized patients is yet unknown. We studied the association between HGS and muscle mass with ADL and IADL dependency at admission and change of ADL and IADL dependency at three months after discharge in older hospitalized patients.DesignObservational longitudinal inception cohort (EMPOWER) including 378 patients aged 70 years and older.SettingFour different clinical wards of a university teaching hospital, The Netherlands.MeasurementsHGS and muscle mass were measured within 48 hours after admission using hand dynamometry and Bio-electrical Impedance Analysis respectively. ADL dependency was assessed using the Katz score (0-6 points) and IADL dependency using the Lawton and Brody score (0-8 points) within 48 hours after admission and three months after discharge.ResultsAt admission, lower HGS was associated with ADL dependency in both males and females. Lower muscle mass was associated with ADL dependency in males. Lower HGS was associated with IADL dependency, but only in males. Lower HGS at admission in males was associated with an increase in ADL dependency three months after discharge.ConclusionIn hospitalized older patients, HGS is associated with ADL and IADL and muscle mass measures with ADL in male patients only. HGS should be explored as predictive marker for outcome of hospitalized older patients after discharge.

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

Cirrhosis is associated with disabling symptoms and diminished health-related quality of life (HRQOL). However, for patients with compensated disease, data are limited regarding associations with poor patient-reported outcomes (PROs). We prospectively enrolled 300 patients with cirrhosis and portal hypertension without a history of hepatic encephalopathy (HE) and reviewed medical and pharmacy records. We characterized determinants of PROs using the 8-item Short-Form Health Survey (SF-8) scale (0-100) and sleep quality using the Pittsburgh Sleep Quality Index (PSQI; poor sleep >5). Disability and frailty measures were assessed using activities of daily living (ADLs), falls, hand-grip, and chair-stands. Cognitive function was measured using weighted-lures from the Inhibitory Control Test (ICT). The median age of our cohort was 60 (interquartile range [IQR], 52-66) years, 56.3% were male, and 70% Child class A. All patients had portal hypertension, 76% had varices, and 41% had a history of ascites (predominantly well controlled). The median Model for End-Stage Liver Disease with Sodium (MELD-Na) score was 9 (IQR, 7-13). The overall median SF-8 was 70 (IQR, 54-86). Multivariate analysis showed that after adjusting for age, sex, education, and MELD-Na, performance on chair-stands (9.28 HRQOL points [95% confidence interval {CI}, 4.76-13.8] per 10-stands), ADL dependence (-6.06 [-10.8 to -1.36]), opiate use (-5.01 [-7.84 to -2.19]), benzodiazepine use (-3.50 [-6.58 to -0.42]), and ICT performance (-0.10 [-0.20 to 0.001] per weighted-lure) were significantly associated with HRQOL. Among patients completing the ICT, poor HRQOL (score <50) was significantly associated with chair-stands (odds ratio [OR] per 10-stands, 0.24; 95% CI [0.11-0.56]) and weighted lures (OR per weighted-lure, 1.01 [1.00-1.03]). Poor sleep quality was associated with opiate use (OR, 2.85 [1.11-7.29]) and lures (OR per-lure, 1.03 [1.00-1.05]). Conclusion: Disability, chair-stand performance, cognitive dysfunction, as well as psychoactive medication use are significantly associated with PROs in patients with clinically stable cirrhosis.

Urinary tract infection-related hospitalization among older adults receiving home health care

Urinary tract infection (UTI)- related hospitalizations are a poor patient outcome in the rapidly growing home health care (HHC) arena that serves a predominantly elderly population. We examined the association between activities of daily living (ADL) and risk of UTI-related hospitalization among this population. Using a retrospective cohort design, we conducted a secondary data analysis of a 5% random sample of a national HHC dataset, the Outcome and Assessment Information Set for the year 2013. Andersen's Behavioral Model of Health Service Utilization was used as a guiding framework for statistical modeling. We used logistic regression to examine the association between UTI-related hospitalization and predisposing, enabling, or need factors. Among beneficiaries (n = 24,887) hospitalized in 2013, 1,133 had UTI-related hospitalizations. HHC patients with a UTI-related hospitalization were more likely to have severe ADL dependency, impaired decision making, and lower Charlson Comorbidity Index, than those with a non UTI-related hospitalization (P < .001). Risk factors for UTI-related hospitalization included female sex, (adjusted odds ratio [AOR], 1.44; 95% confidence interval [CI], 1.25-1.66), Medicaid recipient (AOR, 1.99; 95% CI, 1.09-3.64), severe ADL dependency (AOR, 1.50; 95% CI, 1.16-1.94), the presence of a caregiver to assist with supervision and safety (AOR, 1.26; 95% CI, 1.06-1.49), treatment for UTI in the previous 14 days (AOR, 2.85; 95% CI, 2.46-3.29), presence of a urinary catheter (AOR, 3.77; 95% CI, 2.98-4.77), and prior history of indwelling or suprapubic catheter (AOR, 1.44; 95% CI, 1.06-1.94). ADL dependency levels are a potentially modifiable risk factor for UTI-related hospitalization on admission to HHC. ADL dependency levels can inform clinical interventions to ameliorate ADL dependency in HHC settings and identify groups of patients at high risk for UTI-related hospitalization.

Functional Recovery Within a Formal Home Care Program

ObjectiveTo identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. DesignRetrospective longitudinal analysis of an international home care database. Setting and participants523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. MeasuresRecovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. ResultsThe Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. Conclusions/ImplicationsThe Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.

The “Eyeball Test” for Risk Assessment in Aortic Stenosis: Characterizing Subjective Frailty Using Objective Measures

ABSTRACT Background: Subjective frailty assessment is widely employed in risk stratification of patients with severe aortic stenosis (AS), but the association with objective frailty parameters is poorly characterized. Methods: Frailty was subjectively assessed (dichotomously as frail or not frail) in high-risk patients with AS referred to a Heart Valve Clinic. An objectively derived composite frailty score was derived by summing quartiles of the following frailty measures: 15-foot walk time, grip strength, independence in activities of daily living (ADL), and serum albumin. The objective measures and composite score were compared between those considered frail and not frail by subjective assessment. The relationship between frailty status and outcomes was analyzed. Results: Of 100 subjects, 31 were frail by subjective assessment. When compared to those considered not frail, there were no differences in age, sex, and BMI. However, frail subjects had higher STS scores and had significantly greater dependence in ADL, slower gait speed, weaker grip strength, and lower albumin than non-frail subjects. The composite frailty score was highly correlated with frailty designation by subjective assessment. Subjective and objective frailty were both highly predictive of treatment assignment to either medical therapy or aortic valve replacement, and of mortality. Conclusion: Among patients with AS evaluated in a Heart Valve Clinic, those considered frail by subjective assessment were slower, weaker, more malnourished, and had greater ADL impairment. Subjective assessment of frailty and objective frailty measures were similarly predictive of treatment assignment and mortality.

A Behavioral Physical Activity Intervention to Manage Moderate and Severe Fatigue Among Head and Neck Cancer Patients-Pre-efficacy Study in the National Institutes of Health ORBIT Model.

Cancer-related fatigue (CRF) reduces head and neck cancer (HNC) survival rates and is the most common, severe, and distressing symptom negatively impacting activities of daily living (ADLs) dependence among HNC patients. These patients remain physically inactive after their cancer treatment, although there is consensus that physical activity mitigates CRF in cancer patients. A home-based personalized behavioral physical activity intervention with fitness graded motion exergames (PAfitME) was evaluated for its intervention components, intervention delivery mode, and intervention contact time/duration with initial assessment of the feasibility, acceptability, safety, and outcomes. This study (N = 8) was a single-group, pre-post design to evaluate a 6-week PAfitME at the end of HNC treatment. Health outcomes were CRF, ADL dependence, and fitness performance. Behavioral outcomes were exergame adherence. Positive health and behavioral outcomes support the PAfitME protocol including intervention components, intervention delivery mode, and intervention contact times/duration. The PAfitME intervention is feasible and acceptable with promising adherence rates. No adverse events were reported. There was marked improvement in CRF, ADL dependence, cardiorespiratory fitness, balance, muscle strength, and shoulder forward flexion, with large to moderate effect sizes as a result of the PAfitME intervention. The PAfitME protocol is ready for additional testing in a randomized clinical trial. The PAfitME intervention is a nurse-led nonpharmacological intervention. It can be integrated into home care or telehealth care for HNC patients at the end of their cancer treatment once effectiveness is established.

Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries.

Background:The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries.Methods:Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care’s (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses.Results:Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs.Conclusions:Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.

Functional loss in daily activity in ovarian cancer patients undergoing chemotherapy.

Cancer survivors frequently experience cancer or treatment-related symptoms and functional morbidities that can be addressed through rehabilitation services, but these symptoms often go unnoticed and seldom managed. This study seeks to investigate the undetected patient symptoms and functional loss related to the activities of daily living (ADLs) in ovarian cancer patients during chemotherapy and to identify the influence of chemotherapy on such loss. Ovarian cancer patients undergoing chemotherapy were identified from June to August 2016, who were treated at the department of Gynecology and Obstetrics of two tertiary hospitals. The questionnaires on the present cancer and treatment-related symptoms, patient recognition of rehabilitation needs, and the Katz index score were collected. Records of total 168 ovarian cancer patients were selected and reviewed. The majority of patients (93.5%) experienced at least one symptom, with paresthesia (76.2%), fatigue (63.1%), pain, muscle weakness, memory and concentration dysfunction, lymphedema, breathing discomfort, dysphagia, and speech difficulty being the primary complaints in descending order. About 20% of ovarian cancer patients under chemotherapy had functional dependence in ADLs. The most affected ADL functions were continence, bathing, transfer, and dressing in descending order. Fatigue symptom and the functional dependence showed a significant correlation in proportion to the total number of chemotherapy cycles. There are undetected symptoms and functional loss in ovarian cancer patients during chemotherapy, which aggravated in relation to the increase in accumulated chemotherapy. Timely and appropriate rehabilitative intervention may help minimize these symptoms and functional loss, and further contribute to the improved quality of life.

Extrapyramidal motor signs in older adults with HIV disease: frequency, 1-year course, and associations with activities of daily living and quality of life.

Age and HIV disease have additive effects on neural systems that support motor functioning. The current study examined the combined impact of aging and HIV on extrapyramidal motor functions, which were hypothesized to influence on activities of daily living (ADLs) and quality of life (QoL). Participants included 336 adults classified by HIV serostatus and age. A research nurse administered the Unified Parkinson's Disease Rating Scale (UPDRS) and participants completed the modified Lawton & Brody ADL and the Short Form Survey Instrument (SF-36) questionnaires as part of a larger neuropsychological research battery. A convenience subset of 172 participants completed a 14-month follow-up evaluation. At baseline, only older age was associated with mild extrapyramidal signs; however, at 14-month follow-up, independent adverse effects of both HIV status and age group were observed on a 3-level UPDRS change variable. Among older HIV+ adults, the presence of mild UPDRS motor signs was independently associated with basic and instrumental ADL dependence, as well as lower physical (ps < .05), but not mental QoL. In the modern treatment era, older HIV+ adults show higher frequency of mild extrapyramidal signs as compared to younger individuals (but not older HIV- persons) and are at higher risk of incident extrapyramidal signs relative to HIV- persons (but not younger HIV+ persons). When present in older HIV+ adults, extrapyramidal signs are of mild severity but nevertheless increase the risk of daily functioning problems and lower health-related physical QoL.

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Physical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear. To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years. Prospective cohort study. The Health and Retirement Study (HRS). A total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014. The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status. The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001). Physical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function. J Am Geriatr Soc 67:477-483, 2019.