Dependence For Basic Activities Research Articles

Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern

BackgroundDespite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status.MethodsThis cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used.ResultsThe prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6–10.7) and 4.8% (95% CI, 4.4–5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1–14.4) and 15.6% (95% CI, 14.9%–16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased.ConclusionsChronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.

Dependence in instrumental activities of daily living and its associations with other geriatric syndromes in people over 65 years of age: data from the Russian epidemiological study EUCALYPT

Aim to assess the frequency of disability in instrumental activities of daily living (IADLs) and to analyze its associations with other geriatric syndromes in persons aged 65 years.
 Material and methods. The study involved 4,308 people (30% male) living in 11 regions of the Russian Federation, aged 65 to 107 years (average age 78 8 years). The majority (60%) of participants were examined in a polyclinic, every fifth in a hospital (20%) or at home (19%), 1% in nursing homes. All patients underwent a comprehensive geriatric assessment, including an assessment of instrumental activities of daily living on the Lawton scale.
 Results. Among the elderly, a high (54%) prevalence of dependence in IADLs was revealed, and with increasing age, this indicator increased significantly, reaching 82% in people over 85 years old. In patients with disability in IADLs, the frequency of all geriatric syndromes, except orthostatic hypotension, was higher, of which the most common were chronic pain syndrome (90%), frailty (80%), dependence in basic activities of daily living (ADLs) (78%), cognitive impairment (75%), probable depression (63%) and urinary incontinence (54%). One-factor regression analysis showed that the presence of disability in IADLs increases the chances of detecting other geriatric syndromes by 1.65.9 times.
 Conclusion. The results of the EUCALYPT epidemiological study demonstrate a high prevalence of dependence in IADLs among the Russian population. The study also gives an idea of the relationship of dependence in IADLs with various geriatric syndromes.

The icope Intrinsic Capacity Screening Tool: Measurement Structure and Predictive Validity of Dependence and Hospitalization.

To evaluate the measurement structure of the ICOPE screening tool (IST) of intrinsic capacity and to find out whether the IST as a global measure adds explanatory power over and above its domains in isolation to predict the occurrence of adverse health outcomes such as dependence and hospitalization in community-dwelling older people. Secondary analysis of a cohort study, the Toledo Study of Healthy Ageing. Province of Toledo, Spain. Community-dwelling older people. Items equal or similar to those of the IST were introduced as a reflective-formative construct in a Structural Equation Model to evaluate its measurement structure and its association with dependence for basic and instrumental activities and hospitalization over a three-year period. A total of 1032 individuals were analyzed. Mean age was 73.5 years (sd 5.4). The least preserved indicators were ability to recall three words (18%) and to perform chair stands (54%). Vision and hearing items did not form a single sensory domain, so six domains were considered. Several cognition items did not show sufficiently strong and univocal associations with the domain. After pruning the ill-behaved items, the measurement model fit was excellent (Satorra-Bentler scaled chi-square: 10.3, degrees of freedom: 11, p=0.501; CFI: 1.000; RMSEA: 0.000, 90% CI: 0.000-0.031, p value RMSEA<=0.05: 1; SRMR: 0.055). In the structural model, the cognition domain items were not associated as expected with age (p values 0.158 and 0.293), education (p values 0.190 and 0.432) and dependence (p values 0.654 and 0.813). The IST included as a composite in a model with the individual domains showed no statistically significant associations with any of the outcomes (dependence for basic activities: 0.162, p=0.167; instrumental: -0.052, p=0.546; hospitalization: 0.145, p=0.167), while only the mobility domain did so for dependence (basic: -0.266, p=0.005; instrumental: -0.138, p=0.019). The model fit of the last version was good (Satorra-Bentler scaled chi-square: 52.1, degrees of freedom: 52, p=0.469; CFI: 1.000; TLI: 1.000; RMSEA: 0.01, 90% CI: 0.000-0.02, p value RMSEA<=0.05: 1; SRMR: 0.071). The IST operationalized as the sum of non-impaired domains was not associated after covariate adjustment (dependence for basic activities: -0.065, p=0.356; instrumental: -0.08, p=0.05; hospitalization: -0.003, p=0.949) either. The cognitive domain of the IST, and probably other of its items, may need a reformulation. A global measure of intrinsic capacity such as the IST does not add explanatory power to the individual domains that constitute it. So far, our results confirm the importance of checking the findings of the IST with a second confirmatory step, as described in the WHO's ICOPE strategy.

Physical inactivity before stroke is associated with dependency in basic activities of daily living 3 months after stroke.

Physical inactivity is a leading risk factor for non-communicable diseases, including stroke. Moreover, physical inactivity before stroke is associated with stroke severity, which, in turn, can cause disability. However, it remains unclear whether physical inactivity before stroke is associated with dependency in basic activities of daily living (ADL). The aim of this study was to evaluate whether physical inactivity before stroke influences ADL dependency 3 months after stroke. This longitudinal study was based on data from three Swedish registries. Patients with acute stroke who were admitted to the Sahlgrenska University Hospital between 9 November 2014 and 30 June 2019 were included in the study. Baseline data were collected from the three stroke units, and self-reported questionnaires were used to collect 3-month follow-up data. Physical inactivity before stroke was the primary independent variable that was self-reported using the Saltin-Grimby physical activity level scale. ADL dependency was a composite measure of three tasks: mobility, dressing, and toilet use. A binary logistic regression analysis was used to explain the association between physical inactivity before stroke and basic ADL 3 months after stroke. In total, 3,472 patients were included in the study. The median age was 75 years, 49% of the patients were physically inactive before stroke, and 75% had a mild stroke. ADL dependency at follow-up was reported to be 32%. Physically inactive patients, compared with physically active patients, had 2.35 times higher odds for ADL dependency 3 months after stroke (odds ratio 2.30 [95% CI 1.89 - 2.80]). The model correctly classified 84% of the patients (the area under the receiver operating characteristic curve was 0.84 [95% CI, 0.83 - 0.86]). The findings of this study suggest that physical inactivity before stroke is associated with dependency in basic ADL 3 months after stroke. In addition, older age, female sex, pre-stroke living conditions, need for help, previous stroke, and admission stroke severity are significant contributors to dependency.

Functional Status of Senior Citizens of a Metropolitan City in Morang

Background Functional abilities start to decelerate after the age of 70 and causes need for assistance to do their basic activities of daily living (BADL) as well as instrumental activities of daily living (IADL).&#x0D; Objective To find out the functional status of senior citizens of a Metropolitan city in Morang.&#x0D; Method A descriptive cross-sectional study was carried out at Biratnagar Metropolitan City among 254 senior citizens receiving old age allowance using cluster sampling technique. Data were collected through face to face interview and measuring height and weight by researcher herself for the period of four weeks. Basic activities of daily living and instrumental activities of daily living were assessed using Katz Index of Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living tool with some modifications. Chi square test was used to assess the association between variables.&#x0D; Result About 48.4% and 90.6% of senior citizens had dependency in Basic Activities of Daily Living and Lawton Instrumental Activities of Daily Living respectively. The most common dependency for Basic Activities of Daily Living and Instrumental Activities of Daily Living was control of urination and defecation (31.9%) and using telephones (75.2%) respectively. Basic activities of daily living was significantly associated with age (p=0.0017), sex (p=0.013), literacy status (p=0.001), years of smoking (p=0.0029), social participation (0.0029) and history of fall within 1 year (p=0.038). Likewise Instrumental Activities of Daily Living was significantly associated with age (p=0.03), sex (p=0.035), literacy status (p=0.002), exercise (p=0.033) and social participation (p= 0.001).&#x0D; Conclusion It is concluded that about half of the senior citizens are dependent in Basic Activities of Daily Living and almost all of them are dependent in Instrumental Activities of Daily Living. So senior citizen clubs/ groups are suggested to be strengthened which may be effective in promoting independence, extending an active and healthy ageing.

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

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

Family quality of life among families who have children with mild intellectual disability associated with mild autism spectrum disorder.

Intellectual disability (ID) and autism spectrum disorder (ASD) are often concomitant childhood developmental disorders. These disorders can alter family quality of life (FQoL). To investigate FQoL among families who have children with mild ID, associated with mild ASD. Cross-sectional descriptive study with 69 families who have children with mild ID and ASD, ranging from six to 16 years old, and who were provided with disability-related services in Brazil. Data were collected using a family sociodemographic questionnaire, an ID and ASD personal profile form, the Barthel index for activities of daily living and the Beach Center FQoL scale. People with ID and ASD had an average score of 88.2±11.5 in the Barthel index, thus indicating moderate dependency in basic activities of daily living. The average total FQoL score (3.56±0.34) was lower than the scores for the "family interaction" (3.91±0.42; p<0.001), "parenting" (3.79±0.35; p<0.001) and "disability-related support" (3.98±0.16; p<0.001) domains; and higher than the scores for the "physical/material well-being" (3.19±0.64; p<0.001) and "emotional wellbeing" (2.75±0.62; p<0.001) domains. Parents' marital condition, monthly family income, family religious practice and effective communication skills among the people with ID and ASD were predictors for FQoL (R2=0.407; p<0.001). FQoL was sustained through factors such as family interaction and parents' care for their children. Improving families' emotional wellbeing and physical and material conditions is likely to positively affect the FQoL of these families.

Analysis of Older Adults in Spanish Care Facilities, Risk of Falling and Daily Activity Using Xiaomi Mi Band 2.

Background: Presently the use of technological devices such as wearable devices has emerged. Physical activity monitoring with wearable sensors is an easy and non-intrusive approach to encourage preventive care for older adults. It may be useful to follow a continuous assessment of the risk of falling. The objective is to explore the relationship between the daily activity measured by Xiaomi Mi Band 2 and the risk of falling of older adults residing in or attending care facilities. Methods: A cross-sectional study was conducted on three different institutions located in Galicia (autonomous community) (Spain). Results: A total of 31 older adults were included in the study, with a mean age of 84 ± 8.71 years old. The main findings obtained were that a greater number of steps and distance could be related to a lower probability of falling, of dependency in basic activities of daily living, or of mobility problems. Conclusions: The importance of focusing on daily steps, intrinsically related to the objective assessment of daily physical activity, is that it is a modifiable factor that impacts different aspects of health and quality of life.

Predictors of Instrumental Activities of Daily Living Performance in Patients with Stroke.

Objective Instrumental activities of daily livings are important for independent living and active participation in the community. The present study is aimed at determining factors predicting instrumental activities of daily living performance in patients with stroke. Methods In this cross-sectional study, a convenient sample of 90 patients with stroke entered from five occupational therapy centers, which were selected based on the cluster randomization method. Lawton IADL scale, Barthel Index, Trail Making Test (A and B), Digit span subtest of Wechsler memory scale, Motorcity index, and Beck Depression Inventory-II were used to investigate the study's aim. Statistical analyses were performed using independent sample t-test, one-way ANOVA, Pearson correlation, and multiple linear regression analysis. Results Age (r = −0.384, p < 0.001), memory (r = 0.565, p < 0.001), basic activities of daily living (r = 0.818, p < 0.001), depression (r = −0.758, p < 0.001), Trial Making Test (B-A) (r = −0.614, p < 0.001), and motoricity index (r = 0.670, p < 0.001) were significantly associated with instrumental activities of daily living performance. Conclusions Basic activities of daily living were the strongest predictor of IADL's performance. Age, TMT (B-A), and depression were orderly the next strongest predictors. Stroke patients with more dependency in basic activities of daily living, older age, cognitive impairment, and depression are more opted to be dependent in instrumental activities of daily living and as a result, less participation in home and community affairs.

Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care.

Objective:to analyze the association of global functionality with the main functional systems and the sociodemographic variables of older adults followed by Home Care in Primary Health Care.Method:a cross-sectional study with 124 older people developed through home interviews. Functionality was assessed by Basic Activities of Daily Living (Barthel) and Instrumental Activities of Daily Living (Lawton and Brody); the main functional systems were assessed using the Mini-Mental State Exam, by the Timed Up and Go test, by the Geriatric Depression Scale (15 items), and questionnaire with sociodemographic variables. Bivariate and multivariate analyses were applied (Poisson Regression).Results:46% of the older adults showed moderate/severe/total dependence for basic activities and instrumental activities had a median of 12. In the multivariate analysis, there was an association between moderate/severe/total dependence on basic activities with cognitive decline (p=0.021) and bedridden/wheelchair users (p=0.014). Regarding the dependence on instrumental activities, there was an association with age ≥80 years (p=0.006), single/divorced marital status (p=0.013), cognitive decline (p=0.001), bedridden/wheelchair (p=0.020), and Timed Up and Go ≥20 seconds (p=0.048).Conclusion:the decline in cognitive and mobility was associated with poor functionality in basic and instrumental activities. The findings highlight the need to monitor Home Care for these individuals and serve as guidelines for health actions.

Validation of a UPDRS-/MDS-UPDRS-based definition of functional dependency for Parkinson's disease

IntroductionFunctional dependency in basic activities of daily living (ADLs) is a key outcome in Parkinson's disease (PD). We aimed to define dependency in PD, using the original and MDS versions of the Unified Parkinson's Disease Rating Scale (UPDRS). MethodsWe developed two algorithms to define dependency from items of UPDRS Part 2 and MDS-UPDRS Part 2 relating to basic ADLs (feeding, dressing, hygiene and walking, and getting out of a chair). We validated both algorithms using data from 1110 patients from six community-based PD incidence cohorts, testing concurrent validity, convergent validity, and predictive validity. ResultsOur optimal algorithm showed high specificity and moderate to high sensitivity versus Schwab & England <80% (specificity 95% [95% confidence interval (CI) 93–97] and sensitivity 65% [95% CI 55–73] at baseline; 88% [95% CI 85–91] and 85% [95% CI 79–97] respectively at five-years follow-up). Convergent validity was demonstrated by strong associations between dependency defined by the algorithm and cognition (MMSE), quality of life (PDQ39), and impairment (UPDRS part 3) (all p < 0.001). Algorithm-defined dependency status also predicted mortality: HR for mortality in those dependent vs independent at baseline was 1.6 (95%CI 1.2–2.1) and in those dependent vs independent at five-years’ follow-up was 2.2 (1.6–3.0). DiscussionWe have demonstrated the concurrent validity, convergent validity, and predictive validity of a UPDRS-/MDS-UPDRS-based algorithm to define functional dependency in PD. This can be used for studying dependency in any study where UPDRS or MDS-UPDRS part 2 data have been collected.

Social Profile of Patients Admitted for COPD Exacerbations. A Gender Analysis

ObjectiveTo describe and compare from a gender perspective the social profile of patients admitted to a respiratory unit for COPD exacerbations (COPDE). MethodologyA cross-sectional study in patients with serious COPDE in which demographic, clinical, and social data (economic situation, care, dependency for basic and instrumental activities, social risk, caregiver overload, use of social services) were collected using questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber, and Gijón. A descriptive analysis was made of patients’ social and healthcare situation, compared on the basis of gender. ResultsWe included 253 patients, aged 68.9±9.8years, 58 (23%) women, FEV1 42.1±14.2%, and Charlson index 1.8±0.9; 37.9% were active smokers. In total, 55.2% had an income of less than €800/month, 46.2% had some dependency for basic activities, and 89.3% for instrumental activities, 89% presented social fragility, while 64% were in a situation of social problem/risk; 49% had a caregiver, 83% in a non-formal arrangement, 90.9% of whom were women, with some overload reported by 69.2%. A total of 21.4% lived alone, and 22.9% had contacted social services. Women with COPDE are younger, smoke more actively, and have fewer comorbidities. They have more scant economic resources and assistance and are in a poorer socio-familiar situation, but they are less dependent for some activities. ConclusionsThe social profile of patients with serious COPDE admitted to respiratory units is very unfavorable, especially among women. These inequalities appear to go beyond differences in the expression of COPD, and are associated with gender.

Role of Gait Speed, Strength, and Balance in Predicting Adverse Outcomes of Acutely Ill Older Outpatients.

To evaluate the ability of the Short Physical Performance Battery (SPPB) for predicting 1-year adverse outcomes of acutely ill older outpatients. Prospective study with 512 acutely ill older outpatients (79.4±8.3 years, 63% female) in an acute care day hospital. The SPPB was administered at admission. Participants were classified as low (0-4 points), intermediate (5-8 points), or high (9-12 points) performance. Primary outcomes were new dependence in basic activities of daily living (ADL), hospitalization, and death at 1 year. Cox models tested whether the SPPB predicted outcomes after adjustment for sociodemographic factors, comorbidities and well-known geriatric conditions. We also estimated whether the chair-stand and balance tests improve the SPPB's ability to identify patients at high risk of adverse outcomes. Patients with intermediate or low SPPB performance were at higher risk of 1-year new ADL dependence (32% vs 13%: adjusted hazard ratio [aHR]=2.00; 95%CI=1.18-3.37; 58% vs 13%: aHR=3.40; 95%CI=2.00-5.85, respectively), hospitalization (43% vs 29%: aHR=1.56; 95%CI=1.04-2.33; 44% vs 29%: aHR=1.80; 95%CI=1.15-2.82), and death (18% vs 6%: aHR=2.54; 95%CI=1.17-5.53; 21% vs 6%: aHR=2.70; 95%CI=1.17-6.21). Use of all three components (versus gait speed alone) improved predictions of new ADL dependence (Harrell's C=0.73 vs 0.70;P=0.01), hospitalization (Harrell's C=0.60 vs 0.57;P=0.04), and death (Harrell's C=0.67 vs 0.62;P=0.04). The SPPB is as a powerful tool for identifying acutely ill older outpatients at high-risk of adverse outcomes. The combination of the three components of the SPPB resulted in better predictive performance than gait speed alone.

Frailty-associated factors among Brazilian community-dwelling elderly people: longitudinal study.

Frailty among elderly people is associated with negative health outcomes. Through gaining better understanding of this syndrome over different time periods, healthcare actions that take predictive factors into consideration may be facilitated. To identify factors associated with frailty syndrome among community-dwelling elderly people over a two-year follow-up. Longitudinal study on elderly people living in Uberaba (MG), Brazil.Methods: Elderly individuals were selected through multiple-stage conglomerate sampling from a national database. Participants were interviewed and evaluated in 2014 and again in 2016. Predictors were considered at the baseline, and frailty categories (frail, pre-frail or non-frail) at the follow-up. Frailty was identified based on the Fried criteria. Associations with socioeconomic factors, health status and physical performance were investigated using multinomial logistic regression. 353 individuals participated in both assessments. The final model showed that age over 80 years was predictive of both pre-frailty and frailty (odds ratio, OR 4.92; 95% confidence interval, CI: 1.57-15.38; OR 8.64; 95% CI: 2.05-36.35, respectively), while dependency regarding basic activities of daily living (OR 3.66; 95% CI: 1.22-11.02) and poor lower-limb physical performance (OR 7.87; 95% CI: 1.97-31.39) predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15% (OR 0.85; 95% CI: 0.74-0.99). Age over 80 years was predictive of pre-frailty and frailty, while dependency in basic activities of daily living and poor physical performance predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15%.

Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos

IntroductionThe VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability.The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. MethodsA prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index.The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. ResultsThe median age was 81 years (IQR 74.5-85), and 45.2% were women.At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). ConclusionsOverall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term.

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.

Perfil social de los pacientes que ingresan por una agudización de EPOC. Un análisis desde una perspectiva de género

ObjectiveTo describe and compare from a gender perspective the social profile of patients admitted to a respiratory unit for COPD exacerbations (COPDE). MethodologyA cross-sectional study in patients with serious COPDE in which demographic, clinical, and social data (economic situation, care, dependency for basic and instrumental activities, social risk, caregiver overload, use of social services) were collected using questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber, and Gijón. A descriptive analysis was made of patients’ social and healthcare situation, compared on the basis of gender. ResultsWe included 253 patients, aged 68.9±9.8years, 58 (23%) women, FEV1 42.1±14.2%, and Charlson index 1.8±0.9; 37.9% were active smokers. In total, 55.2% had an income of less than €800/month, 46.2% had some dependency for basic activities, and 89.3% for instrumental activities, 89% presented social fragility, while 64% were in a situation of social problem/risk; 49% had a caregiver, 83% in a non-formal arrangement, 90.9% of whom were women, with some overload reported by 69.2%. A total of 21.4% lived alone, and 22.9% had contacted social services. Women with COPDE are younger, smoke more actively, and have fewer comorbidities. They have more scant economic resources and assistance and are in a poorer socio-familiar situation, but they are less dependent for some activities. ConclusionsThe social profile of patients with serious COPDE admitted to respiratory units is very unfavorable, especially among women. These inequalities appear to go beyond differences in the expression of COPD, and are associated with gender.

Complexity of care of hospitalized older adults and its relationship with sociodemographic characteristics and functional independence

Abstract Objectives: To investigate the relationship between the complexity of care of hospitalized older adults and sociodemographic and functional independence characteristics. Method: A quantitative cross-sectional and descriptive study was carried out in the medical and surgical clinics of the University Hospital of the Universidade de São Paulo, in the state of São Paulo SP, Brazil. A total of 382 older adults were assessed through a socio-demographic inventory, the Mini Mental State Exam, the Katz Index of Independence in Activities of Daily Living and the Interdisciplinary Medicine Instrument Method. Results: The complexity of care of participants was associated with the female sex (p=0.003), not having a partner (p=0.003), having a lower income (p=0.022), cognitive decline (p&lt;0.001) and dependence in basic activities of daily living (BADL) (p&lt;0.001). In the multiple logistic regression model, variables such as the female sex (OR=1.76; p=0.018), dependence in one or more activities of daily living (OR=1.26; p&lt;0.001) and cognitive decline (OR=3.31; p&lt;0.001) remained associated with complexity of care. Conclusion: The complexity of care of hospitalized older adults, as it is associated with limitations in BADL and cognitive decline, requires actions by the interprofessional team to ensure the rehabilitation, integration of long-term care and planning of care resources for older patients. Thus, it is necessary to adopt integrated services that include home care and care networks for the elderly, in order to provide qualified post-hospital discharge care and promote the health of the hospitalized older population.

Needs of older adults living in long-term care institutions: an observational study using Camberwell Assessment of Need for the Elderly

IntroductionNo comprehensive needs assessment is performed routinely in Poland.PurposeThe goal of the study was to investigate the patterns of needs in older individuals living in long-term care institutions (LTCIs) using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire, based on a previously published study protocol.Participants and methodsThe study included 306 LTCI residents (age: ≥75 years) with the a Mini-Mental State Examination (MMSE) score of at least 10 points. The dependence in basic activities of daily living was measured using the Barthel index (BI). A screening for depression was performed using the Geriatric Depression Scale (GDS) in subjects with an MMSE score of ≥15 points. Thereafter, CANE was used to analyze needs receiving adequate support (met needs) and those without appropriate interventions (unmet needs).ResultsThe mean age of studied individuals was 83.2±6.0 years. They had 10.4±3.2 met needs and 0.8±1.2 unmet needs. Unmet needs were reported most commonly in the following areas: company (15.9%), psychological distress (14.0%), intimate relationship (11.4%), eyesight/hearing/communication (11.4%), and daytime activities (11.0%). The OR of having a large number of met needs (ie, above the median) was almost eight times higher in residents with a BI score of 0–49 points versus those with ≥80 points. The group between (with 50–79 points) had this parameter almost four times higher. The OR of having a large number of unmet needs depended neither on BI nor on GDS and was more than four times higher in the group of 10–19 MMSE points (ie, with symptoms of moderate dementia) versus subjects with 24–30 MMSE points (ie, without symptoms of dementia).ConclusionWe defined the target group with high probability of unmet needs and the areas in which resources and efforts should be concentrated. We believe that the results can be used to optimize care in LTCIs.

Anticholinergic Burden is Associated With Increased Mortality in Older Patients With Dependency Discharged From Hospital

ObjectivesTo determine whether anticholinergic burden may predict differently 1-year mortality in older patients discharged from acute care hospitals with or without dependency in basic activities of daily living (BADL). DesignProspective observational study. Setting and participantsOur series consisted of 807 patients aged 65 years or older consecutively discharged from 7 acute care geriatric wards throughout Italy between June 2010 and May 2011. MeasuresOverall anticholinergic burden was assessed by the anticholinergic cognitive burden (ACB) score. Dependency was rated by BADL, and dependency in at least 1 BADL was considered as a potential mediator in the analysis. The study outcome was all-cause mortality during 12-months of follow-up. ResultsPatients included in the study were aged 81.0 ± 7.4 years, and 438 (54.3%) were female. During the follow-up period, 177 out of 807 participants (21.9%) died. After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with dependency in at least 1 BADL [hazard ratio (HR) 2.25 95% confidence (CI) 1.22‒4.14], but not among independent ones (HR 1.06 95% CI 0.50‒2.34). The association was confirmed among dependent patients after adjusting for the number of lost BADL at discharge (HR 2.20 95% CI 1.18‒4.04) or ACB score at 3-month follow-up (HR 2.18 95% CI 1.20‒3.98), as well as when considering ACB score as a continuous variable (HR 1.28 95% CI 1.11‒1.49). The interaction between ACB score at discharge and BADL dependency was highly significant (P < .001). Conclusions/ImplicationsACB score at discharge may predict mortality among older patients discharged from an acute care hospital carrying at least 1 BADL dependency. Hospital physicians should be aware that prescribing anticholinergic medications in this population may have negative prognostic implications and they should try to reduce anticholinergic burden at discharge whenever possible.