Activities Of Daily Living Difficulties Research Articles

Disability due to knee pain and somatising tendency in Japanese adults

BackgroundKnee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency.MethodsJapanese adults (aged 20–64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia.ResultsGreater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10–2.66] in group 2 vs. group 1, aOR = 3.23 [2.66–3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42–3.23] in group 2 vs. group 1, aOR = 4.51 [3.64–5.58] in group 3 vs. group 1).ConclusionsSomatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain.

Unmet need for social care among older people

ABSTRACTUnderstanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.

The Onset of ADL Difficulties and Changes in Health-Related Quality of Life

BackgroundThe effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs).MethodsWe analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015. The four HRQoL measures were the physical and mental health component scores (PCS and MCS) from the SF-12V, and the CDC’s counts of physically unhealthy and mentally unhealthy days (PUD and MUD) in the past month. Ordinary least squares (OLS) and zero-inflated negative binomial regressions were used.ResultsThe onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet significantly reduced PCS scores by 10.84, 11.29, 9.18, 8.98, 9.49 and 10.67 points, and MCS scores by 7.93, 8.72, 10.13, 5.34, 4.37 and 9.00 points, respectively. The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet increased PUD days by 6.24, 6.83, 6.34, 4.93, 4.96 and 6.72 days, and MUD days by 3.00, 3.19, 3.54, 2.26, 2.07 and 3.27 days, respectively.ConclusionsThere is robust evidence that the onset of ADL difficulties/inabilities significantly and substantially reduced age-eligible MAO beneficiaries’ HRQoL. Prevention strategies focused on ADLs would benefit the performance of MAOs.

Effects of aging on illusory target motion in a hitting task.

Age-related changes in multisensory integration (MSI, brain integration of multiple unisensory signals) were investigated. Accurate MSI is a key component of successful aging and crucial to perform activities of daily living (ADLs). Previous research suggests that with aging, different sources of sensory information are not properly weighted anymore. Twenty healthy younger (YA, age 18-34) and twenty-four healthy older adults (OA, age 60-82) were asked to hit discs moving downwards on a screen with their index finger. Illusory direction of motion was included (moving a checkerboard-like background either to the left or right). The discs disappeared before the screen was reached. Experimental conditions were: sitting (baseline), standing on foam (balance task), and sitting while doing a cognitive dual task (counting task). Participants hit the disc more to the right for left background motion compared to right background motion, conforming the illusory effect. OA show a larger effect of the illusion compared to YA in the baseline and balance conditions (p=.036 and p=.047, respectively). The same tendency was shown in the counting condition. Overall, background motion had a greater influence on the counting condition compared to the other conditions (p=.005 for YA and p=.009 for OA). No significant differences were found for the summed reaction and movement time, and no correlations between hitting performance and results of clinical pretests were found. We conclude that OA are more affected by the background motion than YA, which supports the idea that OA do not weigh information properly. Our finding that a cognitive dual task increases the illusion effect in both groups of participants suggests that cognitive resources are required for proper weighting, which may be a problem for OA. Future research will include OA with ADLs difficulties in order to develop a toolkit for early detection of MSI problems in the elderly population.

Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents

ObjectivesTo describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. DesignRetrospective cohort study. SettingA total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. ParticipantsAll newly admitted residents between January 1, 2010 and March 1, 2012. MeasurementsWe categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous “Balance of Care” studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. ResultsA population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. ConclusionsThe majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.

Comparison of Gait Speed and Peripheral Nerve Function Between Chronic Kidney Disease Patients With and Without Diabetes.

ObjectiveTo compare overall physical function, including gait speed and peripheral nerve function, between diabetic chronic kidney disease (CKD) patients and nondiabetic CKD patients and to investigate the association between gait speed and peripheral nerve function in CKD patients.MethodsSixty adult CKD patients (35 with and 25 without diabetes), who received maintenance hemodialysis (HD), were included in this study. Demographic data, past medical history, current medical condition and functional data—usual gait speed, vibration perception threshold for the index finger (VPT-F) and the great toe (VPT-T), activity of daily living (ADL) difficulty, and peripheral neuropathy (PN) along with the degree of its severity—were collected and compared between the two groups. Correlations between the severity of PN and the impairment of other functions were identified.ResultsDiabetic CKD patients showed significantly slower gait speed (p=0.029), impaired sensory function (VPT-F, p=0.011; VPT-T, p=0.023), and more frequent and severe PN (number of PN, p<0.001; severity of PN, p<0.001) as compared to those without diabetes. Usual gait speed had a significant negative correlation with the severity of PN (rho=−0.249, p=0.013). By contrast, VPT-F (rho=0.286, p=0.014) and VPT-T (rho=0.332, p=0.035) were positively correlated with the severity of PN. ADL difficulty was comparatively more frequent in the patients with more severe PN (p=0.031).ConclusionIn CKD patients with maintenance HD, their gait speed, sensory functions, and peripheral nerve functions were all significantly impaired when they have diabetes, and the severity of PN was negatively correlated with their gait speed, sensory function, and ADL function. Adverse effects of diabetes impacted physical performance of CKD patients. The physical disability of those patients might be attributable to PN and its severity.

Prevalence and Clinical Characteristics of Rheumatoid Arthritis in an Inner City Population with Sickle Cell Disease.

Rheumatoid arthritis (RA) has been rarely reported in association with sickle cell disease (SCD). Our study aimed to estimate the prevalence of RA in SCD population and to describe the clinical characteristics of RA associated with SCD. Retrospective chart review of SCD and RA patients followed at 2 large urban hospitals. Seven RA/SCD patients were identified and compared to age and sex matched cohort of SCD only and of RA only group. All patients were Black. There were 739 SCD cases, seven (0.94%) met ACR criteria for RA (SCD-RA), 411 cases were RA only group. Mean age was significantly higher in SCD-RA compared to the entire population of SCD and RA (41.7 ± 3.9 (± SEM) vs. 33.26 ± 0.47, vs. 61.39 ± 0.79, p<0.01). SCD-RA patients had lower hemoglobin (g/dl) when compared to the age and sex matched SCD or RA only patients (7.4 ± 0.49 vs. 8.3 ± 0.60 vs. 11 ± 0.59, p <0.01) respectively. There were no significant differences in laboratory and treatment approach between SCD-RA and RA only groups, except for the radiographic evidence of periarticular osteopenia and greater difficulty in the activities of daily living (ADL) among SCD-RA cohort, compared to the age and sex matched RA cohort (p=0.01). In contrast to older reports, the prevalence of RA among SCD patients in our study (0.94%) was similar to that reported in the general population (0.5-1%) and was to be associated with difficulty in ADL and periarticular osteopenia. Since RA manifests at an older age, our reported prevalence is likely explainable by improved survival of SCD patients due to enhanced medical care and the advent of hydroxyurea as a major therapeutic breakthrough for SCD.

Understanding Socioenvironmental Contributors to Racial and Ethnic Disparities in Disability Among Older Americans.

Our understanding of the mechanisms through which racial/ethnic disparities in disability in older adults develop and are maintained is limited. We examined the role of physical impairment, socioeconomic factors and health for racial/ethnic disparities in activities of daily living (ADL), and the modifying role of the indoor home environment. Data come from the National Health and Aging Trends Study ( N = 5,640), and negative binomial regression models were specified separately for men and women. Blacks and Hispanics reported more ADL difficulty than Whites. Living in homes with clutter was associated with higher rates of ADL difficulty, but it was not related to racial/ethnic disparities. Racial/ethnic differences were explained by physical impairment for men, but not for women. Socioeconomic factors and health accounted for remaining disparities for Black, but not for Hispanic women. Attention to individual and environmental factors is necessary to fully understand and address race/ethnic disparities in disability in older Americans.

The Impact of Leisure and Social Activities on Activities of Daily Living of Middle-Aged Adults: Evidence from a National Longitudinal Survey in Japan.

This study investigated the effects of leisure and social activities on the ability of middle-aged adults to maintain activities of daily living (ADL), and whether performing these activities alone or with others contributed to the ability to perform ADL. The study used nationally representative longitudinal data of 22,770 adults in Japan, aged 50–59 years, who did not have limitations in performing ADL at the beginning of the 5-year survey period. The study considered six activity categories: two leisure activities (“hobbies or cultural activities” and “exercise or sports”) and four social activities (“community events,” “support for children,” “support for elderly individuals,” and “other social activities”). Multiple logistic regression analysis was used to examine the relation between participation in these categories at baseline and difficulties in ADL at the 5-year follow-up. The association between the extent of social interaction during these activities (“by oneself,” “with others,” or “both”) and difficulties in ADL was also investigated. The analysis yielded significant negative correlations between “exercise or sports” and difficulties in ADL for both men and women, and between “hobbies or cultural activities” and difficulties in ADL for women. However, these significant relationships occurred only when activities were conducted “with others.” The present findings might help prevent deterioration in middle-aged adults’ performance of ADL in Japan.

Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study.

Obesity has been associated with increased physical limitations among older adults, although few studies have adjusted for important covariates. There is limited information about the relationship between apolipoprotein E (APOE) polymorphisms and physical limitations, and the findings have been inconsistent. This study examined the longitudinal associations of obesity and APOE ε4 with difficulties in activities of daily living (ADLs) over a 6-year follow-up period controlling for multiple covariates. Data were analyzed from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age=66). Body mass index (BMI) was used to define obesity at a baseline, and the APOE genotype was classified into an APOE ε4 carrier and non-carrier status. The combination of basic and instrumental activities of daily living (ADLs and IADLs) was used to define impaired ADLs. APOE ε4 carriers had greater difficulties in combined ADLs (incident rate ratio; IRR=1.87, 95% CI=1.40-2.51) than non-carriers. Obese but not overweight adults had greater difficulties in activities of daily living (IRR=1.59, 95% CI=1.20-2.10) compared with the normal/underweight group. Obese older adults without APOE ε4 had greater subsequent difficulties in ADLs than non-obese non-carriers. Among APOE ε4 carriers, obesity was not a significant risk factor for the development of impaired ADLs in older adults, indicating an interaction between genotype and obesity. The interaction between genotype and obesity phenotype adds new information about the determinants of physical impairment.

Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?

To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. Community-based cohort study of older adults followed from 1989 to 2015. Four U.S. communities. Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.

The association between indicators of health and housing in people with Parkinson's disease.

BackgroundThere are knowledge gaps about the life situation for people ageing with Parkinson’s disease (PD), with virtually no understanding of home and health dynamics. Therefore, the aim of the present study was to explore the association between aspects of health and objective as well as perceived housing in people with PD.MethodsParticipants were recruited from three hospitals in the region of Skåne in southern Sweden. The sample for the present study included 231 (62 % men) participants with PD, with a mean age of 75 (min-max, 45–93) years. The data collection procedure included a self-administered postal survey and a subsequent home visit where structured interviews, observations and clinical assessments were administered. To study the association between aspects of health and housing canonical correlation was applied. Twelve variables (6 in the health and 6 in the housing set) were included. This corresponds to about 20 individuals per variable and is considered sufficient to accurately interpret the largest (i.e., first) canonical correlation.ResultsThe analysis between the health variables and housing variables set yielded two significant pairs of variates with the canonical correlations 0.68 (p < 0.0001) and 0.33 (p = 0.0112), respectively. For the first pair of variates the canonical R2 was 0.46. The results showed that external control beliefs and behavioral aspects of meaning of home contributed the most to the housing variate, whereas difficulties/dependence in activities of daily living (ADL) and functional limitations contributed the most to the health variate. Although a significant relationship was found for the second canonical correlation, the shared variance between the two variates was considerably lower; R2 = 0.11.ConclusionsThis study suggests that people with PD who have more functional limitations, difficulties in ADL and are more dependent perceive their homes as less meaningful from a behavioral perspective. Moreover, they tend to rely on external influences managing their housing situation. With this kind of knowledge at hand, health care and social services professionals are in a better position to observe and efficiently address problems related to health and housing among people with PD.

Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care.

Older adults with advanced chronic kidney disease (CKD) experience functional impairment that can complicate CKD management. Failure to recognize functional impairment may put these individuals at risk of further functional decline, nursing home placement, and missed opportunities for timely goals-of-care conversations. Routine geriatric assessment could be a useful tool for identifying older adults with CKD who are at risk of functional decline and provide contextual information to guide clinical decision-making. Two innovative programs were implemented in the Veterans Health Administration that incorporate geriatric assessment into a nephrology visit. In one program, a geriatrician embedded in a nephrology clinic used standardized geriatric assessment tools with individuals with CKD aged 70 and older (Comprehensive Geriatric Assessment for CKD) (CGA-4-CKD). In the second program, a nephrology clinic used comprehensive appointments for individuals aged 75 and older to conduct geriatric assessments and CKD care (Renal Silver). Data on 68 veterans who had geriatric assessments through these programs between November 2013 and May 2015 are reported. In CGA-4-CKD, difficulty with one or more activities of daily living (ADLs), history of falls, and cognitive impairment were each found in 27.3% of participants. ADL difficulty was found in 65.7%, falls in 28.6%, and cognitive impairment in 51.6% of participants in Renal Silver. Geriatric assessment guided care processes in 45.4% (n = 15) of veterans in the CGA-4-CKD program and 37.1% (n = 13) of those in Renal Silver. Findings suggest there is a significant burden of functional impairment in older adults with CKD. Knowledge of this impairment is applicable to CKD management.

Assessment of impairment in activities of daily living in mild cognitive impairment using an individualized scale.

Mild impairment in activities of daily living (ADL) can occur in Mild Cognitive Impairment (MCI), but the nature and extent of these difficulties need to be further explored. The Canadian occupational performance measure (COPM) is one of the few individualized scales designed to identify self-perceived difficulties in ADL. The present study investigated impairments in ADL using the COPM in elderly with MCI. A total of 58 MCI patients were submitted to the COPM for studies of its validity and reliability. The COPM proved a valid and consistent instrument for evaluating ADL in elderly MCI patients. A total of 74.6% of the MCI patients reported difficulties in ADL. Of these problems, 41.2% involved self-care, 31.4% productivity and 27.4% leisure. This data further corroborates recent reports of possible functional impairment in complex ADL in MCI.

"I Know that You Know that I Know": Neural Substrates Associated with Social Cognition Deficits in DM1 Patients.

Myotonic dystrophy type-1 (DM1) is a genetic multi-systemic disorder involving several organs including the brain. Despite the heterogeneity of this condition, some patients with non-congenital DM1 can present with minimal cognitive impairment on formal testing but with severe difficulties in daily-living activities including social interactions. One explanation for this paradoxical mismatch can be found in patients’ dysfunctional social cognition, which can be assessed in the framework of the Theory of Mind (ToM). We hypothesize here that specific disease driven abnormalities in DM1 brains may result in ToM impairments. We recruited 20 DM1 patients who underwent the “Reading the Mind in the Eyes” and the ToM-story tests. These patients, together with 18 healthy controls, also underwent resting-state functional MRI. A composite Theory of Mind score was computed for all recruited patients and correlated with their brain functional connectivity. This analysis provided the patients’ “Theory of Mind-network”, which was compared, for its topological properties, with that of healthy controls. We found that DM1 patients showed deficits in both tests assessing ToM. These deficits were associated with specific patterns of abnormal connectivity between the left inferior temporal and fronto-cerebellar nodes in DM1 brains. The results confirm the previous suggestions of ToM dysfunctions in patients with DM1 and support the hypothesis that difficulties in social interactions and personal relationships are a direct consequence of brain abnormalities, and not a reaction symptom. This is relevant not only for a better pathophysiological comprehension of DM1, but also for non-pharmacological interventions to improve clinical aspects and impact on patients’ success in life.

Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality.Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study.Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register.Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates.Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

Purpose: To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods: Those aged ≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined. Results: The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory. Conclusions: Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice.Implications for rehabilitationAfter age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities.Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility.After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics.Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults’ engagement in activities that are cognitively demanding and socially interactive.

Disability Among Veterans: Analysis of the National Survey of Veterans (1997-2001).

This manuscript assesses whether the Veterans Administration Rating System (VADR) correlates with self-reported activities of daily living (ADL) used in the National Survey of Veterans and likelihood of employment. Veterans' disability benefits are determined based on a single-index standardized rating scheme, measured at time of discharge. The primary aim of this study was to assess how this single-index rating of disability for veterans compares to multidimensional measures of disability (ADL and instrumental activities of daily living [IADL]). The relationship between disability ratings and labor market outcomes such as job search behavior and the likelihood of being employed was assessed. Successful labor market reintegration requires both physical/mental well-being, we examined the extent that VADR can capture the relationship between job market behavior and measures of mental/physical health. Kernel regression estimates were obtained of the likelihood of working/looking for work. Mean numbers of IADL and ADL difficulties and medical conditions were positively associated with VADR (p-trend < 0.001). An inverse relationship was observed with VADR and predicted probability of working (p-trend < 0.001). The combination of >4 ADL/IADL deficits and mental health diagnosis increased the likelihood of not working. The probability of not working correlated with VADR when VADR was greater than 40%.

Identification of Older People at Risk of ADL Disability Using the Life-Space Assessment: A Longitudinal Cohort Study

ObjectivesLife-space mobility, assessed with the Life-Space Assessment (LSA), reflects an individual's mobility in terms of the spatial area, frequency, and need for assistance. The aims were to study associations between life-space mobility and disability status in activities of daily living (ADL), and to define cutoff scores for baseline LSA and LSA change over time identifying individuals who developed ADL inability during 2 years of follow-up. Robustness of the cutoff scores was tested accounting for potential confounders. DesignLongitudinal analyses of the “Life-space mobility in old age” cohort study. SettingHome-based interviews at baseline and phone interviews 2 years later. ParticipantsA total of 755 community-dwelling 75- to 90-year-old people living in Central Finland. MeasurementsLSA score (range 0–120) and ADL disability status (no difficulty, difficulty in ≥1 tasks, or inability in ≥1 tasks) were determined based on self-reports. ResultsParticipants who developed difficulty or inability in ADL over time presented lower LSA scores at baseline and larger declines compared to those who remained without task difficulty or inability during the follow-up, respectively. Sensitivity and specificity analyses showed that baseline LSA ≤52.3 (0.86 and 0.74, respectively) and LSA decline of >11.7 (0.76 and 0.71, respectively) identified participants who developed ADL inability over the follow-up. Multinomial regression showed that, after adjustment for potential confounders, these cutoff scores increased the odds to develop new difficulty in ADL tasks, and the odds to develop ADL inability among those with baseline difficulty. ConclusionOur results suggest that restrictions and declines in life-space mobility may be early signs of increasing vulnerability to disability in old age. These longitudinally defined cutoff points may help to find clinical applications for the LSA.

Informant Perceptions of the Cause of Activities of Daily Living Difficulties in Parkinson’s Disease

Objective: Individuals with Parkinson’s disease (PD) can have difficulties with activities of daily living (ADL) that stem from cognitive, motor, or affective manifestations of the disease. Accurately attributing ADL difficulty specifically to cognitive decline is critical when conducting a neuropsychological evaluation of a person with PD. Informant description of ADL performance is frequently used for this purpose, but there has been little work assessing informants’ ability to attribute ADL dysfunction to a specific symptom source in PD. Method: Fifty community dwelling individuals with PD completed cognitive, motor, and affective measures. A knowledgeable informant completed an ADL scale that asked about degree and perceived source of difficulty (cognitive, motor, affective) for each task. Results: Informants indicated that motor dysfunction was the most common source of ADL difficulty, but the informants viewed difficulty with certain tasks, such as financial management, as particularly related to cognitive dysfunction. Informant reports of the source of ADL dysfunction (cognitive, motor, affective) were consistent with clinical measures of those specific dysfunctions. ADL dysfunction attributed to cognition specifically (χ2 = 9.80, p = .01) was higher in those with measurable cognitive impairment. Conclusions: Informant reports of the sources of ADL dysfunction correlate with clinical measures of these symptoms, suggesting that informants may provide useful clinical information about the cause of ADL dysfunction in persons with PD.