Higher Activities Of Daily Living Scores Research Articles

Is patients’ activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BackgroundProlonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients’ activities of daily living (ADL) score may be a proxy for home care workers’ standing time at work. The objective of the present study was to investigate the association between patients’ ADL self-care score, and workers standing time.MethodsThis cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients’ ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories.ResultsWe analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients.ConclusionOur findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers’ total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Evaluation of activities and instrumental activities of daily living and correlated factors of traumatic brain injury patients in Vietnam

Traumatic brain injury (TBI) is among the leading causes of death in Vietnam. Survivors of TBI suffer from functional and cognitive deficits. Understanding that Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are crucial in measuring the treatment and health-related quality of life among patients with TBI. This study aims to evaluate ADLs and IADLs among the TBI population in Vietnam and determine the correlated factors to these two indices. A cross-sectional study was conducted on 212 patients with TBI in Vietnam from February to September 2020. ADLs and IADLs scales were applied. Depression, quality of sleep, and social support scales were used. Multivariate Tobit regression was adopted to identify factors associated with ADLs and IADLs. Patients who received first aid had higher ADLs scores than those who had not, by a statistical difference with a p value = 0.04. The mean ADLs score was 5.4 (SD = 1.4). The mean score of IADLs was 7.3 (SD = 1.7). Female patients (Mean = 7.6, SD = 1.1) performed better in IADLs than male patients (Mean = 7.1, SD = 1.9). Both ADLs and IADLs were affected strongly by depression and Injury Severity scores (p < 0.01), whereas IADLs were significantly correlated to caregiver types and quality of sleep (p < 0.01). Family support was observed as a negatively correlated factor to IADLs. Findings from the study provided evidence for authorities to adjust the health strategies among patients with TBI. Proper prehospital care, a basic low-cost hospital care model, and mental health counseling services should be considered when developing health interventions in Vietnam.

P26: Self-reported health-related quality of life for people with dementia in long-term care facilities in Taiwan: a nationwide survey

Background:Quality of life is an essential outcome parameter in geriatric research; however, research to date offers mixed evidence about the factors associated with health-related quality of life (HRQOL) among people with dementia (PWDs). We aimed to identify factors relating to HRQOL among PWDs living in long-term care (LTC) facilities.Methods:A total of 299 from 1,607 registered long-term care facilities were randomly selected in every administrative region of Taiwan. A cross-sectional two-phase survey, which included the demographic data, comorbidities, EuroQol-5 dimensions-5 levels (EQ-5D-5L), mini-mental state examination (MMSE) score, clinical dementia rating scores (CDR), behavioral and psychological symptoms of dementia, and activities of daily living (ADL) of PWDs, was then conducted from 2019 to 2020.Results:A total of 1,313 PWDs who self-completed EQ-5D-5L were enrolled in this analysis with a mean age of 76.43 ± 12.7 years. The mean utility and visual analogue scale (VAS) scores of EQ-5D-5L were 0.10 (standard deviation, SD = 0.48) and 66.57 (SD = 20.67), respectively. Multivariate linear regression analysis showed that higher scores in ADL, instrumental ADL, and lower CDR sum scores were associated with higher EQ-5D-5L utility scores. Higher ADL scores and higher MMSE scores were associated with higher scores in an EQ-5D-5L-VAS. More depressive symptoms were related to both lower utility score and lower EQ-5D-5L-VAS score.Conclusion:Findings highlight the importance to recognize and to treat depression to maintain HRQOL of PWDs in LTC facilities. Longitudinal studies are needed to better understand the long-term changes in HRQOL of PWDs.

Barriers to healthcare access in patients with chronic pain or potential migraine in Japan: a cross-sectional internet survey.

Chronic pain and migraines often go untreated despite patient- and economic-related burdens (e.g., impaired quality of life and productivity). Understanding the reasons for non-treatment is important to enable interventions aimed at improving care-seeking behaviors. However, reports on disease-specific justifications for nontreatment in Japan are limited. We aimed to determine the barriers to healthcare access in untreated patients with chronic pain or migraines. This was a non-interventional, cross-sectional, internet questionnaire survey of patients with chronic pain or migraines. The primary endpoint was to identify the reasons for untreated chronic pain or migraines. Secondary endpoints included factors associated with healthcare access, including patient background, patient-reported outcomes, and awareness of generic or authorized generic drugs (AG). We surveyed 1,089 patients with chronic pain [605 (55.6%) untreated] and 932 patients with migraines [695 (74.6%) untreated] in 2021. The main reasons for not seeking treatment for chronic pain was "my pain is tolerable" and for migraine, "I can manage my pain with over-the-counter drugs." Background factors significantly associated with untreated chronic pain were younger age, less time required to access the nearest medical institution, less pain, higher activities of daily living (ADL) scores, and lower awareness of generic drugs and AG. Among patients with migraine, notable characteristics included being female, having shorter travel times to the nearest medical facility, residing in municipalities with populations under 50,000, experiencing moderate to severe pain, having higher ADL scores, and displaying lower awareness of AG. The AG awareness rate was 2-fold higher in treated patients than in untreated patients. Educating patients regarding the risks associated with pain and its underlying causes, availability of inexpensive treatment options, and location of appropriate treatment facilities may increase treatment rates.

Can community-based care moderate widowhood's health impact? -A longitudinal study among older Chinese adults.

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short-term impact of widowhood on the objective health of older adults and to the moderating role of community-based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM-DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B=0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B=2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B=-0.154, SE=0.082) and the number of hospitalisations (B=-1.402, SE=0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B=-0.197, SE=0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

Functional Activity After Flatfoot Reconstruction With Lateral Column Lengthening.

The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery. Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed. A total of 54 patients were included. A body mass index (BMI) of 30 kg/m2 or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores. This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction. Level III: Retrospective case control.

Perspectives on Home Time and Its Association With Quality of Life After Inpatient Surgery Among US Veterans

Home time, defined as time spent at home after hospital discharge, is emerging as a novel, patient-oriented outcome in stroke recovery and end-of-life care. Longer home time is associated with lower mortality and higher patient satisfaction. However, a knowledge gap exists in the measurement and understanding of home time in the population undergoing surgery. To examine the association between postoperative home time and quality of life (QoL), functional status, and decisional regret and to identify themes regarding the meaning of time spent at home after surgery. This mixed-methods study including a survey and qualitative interviews used an explanatory sequential design involving 152 quantitative surveys followed by in-depth interviews with 12 participants from February 26, 2020, to December 17, 2020. US veterans older than 65 years who underwent inpatient surgery at a single-center veterans hospital within the prior 6 to 12 months were studied. Quality of life, measured by the Veterans RAND 12-item Health Survey and 19-item Control, Autonomy, Self-realization, and Pleasure scale; functional status, measured by activities of daily living (ADL) and instrumental ADL scales; and regret, measured by the Decision Regret Scale. Home time, standardized as percentage of total time spent at home from the time of surgery to the time of survey administration. Associations between home time and QoL, function, and decisional regret in the survey data were analyzed using Spearman correlation in the overall cohort and in operative stress score subcohorts (1-2 [low] vs 3-5 [high]) in a stratified analysis. The 12 semistructured interviews were analyzed to elicit patients' perspectives on home time in postoperative recovery. Qualitative data were coded and analyzed using content and thematic analysis and integrated with quantitative data in joint displays. A total of 152 patients (mean [SD] age, 72.3 [4.4] years; 146 [96.0%] male) were surveyed, and 12 patients (mean [SD] age, 72.3 [4.8] years; 11 [91.7%] male) were interviewed. The median time to survey completion was 307 days (IQR, 265-344 days). The median home time was 97.8% (IQR, 94.6%-98.6%; range, 22.2%-99.5%). Increased home time was associated with better physical health-related QoL in the Veterans RAND 12-item Health Survey (r = 0.33; 95% CI, 0.18-0.47; P < .001) and higher ADL scores (r = 0.21; 95% CI, 0.06-0.36; P = .008) and instrumental ADL functional scores (r = 0.21; 95% CI, 0.04-0.37; P = .009). Decisional regret was inversely associated with home time in only the high operative stress score subcohort (r = -0.22; 95% CI, -0.47 to -0.04; P = .047). Home was perceived as a safe and familiar environment that accelerated recovery through nurturing support of loved ones. In this mixed-methods study including a survey and qualitative interviews, increased home time in the first year after major surgery was associated with improved daily function and physical QoL among US veterans. Interviewees considered the transition to home to be an indicator of recovery, suggesting that home time may be a promising, patient-oriented quality outcome measure for surgical recovery that warrants further study.

Correlation between Level of Functional Ability and Sports Performance among Football Players with Chronic Ankle Instability (CAI)

Background: Chronic ankle instability (CAI) is the most common injury among the football players and it occurs with the players who have history of repetitive ankle sprain. This will result in limitation of functional ability and sport performance of a football player. However, most of the sport rehabilitation focused on the sport performance of an athletic after ankle sprain injury and the functional ability was not stressed on during the return to sport process. It is because the relationship between the level functional ability and sport performance among the football players with CAI is still unclear.&#x0D; Objectives: To determine the relationship between the level of functional ability and sports performance among the football players with chronic ankle instability (CAI).&#x0D; Study Design: Correlation study.&#x0D; Methods: Forty two (n=42) of football players were involved in this study by convenience sampling design. Football players filled in the questionnaire which was Foot and Ankle Ability Measure (FAAM) which included the activities of daily living (ADL) subscale and sports subscale. The total score of each subscale for all the players were calculated and Pearson’s Correlation Coefficient was used to analyze the relationship.&#x0D; Results: A total of twenty five (60%) of the football players had higher ADL score than the sports score while seventeen (40%) of them had higher sports score than ADL score. The mean score for ADL subscale was 79.63±20.64 (%) whereas for sports subscale was 75.59±25.43 (%). Pearson’s correlation was .92 (r=.92) and it is significant at .01 level (p &lt;.00).&#x0D; Conclusion: There is a significant relationship between the level of functional ability and sports performance among the football players with chronic ankle instability (CAI).&#x0D; Implication: It provides a guideline for the physiotherapy or football player to plan a more structured rehabilitation in order to improve the quality of return to sport performance.

Sodium ozagrel and atorvastatin for type 2 diabetes patients with lacunar cerebral infarction.

BACKGROUNDThe main pathological factor of cerebral infarction is atherosclerosis, which is the pathological process of chronic inflammatory diseases such as vascular smooth muscle hyperplasia, inflammatory cell infiltration, extracellular matrix increase, and thrombosis. At present, the focus of clinical treatment is anti-platelet aggregation and improving blood status, and current research is limited to improving symptoms only.AIMTo observe the effect of sodium ozagrel and atorvastatin on type 2 diabetes patients with lacunar cerebral infarction.METHODSEighty-two patients with type 2 diabetes and lacunar cerebral infarction admitted to our hospital from January 2018 to February 2020 were equally categorized into two groups according to their treatment method. The control group was administered atorvastatin, and the observation group was administered sodium ozagrel combined with atorvastatin. The National Institutes of Health stroke scale (NIHSS) score, activities of daily living (ADL) score, blood glucose, lipid levels, inflammatory factors, high-mobility group box 1 (HMGB1) levels, paraoxonase-1 (PON-1) levels, erythrocyte sedimentation rate (ESR), and macrophage migration inhibitory factor (MIF) levels were recorded before and after treatment. The total effective rate and adverse reaction rate of the two groups were analyzed. RESULTSThe total effective rate of the observation group (94.00%) was significantly higher than that of the control group (80.00%) (χ2 = 3.998; P = 0.046). The blood glucose indexes, total cholesterol levels, triglyceride levels, low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein levels, interleukin-1β levels, tumor necrosis factor-α levels, HMGB1 Levels, ESR, MIF levels, platelet aggregation rates, and plasma viscosity of the two groups decreased after treatment; however, high-density lipoprotein cholesterol and PON-1 Levels increased after treatment. After treatment, the blood glucose indexes; blood lipid indexes; inflammatory factors; HMGB1, PON-1, and MIF levels; ESR; platelet aggregation rate; and plasma viscosity of the observation group were better than those of the control group (P < 0.05). After treatment, all patients in the observation group had higher ADL scores and lower NIHSS scores than those in the control group (P < 0.05).CONCLUSIONSodium ozagrel with atorvastatin can reduce inflammatory reactions; regulate ESR and HMGB1, PON-1, and MIF levels; control blood glucose and lipid indexes; and alleviate nerve injury without increasing adverse effects of atorvastatin alone.

Clinical and radiological correlates of activities of daily living in cerebellar atrophy caused by PMM2 mutations (PMM2-CDG)

We aimed to identify clinical, molecular and radiological correlates of activities of daily living (ADL) in patients with cerebellar atrophy caused by PMM2 mutations (PMM2-CDG), the most frequent congenital disorder of glycosylation. Twenty-six PMM2-CDG patients (12 males; mean age 13 ± 11.1 years) underwent a standardized assessment to measure ADL, ataxia (brief ataxia rating scale, BARS) and phenotype severity (Nijmegen CDG rating scale, NCRS). MRI biometry of the cerebellum and the brainstem were performed in 23 patients (11 males; aged 5 months–18 years) and 19 control subjects with equal gender and age distributions. The average total ADL score was 15.3 ± 8.5 (range 3–32 out of 36 indicating severe functional disability), representing variable functional outcome in PMM2-CDG patients. Total ADL scores were significantly correlated with NCRS (r2 = 0.55, p < 0.001) and BARS scores (r2 = 0.764; p < 0.001). Severe intellectual disability, peripheral neuropathy, and severe PMM2 variants were all significantly associated with worse functional outcome. Higher ADL scores were significantly associated with decreased diameters of cerebellar vermis (r2 = 0.347; p = 0.004), hemispheres (r2 = 0.436; p = 0.005), and brainstem, particularly the mid-pons (r2 = 0.64; p < 0.001) representing the major radiological predictor of functional disability score in multivariate regression analysis. We show that cerebellar syndrome severity, cognitive level, peripheral neuropathy, and genotype correlate with ADL used to quantify disease-related deficits in PMM2-CDG. Brainstem involvement should be regarded among functional outcome predictors in patients with cerebellar atrophy caused by PMM2-CDG.

Operative timing and outcomes in the elderly patients with hip fracture

Objective To analyze the impacts of operative timing on the operative outcomes in elderly patients with hip fracture. Methods A cohort of 814 elderly patients with hip fracture were analyzed retrospectively who had been treated at Department of Orthopaedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2015. They were 272 males and 542 females, aged from 60 to 99 years (average, 79.9 years). They were divided into 2 categories according to their systemic status by the American Association of Anesthesiologists (ASA) classification. There were 403 cases of ASA class Ⅰ and Ⅱ in the good status category and 411 cases of ASA class Ⅲ and Ⅳ in the poor status category. Each category was further divided into one early operation group and one late operation group depending on whether the patients were operated on within 48 hours after admission. The 2 groups were compared in terms of hospital stay, incidence of complications, 30-day and 1-year mortalities, and 1-year activities of daily living(ADL) scores. Results In the good status patients there were no significant differences between the 2 groups in the preoperative general data, showing compatibility (P>0.05). The early operation group showed significantly lower 30-day mortality [0% (0/94)] and 1-year mortality [5.3% (5/94)], significantly shorter hospital stay (9.6 d ± 5.2 d) and significantly higher 1-year ADL scores [75 (70, 85)] than the late operation group [4.2% (13/309) and 14.2% (44/309), 12.3 d ± 5.9 d, and 70 (60, 80), respectively] (all P 0.05). In the poor status patients there were no significant differences between the 2 groups in the preoperative general data, showing compatibility (P>0.05). The incidence of complications in the early operation group [42.2% (35/83)] was significantly higher than in the late operation group [30.5% (100/328)] (P 0.05). Conclusion For the elderly patients with hip fracture, operation can be carried out as soon as possible if they are in good physical condition, and early operation is not necessary if they are in poor systemic condition because operation should be carried out at an appropriate time after evaluation of their physical condition allows. Key words: Hip fractures; Timing of surgery; Mortality

Constipation and laxative use among people living in nursing homes in 2007 and 2013

BackgroundConstipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation.MethodsIn 2007 and 2013, two surveys were performed in the county of Västerbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013.ResultsThe prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant.ConclusionsThe prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.

Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study.

Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14-3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18-2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44-0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45-0.90) and higher ADL score (OR 0.9, 95% CI 0.92-0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. Copyright © 2016 John Wiley & Sons, Ltd.

Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease.

Background. The purpose of this study was to analyze the factors associated with receiving peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) in a hospital in Southern Taiwan. Methods. The study included all consecutive patients with incident ESRD who participated in a multidisciplinary predialysis education (MPE) program and started their first dialysis therapy between January 1, 2008, and June 30, 2013, in the study hospital. We provided small group teaching sessions to advanced CKD patients and their family to enhance understanding of various dialysis modalities. Multivariate logistic regression models were used to analyze the association of patient characteristics with the chosen dialysis modality. Results. Of the 656 patients, 524 (80%) chose hemodialysis and 132 chose PD. Our data showed that young age, high education level, and high scores of activities of daily living (ADLs) were positively associated with PD treatment. Patients who received small group teaching sessions had higher percentages of PD treatment (30.5% versus 19.5%; P = 0.108) and preparedness for dialysis (61.1% versus 46.6%; P = 0.090). Conclusion. Young age, high education level, and high ADL score were positively associated with choosing PD. Early creation of vascular access may be a barrier for PD.

A Standardized Assessment of Functional Disability Predicts 1-year Mortality in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites.

To determine the association between functional disability and mortality after transjugular intrahepatic portosystemic shunt (TIPS). TIPS is a common therapeutic procedure for cirrhotic patients with refractory ascites. The conventional metric for periprocedure risk stratification is the model for end-stage liver disease (MELD), which uses biochemical parameters to predict post-TIPS mortality. It does not account for functional disability. This is a retrospective cohort study of 83 patients admitted at an academic liver transplant center with cirrhosis and refractory ascites for the purpose of TIPS placement. We assessed the association of patients' reported activities of daily living (ADL) on a scale of 1 to 21 before TIPS with a primary outcome of 1-year mortality. Multivariable regression to adjust for MELD and Child class was performed. A higher ADL score or functional independence, was associated with decreased 1-year mortality when modeled as both a continuous variable [odds ratio (OR), 0.80; 95% confidence interval (CI), 0.66-0.97; P=0.02) and a dichotomous variable (ADL 21 vs. <21; OR, 0.21; 95% CI, 0.05-0.70; P=0.01). After adjusting for MELD and Child class, functional independence was associated with decreased 1-year transplant-free mortality (OR, 0.22; 95% CI, 0.05-0.77; P=0.02). An ADL score consistent with dependence (<21) was significantly associated with a 3.40-day (95% CI, 1.76-5.04) longer hospital stay, adjusting for MELD and Child class (P<0.0001). Functional disability is a predictor of post-TIPS mortality and length of stay after controlling for MELD.

Activities of daily living in patients with Hunter syndrome: Impact of enzyme replacement therapy and hematopoietic stem cell transplantation

The aim of this study was to assess the activities of daily living (ADL) in patients with Hunter syndrome (mucopolysaccharidosis II; MPS II) using a newly designed ADL questionnaire. We applied the questionnaire to evaluate clinical phenotypes and therapeutic efficacies of enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT). We also explored early signs and symptoms to make early diagnosis feasible.We devised a new ADL questionnaire with three domains: “movement,” “movement with cognition,” and “cognition.” Each domain has four subcategories rated on a 5-point scale based on level of assistance. We also scored signs and symptoms unique to MPS by 12 subcategories (five points per category), providing 60 points in total. The questionnaire was first administered to 138 healthy Japanese controls (0.33–50years), and successively, to 74 Japanese patients with Hunter syndrome (4–49years). The patient cohort consisted of 51 severe and 23 attenuated phenotypes; 20 patients treated with HSCT, 23 patients treated early with ERT (≤8years), 25 patients treated late with ERT (>8years), and 4 untreated patients. Among 18 severe phenotypic patients treated by HSCT, 10 were designated as early HSCT (≤5years), while 8 were designated as late HSCT (>5years).Scores from patients with severe phenotypes were lower than controls and attenuated phenotypes in all categories. Among patients with severe phenotypes, there was a trend that HSCT provides a higher ADL score than early ERT, and there was a significant difference in ADL scores between late ERT and HSCT groups. Early ERT and early HSCT provided a higher score than late ERT and late HSCT, respectively.In conclusion, we have evaluated the feasibility of a new questionnaire in control population and patients with Hunter syndrome, leading to a novel evaluation method for clinical phenotypes and therapeutic efficacy. Early treatment with HSCT provides a better consequence in ADL of patients.

Extraction and Analysis of Risk Elements for Korean Homecare Patients with Senile Dementia.

The purpose of this study is to provide information for the protection of Korean homecare patients with senile dementia by investigating accident cases using a survey. With the survey of accident cases, the caregivers of 55 Korean homecare patients with senile dementia (75.9 ± 7.0years) were administered the short form of the Samsung Dementia Questionnaire (S-SDQ) and an activities of daily living (ADL) test. Twelve risk elements were extracted. The order of frequency of occurrence from highest to lowest was "egress," "fall," "violence," "collision," "gas accident," "slip," "faucet misuse," "overeating," "drop," "discharge," "weird eating," and "self-injury." The percentage of risk elements resulting in physical harm was 40.1% across all risk elements. The risk elements resulting in the most physical harm were "fall," "collision," "slip," and "drop," respectively. Regarding the location of occurrence of risk elements, risk elements resulting in physical harm showed no significant differences between indoors and outdoors. Some risk elements, such as "egress," "fall," and "gas accident" happened concurrently with more than four other elements, while "collision," "drop," and "violence" happened together with more than two other elements. "Slip" happened significantly more often in the low ADL score group, while "gas accident" happened significantly more often in the high ADL score group. This study provides basic information about monitoring factors to protect senior homecare patients with senile dementia.

Efficacy of a post-acute interval inpatient neurorehabilitation programme for severe brain injury

Background: Patients with severe acute brain injury often suffer from prolonged limitations in the activities of daily living (ADL) after completion of initial neurorehabilitation.Objective: To analyse the efficacy of an inpatient interval rehabilitation programme (IRP) focused on patient goals in the chronic disease state.Methods: Retrospective longitudinal cohort study of IRP patients. Clinical scoring of ADLs was performed weekly during inpatient treatment. IRP success was rated with the Goal Attainment Scale. Regression analysis was used to identify factors that influence IRP success.Results: Data from 125 patients (50.4 years) were analysed. Delay between discharge from acute/sub-acute rehabilitation and admission to IRP was 552 days. IRP lasted for 46 days and 37% of rehabilitation attempts were rated as successful. A significant increase in FIM scores from 33 ± 22 to 36 ± 24 points (p < 0.001) occurred. Higher ADL scores at discharge from acute/sub-acute rehabilitation and decannulation of a tracheostomy tube as the primary IRP goal made an IRP success more likely.Conclusions: Even several years after severe acute brain injury, an ICF-oriented IRP can lead to ADL improvements and achievement of specific goals. If confirmed by prospective trials, this strategy should be incorporated in healthcare systems.

Cross-sectional and longitudinal associations of functional and health status with institutional care use: Results from the Survey of Health and Living Status of the Elderly in Taiwan

This study evaluated the cross-sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly-old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. Participants with institutional care use had a higher activities of daily living (ADL) score, more self-reported diseases and poorer self-reported health status than participants without institutional care use (all P<0.05). Cross-sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use (P<0.05); whereas the number of self-reported diseases and poor self-reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self-reported diseases over 4- and 8 years were associated with an increased likelihood of subsequent institutional care use (all P<0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. Only ADL and ADL deterioration over time are cross-sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years.

Body Mass Index, Cognition, Disability, APOE Genotype, and Mortality: The “Treviso Longeva” Study

The concurrent contributions of dynamic, interrelated late-life parameters, such as body mass index (BMI), cognition, and physical functioning on mortality in the elderly are unclear, as is the influence of APOE genotype. We explored these measures in relation to 7-year mortality in long-lived Italian elderly. A representative, age-stratified, population sample. The Treviso Longeva (TRELONG) Study, in Treviso, Italy. Three hundred eleven men and 357 women, aged 70 years and older (mean age 84 ± 8 years). Seven-year mortality, BMI, Mini-Mental State Examination (MMSE) score, Activities of Daily Living (ADL), APOE genotype, and a variety of clinical and survey data. In separate age- and sex-adjusted analyses, BMI <18.5 kg/m(2), MMSE ≤24, and ADL <6, were associated with greater 7-year mortality among adults aged 70 years and older. In a multivariate model including all factors, MMSE ≤24, and ADL <6 were associated with greater mortality; BMI ≥30 kg/m(2) was protective. There were no interactions between BMI, MMSE, or ADL. When excluding those dying within 3 years of baseline, only an MMSE ≤24 was related to mortality. APOEε4 was not related to mortality. Higher MMSE score, higher ADL score, and higher BMI, independent of age, sex, and other factors, are markers for longer life among northern Italian adults aged 70 years or older. Global cognition, BMI, and physical functioning, assessed by short, simple tests are profound indicators of death within less than a decade.