Dependence In Instrumental Activities Research Articles

Association between depression, functional capacity, cognitive status and the consumption of fruits and vegetables in elderly in Joinville/SC-Brazil

The consumption of fruits and vegetables seems to contribute to the prevention and/or delay of depression, cognitive decline and, indirectly, to functional dependence, at the same time that it can be influenced by these clinical conditions. The objective of this study was to verify the association between depression, functional capacity, cognitive status and consumption of fruits and vegetables in elderly people in Joinville-SC. A study with secondary data collection carried out in 2021 that assessed depressive symptoms using the Geriatric Depression Scale, functional capacity using the PFEFFER Functional Activities Questionnaire, and cognitive status using the Mini-Mental State Examination. Consumption of fruits and vegetables (FV) was quantified using a food frequency questionnaire and was classified according to regularity. A total of 61 elderly were evaluated, of which 23% had depressive symptoms, 18% functional dependence in instrumental activities of daily living, 14.8% cognitive decline. A low frequency of elderly people with regular consumption of vegetables (36.1%), as well as associated fruits and vegetables (29.5%) was identified. On the other hand, the frequency of regular fruit consumption was high (73.8%) and was associated with a lower frequency of depressive symptoms and functional dependence. It was observed that elderly people with depressive symptoms, functional dependence and cognitive decline consumed FV irregularly.

Prediction of functional dependence with digital clock drawing, word recall, and assessment of lifestyle and health factors

AbstractBackgroundDistinguishing mild cognitive impairment (MCI) and Alzheimer’s disease‐related dementia (ADRD) requires assessing the clinical impact of cognitive deficits on a patient’s activities of daily living. To accurately monitor cognitive decline, it is thus critical to combine early screening of cognitive deficits with the assessment of functional impairment. The Digital Clock and Recall (DCR™), consisting of DCTclock™ and a 3‐word delayed recall, employs AI‐enabled performance analyses to evaluate memory, executive function, visuospatial abilities, and motor functions. The Life and Health Questionnaire (LHQ) is a brief digital survey that captures key lifestyle and health factors for cognitive decline/dementia. We evaluated whether the combination of the DCR and LHQ can predict functional status, measured by the Functional Abilities Questionnaire (FAQ) reported by an informant, in older individuals with statuses ranging from cognitively unimpaired to MCI and ADRD.Method849 participants from a multisite study (age mean±SD = 72.1±6.7; 56.8% female; years of education mean±SD = 15.4±2.7), classified as cognitively unimpaired (n = 369), MCI (n = 262), or ADRD (n = 215). Mild (mFD) and moderate (modFD) levels of functional dependence were defined as FAQ score ≥ 6 and ≥ 9, respectively. We conducted 10‐fold cross‐validated regularized logistic regressions using LHQ responses and DCR metrics to predict mFD or modFD, controlling for age, sex, and education.ResultLHQ significantly predicted mFD and modFD (p’s<0.001, R2 = 0.13, and R2 = 0.12). Adding DCR metrics to the model improved both models (p’s<0.001, R2’s = 0.18 and 0.13, respectively). Surviving LHQ questions for predicting mFD related to unintended weight loss, social engagement/volunteering, cognitively stimulating tasks, sleep, and life satisfaction/purpose. Surviving LHQ questions for predicting modFD related to unintended weight loss, social engagement/volunteering, cognitively stimulating tasks, and sleep.ConclusionA brief assessment that can be completed in primary care settings in <10 min consisting of an objective digital cognitive assessment and a survey of self‐reported lifestyle and health factors can not only identify early cognitive impairment but also reliably predict level of functional dependence in instrumental activities of daily living ‐ without need for an informant.

Occurrence and predictors of delirium in critically ill older patients: a prospective cohort study

Abstract Objectives: This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium. Methods: This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ≤11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded. The Confusion Assessment Method-Short Form (CAM-4) was used to assess the presence of delirium. Results: The final sample (n = 105) had a median age of 80 years, most being female (56.2%), widowed (49.5%), and with complete primary education (53%). Through CAM-4, 36.2% of the patients had delirium. The delirium group was more likely to have previous cognitive decline (48.6% vs 19.6%, P = .04) and severe dependency in instrumental activities of daily living (34.3% vs 14.8%, P = .032), comparing with patients without delirium. The final multiple logistic regression model explained that patients with previous cognitive decline presented a higher risk for delirium (odds ratio: 4.663, 95% confidence Interval: 1.055–20.599, P = .042). Conclusions: These findings corroborate previous studies, showing that cognitive decline is an independent predictor for delirium in older patients. This study is an important contribution for the knowledge regarding the predictors of delirium. The recognition of these factors will help to identify patients who are at high risk for this syndrome and implement early screening and prevention strategies. However, further studies with larger samples, recruited from other clinical settings as well as analyzing other potential factors for delirium, will be needed.

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 impact of self-care behaviour on health-related quality of life across functional dependency phenotipes: insights from a real-world cohort of 1120 patients with chronic heart failure

Abstract Background Poor self-care is associated with higher risk in heart failure (HF). Self-care may influence patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Functional and instrumental autonomy are determinants of QoL. Literature has shown instrumental and/or functional dependency are associated with worse QoL. Purpose Describe the effect of self-care on QoL across to different levels of dependency and explore the potencial interaction between self-care and autonomy. Methods 1120 patients with chronic HF from DAMOCLES study were analyzed. We used modified European Heart Failure Self-care Behavior Scale 9-item version (EHFSCBS-9) to measure self-care, scores were inverted. To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional dependency for basic activities of daily living (BADL) was evaluated using Barthel index (BI). Dependency for instrumental activities (IA) was evaluated using Lawton and Brody questionnaire (LBQ). Regarding dependency, patients were grouped in 3 phenotypes: independent (normal BI and LBQ, phenotype 1), dependency for IA (abnormal LBQ, phenotype 2) and dependency for BADL and IA (abnormal BI ± abnormal LBT, phenotype 3). General linear models (GLM) were constructed to explore interaction between dependency phenotypes and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores and to obtain the estimated marginal means of QoL scores across phenotypes and levels of self-care. All models were adjusted by determinants of HF severity. Results Mean age was 72±11 years, 43% were women and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value <0.0001). Unadjusted MLHFQ scores were consistenly higher in the phenotype 3 (51.5±21.3) compared to phenotype 2 (41.8±25.4, p-value<0.001) or phenotype 1 (41.6±25.6, p-value <0.001). In adjusted GLM, poor global self-care (F=15.7; p-value <0.001) was an independent predictor of higher adjusted scores in MLHFQ. Interaction term dependency phenotypes by poor self-care was not significantly associated with MLHFQ scores (F=0.297; p-value = 0.743; Figure 1): the gap in terms of QoL between self-care strata was observed across dependency phenotypes. Estimated adjusted marginal means of MLHFQ scores stratified according to dependency phenotypes and levels of self-care are displayed in Table 1. In phenotypes 2 or 3, MLHFQ scores were lower in patients with preserved self-care. In phenotype 1 differences in QoL across self-care strata were present but not significant. Conclusions Self-care behaviour is an independent predictor of health-related QoL in HF regardless of the level of patient's autonomy. Better self-care was associated with better QoL particularly in patients with dependendecy to IA and/or BADL. Impact of self-care on QoL was attenuated in patients with normal autonomy. Funding Acknowledgement Type of funding sources: None.

Screening for frailty and sarcopenia in community-dwelling older adults: a cross-sectional study from the Eastern Black Sea region of Turkey.

The purpose of this study was to investigate the prevalence of frailty, sarcopenia and associated factors among community-dwelling older adults living in the Eastern Black Sea region of Turkey. The study sample comprised 404 community-dwelling older adults living in the Eastern Black Sea region of Turkey. These subjects or proxies were contacted by mobile phone or the internet. The sociodemographic characteristics, falls and chronic pain were recorded. Frailty, sarcopenia, malnutrition, activities of daily living and instrumental activities of daily living were assessed using the FRAIL scale, SARC-F, Mini Nutrition Assessment-Short Form, Barthel Index and Lawton instrumental activities of daily living scale, respectively. The 404 older adults comprised 62% females and 38% males with a mean age of 73.4 ± 7.4years. The prevalence of positive frailty and sarcopenia screening were detected as 37.4% and 46.8%, respectively. The strongest associations with frailty were the presence of chronic lung disease [Odds ratio (OR) = 10.3; 95% confidence interval (CI) = 2.1, 49.8] and chronic pain [OR = 6.9; 95% CI = 3.2, 15.0]. The associations with sarcopenia were falls (OR = 7.4; 95% CI = 4.2, 12.9), dependence in instrumental activities of daily living (OR = 4.3; 95% CI = 2.2, 8.4), advancing age (OR = 2.6; 95% Cl = 1.4, 4.7), and dependence in daily living activities (OR = 2.2; 95% Cl = 1.3, 4.0). Female gender and falls were found to be co-related factors for frailty and sarcopenia. Female gender and falls were independently associated with frailty and sarcopenia. In addition, chronic lung disease and chronic pain were major risk factors for frailty, while advancing age and dependence in daily living activities were major risk factors for sarcopenia. These factors should be considered to be able to identify individuals at high risk of frailty and sarcopenia and to prevent these geriatric syndromes.

Geriatric assessment for older adults receiving less-intensive therapy for acute myeloid leukemia: report of CALGB 361101

AbstractGeriatric assessment (GA) predicts survival among older adults with acute myeloid leukemia (AML) treated intensively. We evaluated the predictive utility of GA among older adults treated with low-intensity therapy on a multisite trial. We conducted a companion study (CALGB 361101) to a randomized phase 2 trial (CALGB 11002) of adults ≥60 years and considered “unfit” for intensive therapy, testing the efficacy of adding bortezomib to decitabine therapy. On 361101, GA and quality of life (QOL) assessment was administered prior to treatment and every other subsequent cycle. Relationships between baseline GA and QOL measures with survival were evaluated using Kaplan-Meier estimation and Cox proportional hazards models. One-hundred sixty-five patients enrolled in CALGB 11002, and 96 (52%) of them also enrolled in 361101 (median age, 73.9 years). Among participants, 85.4% completed ≥1 baseline assessment. In multivariate analyses, greater comorbidity (hematopoietic cell transplantation-specific comorbidity index >3), worse cognition (Blessed Orientation-Memory-Concentration score >4), and lower European Organization for Research and Treatment of Cancer global QOL scores at baseline were significantly associated with shorter overall survival (P < .05 each) after adjustment for Karnofsky Performance Status, age, and treatment arm. Dependence in instrumental activities of daily living and cognitive impairment were associated with 6-month mortality (hazard ratio [HR], 3.5; confidence interval [CI], 1.2-10.4; and HR, 3.1; CI, 1.1-8.6, respectively). GA measures evaluating comorbidity, cognition, and self-reported function were associated with survival and represent candidate measures for screening older adults planned to receive lower-intensity AML therapies. This trial was registered at www.clinicaltrials.gov as #NCT01420926 (CALGB 11002).

Alzheimer's Disease: Epidemiology and Clinical Progression.

Alzheimer’s disease (AD) is prevalent throughout the world and is the leading cause of dementia in older individuals (aged ≥ 65 years). To gain a deeper understanding of the recent literature on the epidemiology of AD and its progression, we conducted a review of the PubMed-indexed literature (2014–2021) in North America, Europe, and Asia. The worldwide toll of AD is evidenced by rising prevalence, incidence, and mortality due to AD—estimates which are low because of underdiagnosis of AD. Mild cognitive impairment (MCI) due to AD can ultimately progress to AD dementia; estimates of AD dementia etiology among patients with MCI range from 40% to 75% depending on the populations studied and whether the MCI diagnosis was made clinically or in combination with biomarkers. The risk of AD dementia increases with progression from normal cognition with no amyloid-beta (Aβ) accumulation to early neurodegeneration and subsequently to MCI. For patients with Aβ accumulation and neurodegeneration, lifetime risk of AD dementia has been estimated to be 41.9% among women and 33.6% among men. Data on progression from preclinical AD to MCI are sparse, but an analysis of progression across the three preclinical National Institute on Aging and Alzheimer’s Association (NIA-AA) stages suggests that NIA-AA stage 3 (subtle cognitive decline with AD biomarker positivity) could be useful in combination with other tools for treatment decision-making. Factors shown to increase risk include lower Mini-Mental State Examination (MMSE) score, higher Alzheimer’s Disease Assessment Scale (ADAS-cog) score, positive APOE4 status, white matter hyperintensities volume, entorhinal cortex atrophy, cerebrospinal fluid (CSF) total tau, CSF neurogranin levels, dependency in instrumental activities of daily living (IADL), and being female. Results suggest that use of biomarkers alongside neurocognitive tests will become an important part of clinical practice as new disease-modifying therapies are introduced.

Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study.

ObjectiveTo identify risk factors for functional decline after hospitalization for Gram-negative bacteremia.Patients and methodsA prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Israel and Italy. Hospitalized patients with Gram-negative bacteremia who survived until day 90 and were not bedridden at baseline were included. The primary end point was functional decline at 90 days.ResultsFive hundred and nine patients were included. The median age of the cohort was 71 years (interquartile range [IQR], 60–80 years), 46.4% (236/509) were male and 352 of 509 (69%) patients were independent at baseline. Functional decline at 90 days occurred in 24.4% of patients (124/509). In multivariable analysis; older age (odds ratio [OR], 1.03; for an one-year increment, 95% confidence interval [CI] 1.01–1.05), functional dependence in instrumental activities of daily living at baseline (OR, 4.64; 95% CI 2.5–8.6), low Norton score (OR, 0.87; 95% CI 0.79–0.96) and underlying comorbidities: cancer (OR, 2.01; 95% CI 1.14–3.55) and chronic pulmonary disease (OR, 2.23 95% CI 1.12–4.42) and longer length of hospital stay (OR 1.09; for one-day increment, 95% CI 1.04–1.15) were associated with functional decline. Appropriate empirical antibiotic treatment was associated with lower rates of functional decline within 90 days (OR, 0.4; 95% CI 0.21–0.78).ConclusionsPatients surviving bloodstream infections have poor long term trajectories after clinical recovery and hospital discharge. This has vast implications for patients, their family members and health policy makers.

Falls and fractures in subjects over 65 years old and their associations with geriatric syndromes: Russian epidemiological study EVKALIPT

Background. In the Russian Federation, the prevalence of falls and fractures in older people in the general population is unknown. Single studies have been carried out on small samples (hospitalized patients, patients with diabetes mellitus etc.). Objective. To investigate history of low-energy fractures, frequency of falls in the past year and their associations with other geriatric syndromes (GS) in subjects aged ≥65 years.Materials and methods. We examined 4308 subjects (30% of men) aged 65 to 107 years (mean age 78 ± 8 years) in 11 regions of the Russian Federation, who were divided into 3 age groups (65-74, 75-84 and ≥85 years old). All participants underwent comprehensive geriatric assessment, which consisted of two stages: 1) survey on a specially designed questionnaire; 2) physical examination.Results. The frequency of falls over the past year was 30%, including 25,7% — in subjects aged 65-74 yrs, 29,8% — 75-84 yrs, 37,3% — ≥85 yrs (p for trend &lt;0,001). Of these, 62% of participants fell 1 time, 38% — 2 times or more. With the same frequency, the subjects fell at home (41%) and on the street (42%), 17% of subjects fell both at home and on the street. A history of low-energy fractures was found in 17% of the participants, among which the most frequent (63%) were fractures of the radius. Univariate regression analysis with sex and age (as a discret variable) adjustment, where the falls in the past year were considered as the dependent variable, and GS as independent one, demonstrated that all GS were associated with falls in the past year with odds ratios (ORs) ranging from 1,25 to 3,13. Multivariate regression analysis with age and sex adjustment showed that independent predictors of falls were female gender (ORs 1,51; 95% confidence interval 1,26-1,82; р&lt;0,001) and 6 GS (malnutrition, depression, urinary and fecal incontinence, chronic pain and dependence in instrumental activities in daily life) with a 1,3-2,4 times increase of falls risk.Conclusion. In EVKALIPT study we firstly obtained the domestic data on the prevalence of falls and low-energy fractures history in subjects aged &gt;65 years in the general population and studied associations between falls in the past year and other geriatric syndromes.

Correlates of Frailty in Community-Dwelling Older Adults with Cancer: 2017 Survey of Living Condition of Elderly Study in South Korea

Objective:Frailty is prevalent among community-dwelling older adults with cancer and is associated with increased mortality and complications of treatments. However, evidence on the multiple factors influencing frailty in this population is scarce. This paper aimed to identify the demographic, sociobehavioral, and health status-related correlates of frailty in community-dwelling older adults with cancer.Methods:This was a descriptive cross-sectional study using data from the fourth wave of the Living Condition of Elderly Study in South Korea conducted in 2017. Among the 10,299 individuals aged ≥65 years who participated in the survey, data of 391 individuals with cancer were analyzed. Frailty status (robust, prefrailty, and frailty) was assessed using the Korean version of the 5-item: Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale. We performed descriptive statistical analysis to report summary measures, and bivariate (t-test, Chi-squared test, and analysis of variance) and multivariate regression analyses.Results:Frailty and prefrailty were prevalent in 24.8% and 50.6% of the participants, respectively. The strongest correlate of frailty was a greater level of depression, followed by low levels of physical activity, dependency in instrumental activities of daily living, a greater number of comorbidities, an advanced age, a lower household income, and a widowed marital status.Conclusions:Community-dwelling older adults who had cancer and depression had the highest risk of frailty. Given the adverse impact of frailty on health outcomes in this population, health-care providers need to provide interventions incorporating the management of depression, physical activity, and comorbidities to prevent or manage frailty.

Dependence in instrumental activities of daily living and its implications for older adults' oral health.

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged ≥60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.

Factors contributing to functional dependence among older adults in Ile–Ife, Nigeria

Old age presents myriads of challenges particularly in the dimension of dependence in the performance of activities of daily living and those contributing to maintenance of health. This study therefore, assessed factors contributing to functional dependence among older adults attending care in a Nigerian Teaching Hospital.A cross-sectional correlational design was employed to study 400 respondents 60 years and above attending care in the hospital. Data regarding the respondents’ sociodemographic attributes, their degree of dependence in instrumental activities of daily living (IADLs) as well as health maintenance practices were collected with a validated interviewer-administered questionnaire and were analysed descriptively and inferentially using Stata 12 statistical package.Results revealed that almost a quarter (24.5%) of the respondents were dependent (moderate) on others in all the dimensions of IADLs measured, while majority (83.0%) had moderate health maintenance practices. Furthermore, respondents age (Β = −0.124, p < 0.001), health maintenance practice (Β = 0.180, p < 0.001) sex (Β = 1.181, p < 0.001), Income level (Β = 0.551, p < 0.001), level of education (Β = 0.723, p < 0.001) significantly predicted functional dependence among the older adults.In conclusion, this study showed that functional dependence is prevalent among the residents in this setting. Therefore, there is a need for nurses to carry out a periodic health assessment among the older adults and also educate the general geriatric cohort on the need to scale up the performance of health maintenance practices which will in turn increase their functional capacity and promote better quality of life.

Social support among older adults in Malaysia.

This study aimed to determine the factors that influence perceived social support among older adults in Malaysia. We used the 11-item Duke Social Support Index to assess perceived social support through a face-to-face interview. Higher scores indicate better social support. Linear regression analysis was carried out to determine the factors that influence perceived social support by adapting the conceptual model of social support determinants and its impact on health. A total of 3959 respondents aged ≥60 years completed the Duke Social Support Index. The estimated mean Duke Social Support Index score was 27.65 (95% CI 27.36-27.95). Adjusted for confounders, the factors found to be significantly associated with social support among older adults were monthly income below RM1000 (-0.8502, 95% CI -1.3523, -0.3481), being single (-0.5360, 95% CI -0.8430, -0.2290), no depression/normal (2.2801, 95% CI 1.6666-2.8937), absence of activities of daily living (0.9854, 95% CI 0.5599-1.4109) and dependency in instrumental activities of daily living (-0.3655, 95% CI -0.9811, -0.3259). This study found that low income, being single, no depression, absence of activities of daily living and dependency in instrumental activities of daily living were important factors related to perceived social support among Malaysian older adults. Geriatr Gerontol Int 2020; 20: 63-67.

Reduced Independence in Daily Living Is Associated with the Gut Microbiome in People with HIV and HCV.

Alterations in the gut microbiome are associated with neurocognition and related disorders, including in the context of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, the connection between the gut microbiome and cognitive decline, gauged by increased dependence in instrumental activities of daily living (IADL), remains largely unexplored in the context of these diseases. Here we characterized the gut microbiome using 16S rRNA amplicon sequencing and untargeted metabolomics with liquid chromatography-mass spectrometry from 347 people with HIV, HIV and HCV, or neither, all of whom underwent a comprehensive neuropsychiatric assessment. We observed that IADL-dependent and -independent HIV-monoinfected (HIV-positive [HIV+]/HCV-negative [HCV-]) and coinfected (HIV+/HCV+) individuals have distinct gut microbiomes. Moreover, we found that dependent individuals with HIV or HIV and HCV were enriched in Bacteroides These results may have implications for the characterization of cognitive decline, as well as the development of potential prevention and treatment strategies for individuals infected with HIV and/or HCV. Of particular interest is the possibility that dietary interventions that are known to modify the microbiome could be used to shift the microbiome toward more favorable states for preserving independence.IMPORTANCE The microbes in the gut and the chemicals they produce by metabolism have been linked to brain function. In earlier work, we showed that infection with two viruses, HIV and HCV, changed the gut microbes and metabolism in ways that were associated with a lifetime history of major depressive disorder. Here, we extend this analysis looking at a measurement of independence in daily living. We find that in individuals with HIV, whether or not they also have HCV, those who reported reduced independence were enriched in a genus of bacteria called Bacteroides This result is interesting because Bacteroides is strongly associated with diets low in carbohydrates and high in animal protein, suggesting that diet changes may help preserve independent living in people living long-term with HIV (although clinical intervention trials would be needed in order to confirm this).

Práticas de autocuidado do idoso com diabetes mellitus em um município amazônico

Objetivo: Analisar as práticas de autocuidadoos idosos com Diabetes Mellitus (DM) cadastrados em uma Unidade Básica de Saúde (UBS) em um município Amazônico. Métodos: Estudo descritivo, transversal e quantitativo, composto de pessoas com idade igual ou superior a 60 anos, ambos os sexos, cadastrados na (UBS). Aplicaram-se quatro instrumentos: Formulário sociodemográfico; Questionário de Atividades de Autocuidado com o Diabetes (QAD); Índice de Katz e Escala de Lawton. Os dados coletados foram registrados e o tratamento foi feito pelo uso de estatística descritiva, tendo como auxilio o programa Statistical Package for the Sciences (SPSS) na versão 20.0. Resultados: Constatou-se que o nível de dependência nas Atividades Instrumentais da Vida Diária (AIVDs) se correlacionou predominantemente na variável idade (50%) entre a faixa etária de 60 a 69 anos de idade quando comparada aos idosos da faixa etária de 70 a 79 anos. Nas Atividades Básicas da Vida Diária (ABVDs), sua máxima deu-se para independentes para todas as faixas etárias. Conclusão: Averiguo-se que os idosos com DM desenvolvem as práticas de autocuidado de forma independente em sua pluralidade. As ABVDs apresentaram-se independentemente (75%), em contraste com os dados apresentados pelas AIVDs desempenhadas pelos idosos, demonstrando-se dependentes (75%).

Geriatric assessment and quality of life changes in older adults with newly diagnosed multiple myeloma undergoing treatment

ObjectiveMultiple myeloma (MM) is a cancer of older adults with a median age at diagnosis of 70 years. Our study aimed to understand the changes that occurred in geriatric domains and quality of life parameters as older adults underwent treatment for MM over 6-months following initial diagnosis. MethodsThis was a secondary analysis of a prospective cohort study of 40 adults aged ≥65 with newly-diagnosed MM who completed the Cancer and Aging Research Group geriatric assessment and the Functional Assessment of Cancer Therapy (General and subscale Gynecologic Oncology Group-Neurotoxicity) quality of life tool at baseline and at 6 months following treatment initiation. ResultsThirty-six participants completed 6-months of follow-up. There was no significant change in geriatric domains, including dependence in instrumental activities of daily living (IADLs). Compared to baseline, mental health improved at 6-months of follow-up (Mental Health Inventory-17 score, median 77.1 versus 84.3 at baseline and 6-months respectively, p < .001). Objective physical performance as measured by the Timed Up and Go test showed a trend towards improvement (12.3 versus 11.0 s, p = .057) and remained stable or improved in almost all (30/32, 93.8%) of the adults using the minimum clinically important difference threshold. ConclusionFrom baseline to 6-months of follow-up, older adults with MM showed improvement in mental health but otherwise remained stable with regards to function and overall quality of life. Timed Up and Go Test may provide a dynamic indicator of functional status and needs to be further evaluated in future studies.

Can Brief Cognitive or Medication Management Tasks Identify the Potential for Dependence in Instrumental Activities of Daily Living?

Background and Objectives: The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual’s functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone.Research Design and Methods: Community-dwelling adults age 55 and older (n = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. Receiver operating characteristic (ROC) curve analyses were computed for the Mini-Cog, MTS-R and the Medi-Cog-R using the PCST performance as the criterion measure. The area under the curve (AUC), sensitivity, and specificity were computed for each measure.Results: The Medi-Cog-R most accurately identified individuals as impaired on the PCST. An AUC statistic of 0.82 for the Medi-Cog-R was greater than either the Mini-Cog (0.75) or the MTS-R (0.73). The Medi-Cog-R demonstrated a sensitivity of 0.71 and a specificity of 0.78 in classifying individuals with impaired IADL as measured by the PCST.Discussion and Implications: The Mini-Cog, the MTS-R, and the Medi-Cog-R all show discriminant validity, but the combined measure demonstrates greater sensitivity and specificity than either component measure alone in identifying IADL impairment. The Medi-Cog-R appears to be a useful screening measure for functional cognition and can be used to prompt further assessment and intervention to promote community independence.

Major depression and associated factors in institutionalized older adults

ABSTRACT This quantitative epidemiological study aimed to analyze the prevalence of major depression in 237 older adults aged 60 to 104 years living in long-term care facilities in a large city in the state of Ceará, Northeastern Brazil. A sociodemographic questionnaire (age, gender, education, duration of institutionalization) was administered and the DSM-IV-TR was used as a reference for the clinical assessment of major depression. The Katz scale was used to classify dependence in activities of daily living and the Pfeffer scale was used to classify dependence in instrumental activities of daily living. The Mini Mental State Examination and the Category Fluency Test were used to assess cognitive function. Data underwent descriptive and analytical statistics with a significance level of 5%. The participants’ mean age was 75.3 ± 8.6 years. Of these, 82 older adults (34.6%) presented a diagnosis of major depression. Major depression was significantly associated family visits (p = 0.036). The prevalence of major depression in institutionalized older adults is high. The assessment of the prevalence of major depression should be carried out based on internationally accepted clinical criteria rather than on depressive symptoms screening tests since the diagnosis itself is what will determine the non-drug or drug therapy.

Activity limitations and participation restrictions in people with multiple sclerosis: a detailed 10-year perspective

Aim To conduct a detailed investigation into changes in activity limitations and participation restrictions over 10 years in people with mild, moderate and severe multiple sclerosis. Methods This study was a 10-year longitudinal study of 264 people with multiple sclerosis living in Stockholm County, Sweden. Ten-year changes in personal and instrumental activities in daily living were assessed using the Katz Activities in Daily Living Index Extended and participation in social/lifestyle activities using the Frenchay Activities Index. Results While people with moderate multiple sclerosis, compared to baseline, demonstrated significantly higher proportions of dependency in most activities of personal and instrumental activities in daily living at the 10-year follow-up, the mild group primarily increased their dependency in instrumental activities and the severe group in personal activities. Significantly higher proportions of the moderate group showed restricted participation in domestic and outdoor activities whereas the mild group only showed restrictions in a few domains of participation. A majority of people with severe multiple sclerosis showed restricted participation in all social/lifestyle activities at baseline and the 10-year follow-up. Conclusions Prominent long-term increases in activity limitations and participation restrictions occurred across the spectrum of disease severity but was most pronounced in those more moderately affected. Implications for rehabilitation This study provides guidance with regard to specific activities that are prone to deteriorate across 10 years and thereby reflect important targets and outcomes for interventions. Increases in activity limitations and participation restrictions were most pronounced in those moderately affected by multiple sclerosis. Those mildly affected by multiple sclerosis primarily increased their dependency in instrumental activities of daily living while those severely affected increased their dependency in personal activities of daily living.