IADL Function Research Articles

A - 13 Cognitive Correlates of Technology-Based Instrumental Activities of Daily Living Performance in Older Adults Presenting for Cognitive Evaluations

Abstract Objective Rapid advances in technology have altered how daily activities are performed. Accumulating evidence suggests technology-based instrumental activities of daily living (iADLs) are increasingly common in older adults’ lives, and assessing these skills may improve diagnostic identification of individuals with Alzheimer’s disease and related dementias (ADRD). While iADLs are complex tasks reliant on multiple cognitive processes, prior work suggests memory and executive functioning are the cognitive processes most strongly predictive of iADL performance in ADRD. However, whether similar associations exist with technology-based iADLs has not been established. The goal of the present study was to evaluate the cognitive correlates of technology-based compared to traditional iADL items. Method One hundred seventy-eight individuals (mean age: 75.35 ± 7.30) presenting for evaluation of cognitive status completed tests of memory, executive functioning, language, and processing speed. Care partners completed the Functional Activities Questionnaire (FAQ) and 11 technology-based iADL items. Associations between cognition and traditional and technology-based FAQ items were examined through Pearson’s correlations and multiple regression analyses. Results Cognition was significantly correlated with both traditional and technology-based iADLs (|r’s| > 0.30, p’s.44). In multiple regression models, executive functioning and processing speed but not memory were the strongest predictors of traditional iADL performance (p’s < 0.02), but for independence with technology-based iADLs, executive functioning alone (p < 0.001) emerged. Conclusions Relations between cognition and daily functioning are similar for both traditional and technology-based FAQ items, with executive functioning particularly relevant for both types of tasks. Implications for clinical practice and technology-based interventions are discussed.

Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults

BackgroundThis study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility.MethodsThis cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach’s alphas (α) and McDonald’s omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains.ResultsResults revealed good internal consistency reliability (α = 0.83–0.96) and concurrent validity (rho = 0.45–0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model’s predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress.ConclusionsThe interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers’ strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.

Facilitating clinical use of the Amsterdam Instrumental Activities of Daily Living Questionnaire: Normative data and a diagnostic cutoff value.

The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) is well validated and commonly used to assess difficulties in everyday functioning regarding dementia. To facilitate interpretation and clinical implementation across different European countries, we aim to provide normative data and a diagnostic cutoff for dementia. Cross-sectional data from Dutch Brain Research Registry (N = 1,064; mean (M) age = 62 ± 11 year; 69.5% female), European Medial Information Framework-Alzheimer's Disease 90 + (N = 63; Mage = 92 ± 2 year; 52.4% female), and European Prevention of Alzheimer's Dementia Longitudinal Cohort Study (N = 247; Mage = 63 ± 7 year; 72.1% female) were used. The generalized additive models for location, scale, and shape framework were used to obtain normative values (Z-scores). The beta distribution was applied, and combinations of age, sex, and educational attainment were modeled. The optimal cutoff for dementia was calculated using area under receiver operating curves (AUC-ROC) and Youden Index, using data from Amsterdam Dementia Cohort (N = 2,511, Mage = 64 ± 8 year, 44.4% female). The best normative model accounted for a cubic-like decrease of IADL performance with age that was more pronounced in low compared to medium/high educational attainment. The cutoff for dementia was 1.85 standard deviation below the population mean (AUC = 0.97; 95% CI [0.97-0.98]). We provide regression-based norms for A-IADL-Q and a diagnostic cutoff for dementia, which help improve clinical assessment of IADL performance across European countries.

GETTING BETTER OR GETTING WORSE: MARKERS OF LONGEVITY ACROSS COHORTS AND COUNTRIES

Abstract The expansion of life expectancy and the lengthening of the human life span are extraordinary achievements observed over the last century. Among those accomplishments is the increasing number of centenarians in many countries. However, it is not clear whether new cohorts of centenarians are in better health when compared to earlier born cohorts of centenarians. The purpose of this symposium is to compare centenarian cohorts across different countries. Two centenarian cohorts each from Hong Kong, Japan, and the United States are included in the analyses. Results provide different perspectives across countries. The Hong Kong Centenarian Studies compared current centenarians to those who participated at an earlier time and noted that proxies in the second study rated centenarians in worse health when compared to centenarian self-ratings. The Kyotango study assessed living conditions, care need level, ADL, IADL, and cognitive function by gender and noted cognitive improvement for men. Finally, later cohorts of the U.S. Health and Retirement Study were in worse health when compared to the earlier born cohort. The results provide an indication for policy makers and practitioners who will prepare for a larger number of centenarians in need of additional support. Although some improvement for later born cohorts is noticeable, it is obvious that more care provision will also be needed as centenarians around the world will survive with more health conditions. Additional research should evaluate centenarians in other parts of the world.

Differences in the pattern of influencing factors on instrumental activities of daily living in persons at different stages of mildly impaired cognition

AbstractBackgroundInstrumental Activities of Daily Living (IADL) are crucial for a person’s autonomy. A better understanding of potentially influencing factors at different levels of cognitive impairment is relevant for diagnostic and therapeutic purposes. Therefore, we aimed to explore whether the pattern of influencing factors varies between persons with mild cognitive impairment (MCI) and mild dementia.MethodWe exploratively extended the secondary analysis of a cohort, including persons with amnestic (a‐)MCI and mild Alzheimer’s dementia (MD). We fitted linear regression models to the data within the two subgroups, with IADL as the response variable measured using the Brussels Integrated Activities of Daily Living Inventory (BIA) [1]. Selection of the predictors followed a multi‐step approach, including criterion‐based model selection and model fit. We used multivariate imputation by chained equations to estimate the coefficients of the final models and standardized coefficient estimates to relate and compare the effects of the predictors.ResultPersons with a‐MCI (n = 64, mean age 81.7 years, 69% females) and with MD (n = 41, mean age 82.3 years, 73% females) differed in their mean BIA scores (p<0.001). In persons with MCI, the final model (R2 = 0.46) included memory, attention, executive function, mobility, balance, vision, hearing, education, and living situation. Mobility was the only significant predictor and the predictor with the most considerable effect, followed by memory and attention. The final model (R2 = 0.21) in persons with MD included the same predictors; however, executive function and attention were derived from other assessments. The predictors with the most considerable effect were the living situation, mobility, and executive function, yet none was significant.ConclusionThe pattern of potentially influencing factors on IADL functioning differs between persons with aMCI and MD. Our results suggest that physical function plays an essential role in IADL functioning in persons with aMCI, whereas in MD, no significant predictor was detected. Furthermore, our results indicate that IADL functioning may be used to differentiate between diagnostic groups.[1] De Vriendt P, Cornelis E, Cools W, Gorus E. The Usefulness of Evaluating Performance of Activities in Daily Living in the Diagnosis of Mild Cognitive Disorders. International Journal of Environmental Research and Public Health. 2021;18(21):11623.

What causes relative difficulties with technology and non‐technology based activities of daily living in those with ADRD?

AbstractBackgroundDigital skills are critical to performing a host of instrumental activities of daily living (iADLs) in the 21st century. For example, financial management activities increasingly rely on managing accounts online, social interactions are frequently mediated by technologies like text messaging and social media, and critical health and commerce activities occur via tech enabled platforms. Despite the ever increasing importance of technology related iADLs to real world functioning, there are concerns that the digital divide may disproportionately impact those with ADRD making the modern technological environment more difficult to navigate. The current study explored two broad questions: 1) how do relative difficulties with tech iADLs relate to demographic factors and diagnostic staging?, and 2) what cognitive difficulties predict relative difficulties technology versus traditional iADL performance?MethodCare‐partners of 135 older adults (mean age 75.3 years (sd = 7.9); 10.5% with no cognitive disorder diagnosis, 37.0% with mild cognitive impairment; 51.1% with dementia) referred to a comprehensive interprofessional memory clinic for neuropsychological evaluations completed both the Functional Activities Questionnaire (as a measure of traditional ADL performance) as well as a series of 11 technology based iADL items (i.e. remembering passwords, managing online accounts, etc). In addition, clinic patients completed a battery of neuropsychological measures.ResultWhile decreasing performance in both traditional and technology iADLs were noted with the transition from MCI to dementia, diagnostic stage (Figure 1), age, and verbal memory performance did not predict disproportionately greater difficulties with tech iADLs relative to overall iADL performance. However, lower education (B = ‐1.77; p = .003; Figure 2), and more difficulties with cognitive set shifting (B = 1.03; p = .0116; Figure 3) predicted greater relative difficulties with tech iADLs.ConclusionIn our current sample, relative difficulties with technology related iADLs was associated with greater executive dysfunction and less educational attainment. These factors may identify individuals with ADRD at particular risk for having difficulties navigating an ever more technologically enriched environment. Implications for helping those with ADRD cross the digital divide, clinical assessment, and technology based interventions for ADRD are discussed.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty.

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Longitudinal mediation effects of activity meaning on the association between activity performance and quality of life among older adults with disabilities

BackgroundPhysical limitations may hinder older adults with physical disabilities’ capability to perform various activities, which can affect their quality of life (QOL). Accomplishing meaningful activities may mitigate the impact of limited activity performance on their QOL. This longitudinal study aims to investigate how activity meaning mediates the relationship between activity performance and QOL among older adults with disabilities.MethodsData for this longitudinal study was collected from 813 community-dwelling older adults aged 60 and above who had physical disabilities, over a two year interval. Path analysis was used to examine the cross-sectional and longitudinal mediation effects from activity performance, through activity meaning, to QOL.ResultsAt the same wave, high IADL performance or social activity performance, and high QOL was indirectly associated through high IADL meaning or social meaning. As for longitudinal association, high T1 IADL performance was associated with better T2 QOL through high T1 and T2 IADL meaning. Similarly, high T1 social activity performance also contributed to T2 QOL through high T1 and T2 social activity meaning. Additionally, social activity performance exhibited higher influence on QOL than that of IADL.ConclusionsBoth IADL and social activities have distinct impacts on the QOL of older adults with disabilities. To improve the current and future QOL of older adults with disabilities, professionals must prioritize their involvement in the most meaningful activities while being sensitive to and supportive of their preferences and valued lifestyles.

Latent profile analysis of depression in non-hospitalized elderly patients with hypertension and its influencing factors

BackgroundHypertension is a common chronic disease in the elderly, which seriously affects people's physical and mental health, leading to anxiety, depression and other symptoms. To analyze the types of depression that may occur in elderly patients with non-hospitalized hypertension and explore its influencing factors can reduce the level of depression and improve the quality of life. MethodsBased on the data of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent profile analysis (LPA) was used to establish the potential profile model of elderly hypertensive patients with depression, and multiple logistic regression analysis was employed to explore the influencing factors of patients with depression. Results3514 elderly patients with hypertension could be divided into three potential characteristics of depression: low-level (13.9 %), medium-level (51.9 %) and high-level (34.2 %). Multiple logistic regression showed that anxiety, IADL, age, exercise, economic level, hearing difficulty, self-reported health and visual function predicted the depression of the medium-level in the comparison between the low-level and the medium-level; taking low levels as a reference, anxiety, IADL, co-residence of interviewee, age, exercise, self-reported health marital status and visual function can predict the depression of high-level; anxiety, exercise, self-reported health and marital status predicted the depression of the high-level in the comparison between the medium-level and the high-level. Limitations(1) This study is a cross-sectional study; (2) due to data limitations, other influencing factors may be ignored. ConclusionDepression in elderly patients with hypertension was divided into three potential profiles, which had obvious classification characteristics.

LONELINESS AND ACTIVITIES OF DAILY LIVING PERFORMANCE IN OLDER ADULTS: EXPLORING THE MODERATING ROLE OF COGNITION

Abstract Resulting from changes in the sociodemographic landscape and the global pandemic, rates of loneliness have exponentially risen (Myers &amp; Palmarini, 2017; Piette et al., 2020). Prior research demonstrates that loneliness is associated with an increased risk of cognitive and functional impairment (Cacioppo &amp; Hawkley, 2009; de Jong Gierveld &amp; van Tilburg, 1995; Holmén, et al., 1992; Wilson et al., 2007) as well as depression (Cacioppo et al., 2006; Kwon et al., 2017; Purtill, 2018). Although cognition has been studied as either a predictor or outcome of loneliness, it has yet to be examined as a moderator between loneliness and functional impairment (i.e., performance of basic and instrumental activities of daily living; ADLs, IADLs). Participants (N = 106) were community and non-community dwelling adults aged 65 years and older who completed four self-report measures assessing loneliness, ADLs/IADLs, cognitive functioning and depression. Hierarchical linear regression analyses were conducted to test the moderation model. Data revealed that cognition moderated the relationship between loneliness and IADLs. Follow-up simple slope analyses revealed that high cognition and low cognition were associated with decreased IADL performance amongst individuals with loneliness, and this association was stronger when cognition was low. The current study sheds light on the social, emotional, and physical disruptions the pandemic has caused in the lives of older adults. It highlights the need for interventions to enhance the quantity and quality of social relationships, and older adults’ involvement in physical and cognitive activities to uphold functional independence in later life.

Cognitive and Functional Trajectories in Prediagnostic Parkinson’s Disease

AbstractBackgroundCognitive and functional decline is typically considered a late manifestation of Parkinson’s Disease (PD). However, impactful non‐motor symptoms can occur prior to the typical motor symptoms due to prodromal neurodegeneration. Few studies have investigated prediagnostic trajectories of cognition and function.MethodWe studied 15,390 participants from two prospective cohort studies of community‐dwelling elders (one of men and one of women) followed up to 20 years. PD was repeatedly ascertained by self‐reported physician diagnosis over follow‐up. We excluded individuals with prevalent PD at baseline (n = 152). Global cognition (Modified Mini‐Mental State Examination or the Mini‐Mental Status Exam), executive function (Trails B), and functional status (interviewer administered IADL and physical function questionnaire) were repeatedly evaluated in both studies. Raw scores were z‐transformed to mean 0 and standard deviation 1. We estimated the associations of PD diagnosis with rates of change in cognition and function before and after PD diagnosis compared to healthy older adults using mixed‐effects models adjusted for age, education, race, body mass index, smoking, alcohol use, depression, and cardiovascular risk factors.ResultOver follow‐up, 297 individuals developed incident PD (168 men and 129 women). Interactions between the terms in our model and sex were statistically significant for all three outcomes (p&lt;0.001 for all), so we stratified results by sex. Compared to older men without PD, men who developed PD exhibited faster decline in global cognition (0.04 SD difference in annual change, p&lt;0.001), executive function (0.05 SD difference, p&lt;0.001), and functional status (0.06 SD difference, p&lt;0.001) in the prediagnostic period. Women who developed PD compared to women without PD displayed faster decline in executive function (0.02 SD difference, p = 0.006) and functional status in the prediagnostic period (0.07 SD difference, p&lt;0.001).ConclusionIndividuals who develop PD exhibit decline in executive function and functional status during the prediagnostic phase that exceeds rates associated with normal aging. Men exhibit more cognitive decline prior to PD diagnosis compared to women. Better understanding the prodromal phase of PD may enable earlier diagnosis and open a window for the management of non‐motor symptoms to improve quality of life and facilitate the development of future neuroprotective treatments.

Clinical validation of the Virtual Reality Functional Capacity Assessment Test – Short List (VRFCAT‐SLx) for assessment of iADL functioning in early symptomatic Dementia: Sensitivity to cognitive and functional change over time

AbstractBackgroundAssessment of functional capacity is critical to the diagnosis and monitoring of Alzheimer’s disease and related dementias. The VRFCAT (Keefe et al., 2016) is a performance‐based assessment of iADL functioning that is completed on a tablet. Previous work on the VRFCAT has demonstrated correlations with clinical endpoints and sensitivity to cognitive impairment in individuals with subjective cognitive decline (SCD) and schizophrenia. To facilitate use longitudinally and in more impaired patient groups, the VRFCAT “short list” (VRFCAT‐SLx) was recently developed to reduce task complexity and length (see Atkins et al. AAIC submission). The aim of the present work was to characterize the VRFCAT‐SLx’s sensitivity to longitudinal clinical changes in subjects with early symptomatic MCI/AD dementiaMethodAt the time of submission, participants included 77 adults (32 male; mean baseline? age = 73.29, SD = 7.52) with clinical diagnoses of MCI/AD and CDR global scores of 0.5 or 1.0. Participants completed the VRFCAT‐SLx and other established measures (i.e., ADCS‐ADL‐MCI, MMSE, CDR, BAC cognitive tests) at Baseline and Follow‐up. At submission, 22 participants had completed both visits (mean follow‐up interval ± SD: 13 ± 4.8 months). We evaluated VRFCAT‐SLx performance as a predictor of cognitive and functional change over time, and examined relationships between longitudinal change on the VRFCAT‐SLx, MMSE, ADCS‐ADL‐MCI, and CDR‐SB.ResultBaseline VRFCAT‐SLx performance predicted decline on both the CDR Sum of Boxes (β = 0.44, p&lt;0.05) and MMSE Total score (β = ‐0.48, p = 0.01), even when controlling for baseline performance, age, and length of follow‐up interval. Additionally, increases in the VRFCAT‐SLx Total Adjusted Time (i.e., worsening performance) at follow‐up was significantly correlated with observed decline on the MMSE (r = ‐0.55, p&lt;0.01), CDR‐SB (r = 0.59, p&lt;0.01), and ADCS‐ADL‐MCI (r = 0.44, p&lt;0.05). These associations remained significant after adjusting for age and length of follow‐up interval.ConclusionLongitudinal results indicate that performance on the VRFCAT‐SLx reliably predicts and tracks cognitive and functional change in early symptomatic dementia. These findings support the validity of the VRFCAT‐SLx as a sensitive assessment of iADL functioning in MCI/AD dementia.

Clinical validation of the Virtual Reality Functional Capacity Assessment Test – Short List (VRFCAT‐SLx) for assessment of iADL functioning in early symptomatic dementia: Baseline performance and associations with standard measures

AbstractBackgroundClinical trials in preclinical and early symptomatic Alzheimer’s disease require increased precision for the assessment and monitoring of functional capacity. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a performance‐based assessment of function with the potential to serve this need. Prior work has demonstrated the VRFCAT’s validity and sensitivity as a measure of iADL functioning in subjective cognitive decline (Atkins et al., 2019), but pilot work in more cognitively impaired individuals indicated a risk of floor effects in some patients. The VRFCAT “Short List” (VRFCAT‐SLx) was developed to address this issue by modifying the test to reduce length and complexity. We present Baseline data from an ongoing clinical validation study of the VRFCAT‐SLx in participants with clinically characterized MCI/AD dementiaMethodAt the time of submission, participants included 77 adults (32 male; mean age = 73.29, SD = 7.52) with established diagnoses of MCI or mild AD (NIA‐AA criteria) and CDR global scores of 0.5 or 1.0. Participants completed the tablet‐based VRFCAT‐SLx and other established measures (ADCS‐ADL‐MCI, MMSE, CDR, BAC cognitive tests) at Baseline and Follow‐up. At submission, 22 participants had completed follow‐up. Statistical analyses of baseline data, reported here, examined VRFCAT‐SLx task completion rates, the frequency of “floor” level performance, and baseline correlations with standard measures.ResultMean MMSE at Baseline was 27.47 (SD = 2.0). Cognitive performance reflected diagnoses of MCI, with the greatest impairments on verbal memory (1‐1.5 SD below the normative mean). All participants were able to complete the VRFCAT‐SLx at Baseline; 97.4% of participants (all but 2) met a priori set criteria for performance validity. VRFCAT‐SLx completion time (Total Adjusted Time) was significantly correlated with partner‐reported functioning on the ADCS‐ADL‐MCI (r = ‐.48, p&lt;.001), the CDR‐SB (r = .37, p&lt;.001), and BAC cognitive measures including Verbal List Learning (r = ‐.42, p&lt;.001), Delayed Recall (r = ‐.40, p&lt;.001), Tower of London (r = ‐.45, p&lt;.001), and Symbol Coding (r = ‐.42, p&lt;.001).ConclusionBaseline results support the use of the VRFCAT‐SLx as a performance‐based assessment of functioning in early symptomatic MCI/AD. Strong associations between VRFCAT‐SLx scores, partner‐reported functioning, clinical staging, and cognition replicate and extend earlier findings regarding the construct validity and clinical relevance of the tool.

Validating intrinsic capacity to measure healthy aging in an upper middle-income country: Findings from the ELSI-Brazil

While efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years. This cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors. The IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females. Our results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies. The Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.

Everyday Functioning and Entorhinal and Inferior Temporal Tau Burden in Cognitively Normal Older Adults.

Performance of cognitively complex "instrumental activities of daily living" (IADL) has previously been related to amyloid deposition in preclinical Alzheimer's disease. We aimed to investigate the relationship between IADL performance and cerebral tau accumulation in cognitively normal older adults. Cross-sectional. Data was collected in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies. Participants (n = 447, age 71.9±4.9 years, 57.5% female) who underwent tau positron emission tomography were selected from the A4 and LEARN studies. IADL performance was measured using the self- and study partner-reported versions of the Alzheimer's Disease Cooperative Study Activities of Daily Living - Prevention Instrument (ADCS ADL-PI). We also investigated discordance between participants and their study partners. Cross-sectional associations between entorhinal and inferior temporal tau (independent variables) and ADCS ADL-PI total scores, item-level scores and discordance (dependent variables) were investigated in linear and logistic regressions. Analyses were adjusted for age, sex and education and a tau by amyloid interaction was also included. Participants and their study partners reported high levels of IADL performance. Entorhinal and inferior temporal tau were related to study partner but not to self-reported total ADCS ADL-PI scores. The association was not retained after adjustment for global cerebral amyloid burden. At the item level, greater entorhinal tau was associated with study partner-reported difficulties remembering important dates (odds ratio (OR) = 1.24, 95% confidence interval (95%CI) = [1.06, 1.45], p = 0.008) and difficulties remembering the details of TV programs and movies (OR = 1.32, 95%CI = [1.08, 1.61], p = 0.007). Greater inferior temporal tau was associated with self-reported difficulties managing to find personal belongings (OR = 1.23, 95%CI = [1.04, 1.46], p = 0.018) and study partner-reported difficulties remembering the details of TV programs and movies (OR = 1.39, 95%CI = [1.11, 1.75], p = 0.005). Discordance between participant and study partner-report was more likely with greater entorhinal (OR = 1.18, 95%CI = [1.05, 1.33], p = 0.005) and inferior temporal tau burden (OR = 1.29, 95%CI = [1.10, 1.51], p = 0.002). We found a cross-sectional relationship between study partner-reported everyday functioning and tau in cognitively normal older adults. Participants were more likely to self-report difficulties differently from their study partners when tau burden was higher. This may hint at an altered early-disease awareness of functional changes and underscores the importance of self-report of IADL functioning in addition to collateral report by a study partner.

Assessment of Task Demand and Usability of a Virtual Reality-Based Rehabilitation Protocol for Combat Related Traumatic Brain Injury From the Perspective of Veterans Affairs Healthcare Providers: A Pilot Study

The risk of traumatic brain injury (TBI) is significantly higher among Veterans compared to non- Veterans. Access to treatment for TBI and post concussive symptoms is sometimes difficult, because of barriers related to distance, finances, and public safety (i.e., COVID-19 infection). Virtual reality rehabilitation (VRR) offers an opportunity to incorporate a virtual space into a rehabilitation environment. To our knowledge, VRR has not been used to assist Veterans with TBI and related health problems with Instrumental Activities of Daily Living (iADLs). The purpose of this study is to investigate the usability of a novel VRR ADL and iADL training protocols, developed by the Gaming Research Integration for Learning Laboratory (GRILL®) at the Air Force Research Laboratory, for cognitive rehabilitation for Veterans with a TBI. We deployed a prototype protocol among healthcare providers (n = 20) to obtain feedback on usability, task demand, and recommended adjustments. Our preliminary analysis shows that providers found the VRR protocol involved low physical demand and would likely recommend it to their patients. Although they had some concerns with vertigo-like symptoms from using a digital technology, they believed the protocol would improve iADL functioning and was a good addition to pre-existing rehabilitation protocols. These outcomes provide justification for more impactful studies investigating the effectiveness of this protocol among Veterans with TBI.

Meeting the Needs of The Global Community Through Occupational Revolution: The Evolution of The Plaster House

Research Objectives To investigate the impact of holistic high love, low-cost care to almost 700 children with surgically treatable disabilities in Tanzania. Design After volunteering for two years at a rehabilitation center for the disabled in Tanzania, in 2006, The Plaster House Founder and occupational therapist, Sarah Rejman started out on a mission to improve the lives of children living with surgically treatable disabilities across Tanzania. An idea that existed only on paper, Sarah's dream was to create a temporary home and safe oasis for children with disabilities where they'd be accepted, loved, valued, and where, finally, they would begin to heal. Since then, the ideas on that piece of paper have come to life. The Plaster House provides holistic high love, low-cost care to almost 700 children every year. By creating this home away from home, The Plaster House is helping children realize their full potential. Setting The Plaster House in Tanzania. Participants Children with surgically treatable disabilities in Tanzania. Interventions Holistic high love, low-cost care lead by a team of occupational. Outcome Measures Levels of ADL and IADL function Pain Skin integrity. Results Decrease in disability Increase in ADL and IADL function Decrease in stigma related to persons with disability in Tanzania. Conclusions This presentation will explore the story of the evolution and revolution of The Plaster House and the therapeutic, loving care of children with disabilities in Tanzania. Participants will engage in dialogue about identifying areas of need, idea development, planning, obstacles, and areas of opportunity for revolutionary care practices. Through group discussions, interactive brainstorming, and storytelling, participants will leave this presentation empowered to revolutionize lives across the world through occupation-based interventions. Author(s) Disclosures Nothing to disclose at this time. To investigate the impact of holistic high love, low-cost care to almost 700 children with surgically treatable disabilities in Tanzania. After volunteering for two years at a rehabilitation center for the disabled in Tanzania, in 2006, The Plaster House Founder and occupational therapist, Sarah Rejman started out on a mission to improve the lives of children living with surgically treatable disabilities across Tanzania. An idea that existed only on paper, Sarah's dream was to create a temporary home and safe oasis for children with disabilities where they'd be accepted, loved, valued, and where, finally, they would begin to heal. Since then, the ideas on that piece of paper have come to life. The Plaster House provides holistic high love, low-cost care to almost 700 children every year. By creating this home away from home, The Plaster House is helping children realize their full potential. The Plaster House in Tanzania. Children with surgically treatable disabilities in Tanzania. Holistic high love, low-cost care lead by a team of occupational. Levels of ADL and IADL function Pain Skin integrity. Decrease in disability Increase in ADL and IADL function Decrease in stigma related to persons with disability in Tanzania. This presentation will explore the story of the evolution and revolution of The Plaster House and the therapeutic, loving care of children with disabilities in Tanzania. Participants will engage in dialogue about identifying areas of need, idea development, planning, obstacles, and areas of opportunity for revolutionary care practices. Through group discussions, interactive brainstorming, and storytelling, participants will leave this presentation empowered to revolutionize lives across the world through occupation-based interventions.

Performance of (Instrumental) Activities of Daily Living and Physical Capacity in Spanish Adults with Intellectual Disabilities: A Cross-Sectional Pilot Study.

Performance in basic and instrumental activities of daily living (ADL; IADL) is an essential indicator of daily functioning and health of people with intellectual disabilities (ID). The aims of this pilot study were to describe the profile of ADL and IADL performance in Spanish adults with ID, and to examine its association with functional physical skills. The Waisman Activities of Daily Living Scale for adolescents and adults with developmental disabilities (W-ADL) scale was administered to the caregivers of twenty adults with ID (mean age = 41.0, SD = 10.1; women = 75.0%). In addition, dynamic balance and maximum walking speed (MWS), lower-body strength, aerobic capacity and manual dexterity of participants were individualized assessed. The results showed that 40% of adults with ID were completely independent in ADL, but all participants reported activity limitations in at least one IADL. Dynamic balance and MWS, lower-body strength and manual dexterity showed significant and moderate-to-strong correlations with daily functioning (r = 0.495–0.814; p < 0.05). Linear regression analysis indicated that lower-body strength and manual dexterity significantly predicted activity performance in adults with ID (adjusted R2 = 0.816, p = 0.004–0.016). This study highlights the need to support the performance of both ADL and IADL and to promote physical fitness in Spanish community-based care centers for adults with ID.

Patient self-reported functioning by pain severity and usual analgesic treatment among older adults with osteoarthritis: analysis of the 2017 Spanish National Health Survey.

Osteoarthritis (OA) pain is among the leading causes of disability worldwide in older people. Since its prevalence is growing in aging, a significant burden for society is expected. This work ascertained whether level of disability in self-reported functioning differs by pain severity and usual analgesic treatment among older OA patients in Spain. The Spanish-National-Health-Survey, a large, nationally representative, cross-sectional general health survey including 23,089 persons, was analyzed. Patients aged 65 + years with a self-reported physician OA diagnosis were classified according to severity of pain (no/mild, moderate or severe pain) and treated or untreated with analgesia. Assessment of function included basic and instrumental activities-of-daily-living (BADL, IADL), mental, social, and cognitive functions, scored on a 0% (no limitation) to 100% (complete limitation) standardized metric. Caregiver need for BADL and IADL was also recorded. A total of 3526 patients were analyzed (women 73.3%; age 77.4 [SD: 7.5]). Adjusted functioning scores showed significant association with pain severity, and for BADL, IADL and social function. Patients with severe pain and treated with analgesia had higher limitation scores, ranging on average between 31.5% on BADL, 34.1% on IADL, 45.0% on mental, 42.2% on social, and 23.4% in cognitive domain. The proportions of patients needing a caregiver for BADL (43.4%) and IADL (56.2%) were also the highest in patients with severe pain and treated with analgesia. Regardless of usual utilization of analgesics, the severity of pain seemed to be the major determinant of functional impairment, and caregiving need, in all domains of functioning in older OA patients in Spain. Existing treatment strategies are analgesics based and do not meet patient needs for adequate pain management.

Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

BackgroundThe incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).MethodsThis study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.ResultsSeven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.ConclusionsMerged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.