IADL Scale Research Articles

The Effectiveness Of Physical Therapy And Rehabilitation Approaches In Low Back Pain On Pain Severity And Disability; A Systematic Review

Low Back Pain encompasses nociceptive pain, neuropathic pain radiating to the legs, and nociplastic pain, often classified as non-specific due to central nervous system exaggeration. Globally, Low Back Pain is a leading cause of activity restriction and loss of productivity, significantly impacting finances. Objective; This study aimed to review the efficacy of physical therapy and rehabilitation approaches for LBP, focusing on pain intensity and disability. Materials and Methods; A literature review was conducted in PubMed and Web of Science databases up to January 30, 2024. English studies were required, using keywords: “low back pain,” “pain intensity,” “pain severity,” “disability,” and “physical therapy.” Pain intensity was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS), including the 11-point Pain Intensity Numerical Rating Scale (PI-NRS). Disability was assessed using ADL, IADL scales, Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Results; Seven study met the inclusion criteria from 665 initial records. Interventions included osteopathic manipulative treatment (OMT), core muscle exercise with interferential current (IFC), cognitive functional therapy (CFT), dry cupping therapy, high-intensity machine-based core muscle resistance training (C-IPU), heat therapy, TENS, pelvic traction, Reiki, dynamic muscular stabilization technique (DMST), and McGill Big 3 (MB3). Sample sizes ranged from 30 to 1090 participants. IFC combined with core muscle exercises significantly reduced pain intensity compared to each method alone, though not statistically significant (p > 0.05). The C-IPU group had greater pain relief (P 0.05). Dry cupping did not outperform sham cupping. CFT reduced absenteeism in the first two years but not later. Reiki showed significant improvement in pain and ADL compared to drug therapy, but not to physiotherapy. Conclusions; Physical therapy interventions effectively alleviate symptoms and improve outcomes in LBP. However, variability in interventions and outcome measures necessitates cautious interpretation. Further research with standardized protocols is essential to understand the effectiveness and optimal duration of physical therapy for LBP. Keywords; low back pain; pain intensity; pain severity; disability; physical therapy

Age-associated risk of sarcopenia, falls and fractures: results of Ukrainian cohort study

Background. It is well-known that sarcopenia increases the risk of falls and fractures, and therefore, requires correction to improve the quality of life of elderly people. This research purposed to study the age-related changes in the sarcopenia risk, falls, and fractures in Ukrainian women in the late reproductive and postmenopausal periods. Materials and methods. We examined 573 females aged from 40 to 89 years old. The subjects were grouped by age decades and presence of high sarcopenia risk (HSR). The SARC-F questionnaire measured the sarcopenia risk, and the risk of falls using the Desmond Fall Risk Questionnaire, the 10-year probability of major osteoporotic and hip fractures was assessed by FRAX, and daily activity — according to the IADL scale. Also, we performed the hand grip strength and five-repetition sit-to-stand tests. Results. The frequency of HSR increased with age from 1.5 % in the 40–49-year-old group to 73.7 % in subjects over 80, as well as fracture and fall risks (p < 0.00001 for both indices) related to decreasing independence in the subject’s everyday life. Also, we revealed age-dependent loss of muscle strength according to the hand grip and the five-repetition sit-to-stand tests. After the adjustment of the subjects by age we found that the females with HSR had a higher risk of falls, a lower level of independence, and increased frequency and risk of osteoporotic fractures. Conclusions. Women with HSR have a higher risk of falls, fractures, and more limitations in daily living activities independently from age and body mass index. These findings request comprehensive management of older women with attention to various parameters for the increase of independence and quality of life.

Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the “Taiwan Longitudinal Study on Aging (TLSA),” which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach’s α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Relationships between cognitive function and activities of daily living in psychiatric nursing home patients with schizophrenia

IntroductionSchizophrenia is a common chronic disease in psychiatric long-term care institutions. Taipei City Hospital Songde Branch Psychiatric Nursing Home (TCHSBPNH) is the first public psychiatric nursing home in Taipei City. There’s not only a complete interdisciplinary care system, but also detail initial evaluation at admission of residents, including basic demographic information, cognitive assessments, activities of daily living, and so on. It is known that patients with schizophrenia are generally accompanied by cognitive impairments, which further affects their activities of daily living (ADL) performance, but we still don’t know the correlation between of them.ObjectivesThis study aimed to investigate the relationships between cognitive function and ADL function of psychiatric nursing home residents with schizophrenia. The results would promote clinical intervention in ADL training for institutional patients.Methods39 participants with chronic schizophrenia (mean age =63.95±6.59 years) were recruited for the study from 2020 to 2021 in TCHSBPNH. We collected every resident’s assessment data, including Mini-Mental State Examination (MMSE), Barthel Index, Lawton - Brody Instrumental Activities Of Daily Living Scale (Lawton IADL scale) and Composite Physical Function (CPF) Scale. The Pearson correlation coefficient was used to examine the correlation between cognitive function and ADL.ResultsModerate positive correlations were showed between cognitive function and ADL (p<.05). The statistic results as follow, MMSE and Barthel Index (γ=.627, p<.001), Lawton IADL scale (γ=.431, p=.006), and CPF (γ=.341, p=.034) respectively exhibited significant correlations.Image:Image 2:Image 3:ConclusionsThere is a positive correlation between cognitive function and ADL in psychiatric nursing home residents with schizophrenia. The better cognitive function performance becomes, the better independent ADL functions will be. Thus, the psychiatric nursing home residents’ independent ADL training will also vary from person to person.Disclosure of InterestNone Declared

Evaluation of Serum Myostatin Concentration in Chronic Heart Failure with Preserved and Impaired Left Ventricular Ejection Fraction.

Background: Chronic heart failure (CHF) is a complex clinical syndrome associated with muscle wasting, which can progress to cardiac cachexia. Myostatin, a negative regulator of muscle growth, has been implicated in the pathophysiology of muscle wasting in CHF patients and suggested as a potential biomarker. The objective of this study was to investigate serum myostatin concentration in patients with CHF with preserved and reduced ejection fraction. Methods: The authors conducted a single-centre study comparing serum myostatin levels, functional and echocardiographic parameters, muscle mass, strength and function in patients with CHF to a control group without CHF. The study group was further divided into sub-groups with preserved and reduced or mildly reduced ejection fraction. Results: Results showed no significant differences in myostatin concentration between CHF patients and controls, and no correlation with sarcopenia or dynapenia. However, a higher myostatin concentration was found in patients with impaired systolic function (Me = 1675 pg/mL vs. Me-884.5 pg/mL; p = 0.007). A positive correlation between myostatin concentration and muscle mass (r = 0.27; p = 0.04), and functional parameters such as Norton (r = 0.35; p < 0.01), I-ADL (r = 0.28; p = 0.02) and Barthel scale (r = 0.27; p = 0.03) scores, was also observed. Conclusions: Myostatin appears to play a role in muscle wasting and its progression to cardiac cachexia in patients with impaired ejection fraction. Further research is needed to confirm these findings and explore myostatin's potential as a biomarker for muscle loss and a target for pharmacotherapeutic agents in this population of patients.

Validation of the Italian version of the Parkinson’s Disease- Cognitive Functional Rating Scale

A key distinguishing factor between mild cognitive impairment (MCI) and dementia in Parkinson’s disease (PD) lies in the notable decrease in functioning due to cognitive impairment. The Parkinson’s Disease-Cognitive Functional Rating Scale (PD-CRFS) was developed to assess functional limitations caused by cognitive impairment, while reducing the influence of motor impairment. The aim of this multicenter study was to (i) validate the Italian version of the PD-CFRS in PD, (ii) determine optimal cut-off scores for detecting MCI and dementia in PD, (iii) compare its performances with the most established functional assessment tool (IADL). Six hundred and sixty nine PD participants were recruited from 4 Italian Movement Disorders centers (Venice, Milan, Gravedona, and Salerno). They underwent Level-II cognitive evaluation, which resulted in 282 PD-NC, 310 PD-MCI, and 77 PDD. The PD-CFRS’s psychometric and clinimetric properties, applicability, and responsiveness were analyzed. The PD-CFRS showed high acceptability. Floor and ceiling effects were acceptable. It also displayed strong internal consistency (Cronbach’s α = 0.738), and test–retest reliability (ICC = .854). The PD-CFRS demonstrated higher coefficient of variation to detect dysfunction in PD-MCI patients in comparison to the IADL scale (PD-CFRS 96% vs IADL 22.5%). Convergent validity with the IADL was r = − 0.638 and − 0.527 in males and females, respectively. PD-CFRS total score negatively correlated with global cognition (MoCA corrected score r = − 0.61; p < 0.001). A cut-off score > 6.5 identified PDD with a sensitivity of 90% and specificity of 88% (AUC = .959). A cut-off value of > 1 detected PD-MCI with a sensitivity of 68% and specificity of 69% (AUC = .695). The Italian version of the PD-CFRS demonstrated to be an easy, valid and reliable tool that properly captures functional impairment due to cognitive decline in PD. It also proved to be particularly effective in the advanced stages of PD, and would be a useful support for the diagnosis of PD-MCI and PDD.

Comprehensive Geriatric Assessment of Older and Oldest-Old Patients in the Perioperative Period. Russian Gerontology Research and Clinical Centre Experience

With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness.Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty).Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An individual plan of perioperative management was drawn up.Results. A comparative analysis demonstrated statistically significant improvements in functional status (based on the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group.Conclusion: the management of patients with frailty in the perioperative period with the use of CGA allows for preventive measures aimed at maintaining functional, psycho-emotional status. Individual characteristics of the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.

Predictors of increasing disability in activities of daily living among people with advanced respiratory disease: a multi-site prospective cohort study, England UK

Purpose Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. Method Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. Findings Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14–1⋅74], p = 0⋅002). Conclusion Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.

Ab. No. 180 Association between Balance Confidence and Activities of Daily Living in Community Dwelling Elderly

Introduction: Balance confidence and FOF are essential psychological factors to consider when developing fall intervention strategies to enhance ability of elderly to remain active at home and within the community, and avoid injurious falls. Psychological factors like balance confidence and fear of falling (FOF) are related to balance impairment and falling. Ability to perform activities without falling may have positive effect on confidence in balancing. Study was aimed at obtaining better understanding of association of level activity of daily living (ADL) with individual’s estimation ability to avoid fall or maintain their balance. Methods: 315 ambulatory community dwelling elderly ageing 60 to 85 years were recruited by personal interview from parks, and housings of various areas of city. Elderly with MMSE score &lt; 18, neurological disorders (e.g. Stroke, Parkinson’s disease), any acute injury, hearing/communication problems, nonstable medical conditions, painful osteoarthritis with weight bearing, vestibulopathy were excluded. In this cross-sectional study, all individuals were screened for cognition using MMSE along with demographic details. The participants were assessed using Activities-specific balance confidence (ABC) scale, Katz Index of Independence in ADL and Lawton IADL Scale. Result: Mean sample age was 69.2±6.33 with 46.2% females. ABC score showed significant correlation with the criterion (p&lt;0.000). The multiple regression model with all four predictors produced R²=0.454, F=64.316, p&lt;0.000. MMSE, Lawton and Katz scale had significant positive regression (B=1.232,0.329,3.402 respectively). Age had significant negative weight (B=-0.786). Conclusion: Katz Index was the best predictor of balance confidence followed by MMSE, age and Lawton IADL Scale. Implications: Result provides better understanding of factors predicting balance confidence.

317 Analysing the social history aspects of an integrated care comprehensive geriatric assessment incorporating patients views and wishes

Abstract Background An evaluation of social well-being is an important component of a Comprehensive Geriatric Assessment (CGA). There is no clear guidance about how best to structure and examine these factors as part of a CGA. We sought to examine current practice with respect to the collection of information from a social care perspective across different integrated care CGA proformas. Methods We completed a cross sectional study of the social care domain of integrated care based CGA proformas. All operational leads for each integrated care hub in the country were contacted and invited to share their local CGA. We completed a thematic analysis of the social care section including social, financial and wellbeing assessments. Results We included 16 different CGAs that are in use across different integrated care hubs. All CGAs had a dedicated section for assessing social history with variability in what was included in different CGAs. Patient’s wishes and expectations were commonly included but the manner in which they were collected and emphasis varied. 7 (43%) specifically captured whether the patient has an enduring power of attorney in place, 5 (31%) collected information about formal advanced care directives, and 2 (12%) enquired about nominated assisted decision makers. Ability to manage finances was captured through the Lawton Brody IADL scale in two CGAs. Half of CGAs included a section to capture carer strain and the term ‘next of kin’ was used in 6 of 16 CGAs. Conclusion There is significant heterogeneity in the structure of the social care section of a CGAs across different integrated care hubs, particularly with respect to capturing information surrounding advanced care planning. Signposting of patients’ wishes and expectations was useful for focusing on patient-centred care.

ИНТЕРЛЕЙКИН-6 – МАРКЕР СУБКЛИНИЧЕСКОГО ВОСПАЛЕНИЯ У БОЛЬНЫХ ИБС В СТАРЧЕСКОМ ВОЗРАСТЕ И ДОЛГОЖИТЕЛЕЙ

Introduction. Interleukin-6 is a cytokine involved in the regulation of immune reactions, in the processes of hematopoiesis and inflammation. Levels of interleukin-6 in the blood correlate with the development of senile asthenia. Aim. The study aim was to determine the blood concentration of interleukin-6 and to evaluate the relationship of this cytokine with a number of pathological conditions in very old and centenarians with coronary artery disease. Material and Methods. 128 patients were enrolled in the cross-sectional study of interleukin-6 in very elderly patients and centenarians with coronary artery disease: 94 with coronary artery disease – in the study group, 34 without coronary artery disease – in the control group. The mean age of study patient was 88.3+5.3 years (76 to 98 years). Serum interleukin-6 concentrations (N&lt;7.0 pg/ml) were determined by enzyme-linked immunosorbent assay. Results and discussion. Elevated interleukin-6 levels were found in 45.3% of patients. Mean interleukin-6 concentration was 8.2+6.3 (1.5-36.2) pg/ml. In patients with coronary artery disease mean interleukin-6 concentration reached 9.0 pg/ ml, in the control group – 5.8 pg/ml (p=0.001). Significantly higher interleukin-6 levels were found in patients with heart failure – 11.2 and 6.6 pg/ml, respectively (p=0.00005). Among patients with hyperuricemia mean interleukin-6 values reached 10.8+4.8 pg/ml. Positive correlations were found between interleukin-6 level and leukocytes count (r=0.29; p=0.002), neutrophils count (r=0.37; p=0.00002) and tumor necrosis factor-α (r=0.39; p=0.007). In patients with elevated interleukin-6 level lower Barthel index (70.7 and 80.7, respectively, р=0.003) and IADL scale (3.4 and 5.0, respectively, р=0.0002) values were observed. Conclusion. In patients with chronic coronary artery disease in very old age and centenarians an increase level of interleukin-6 is often found. Higher levels of interleukin-6 are associated primarily with heart failure and hyperuricemia.

Quality of Life Among Geriatric Population Living with Functional Disabilities in Urban Slum Dwellers of Kolkata, India

Introduction: Population aging globally impacts individuals, families, communities, and societies. Longer life spans result in an increasing elderly population, leading to the 21st century being known as the century of the elderly. Disability, stemming from health conditions and surroundings, presents challenges necessitating interventions against environmental and social barriers. This study aims to examine the correlation between disability and quality of life (QOL) among elderly individuals living in Kolkata slums. Methodology: The observational study focused on the 100 geriatric populations in Dhapa slums using systematic random sampling. Data was collected using the Lawton Brody IADL Scale, and QOL assessment using WHOQOL-BREF. Results: Majority of the participants were male (64%) and from the general caste (63%). Disability prevalence was 28%. Better QOL scores were observed in males, younger age groups, married individuals and non-diabetics. The physical health domain had the highest QOL score. Literate individuals and those without hypertension or diabetes had higher QOL. Conclusion: India's aging population poses challenges for society and the economy. The study identified factors impacting disability and QOL in the elderly. Improving psychological care, awareness of government schemes, education, and targeted policies can enhance elderly quality of life.

Prevalence and Determinants of Falls in Community-dwelling Older Adults in Türkiye: A Population-based Cross-sectional Study Conducted between 2014-2015.

Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz's 6-item ADL and Lawton Brody's 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls. Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

The Burden on Caregivers of the Elderly to Care for Patients with Nervous System Diseases

Introduction. Previous studies have shown that the level of care burden depends primarily on the mental state and functional ability of patients, i.e. on factors on the patient’s part. Other reports point to factors also related to the caregiver.&#x0D; Aim. The aim of the study was to analyse the impact of selected factors on the burden on informal caregivers in caring for geriatric patients with nervous system diseases.&#x0D; Material and Methods. The research was conducted at the Geriatrics Clinic of the University Hospital no. 1 of Dr A. Jurasz in Bydgoszcz on a group of 117 informal caregivers and 117 patients with nervous system diseases under their care at home. The prospective studies used survey techniques as well as observation and measurement. The Negative Impact of Care Scale (NIC) included in the COPE-index was used to assess the caregiver’s burden with care. The Barthel scale and Lawton’s IADL scale were used to assess patients’ deficits in basic activities of daily living. To assess the intensity of depression symptoms in older people, the Geriatric Depression Scale — GDS was used.&#x0D; Results. The socio-demographic factors determining caregiver burden (NIC) include: caregiver’s age (p=0.00), place of care (p=0.03), caregiver’s self-assessment of health (p=0.00) and experience in providing care (p=0.03). However, there was no significant (p&gt;0.05) impact of variables such as gender, place of residence, marital status, caregiver’s education and degree of relationship with the patient on the burden of care. The analysis also showed that caregivers feel a negative overload in connection with caring for a patient with a functional impairment (BI and IADL p=0.01) and with vascular disease and dementia (p=0.01).&#x0D; Conclusions. More than half of the surveyed caregivers show a high degree of burden in caring for geriatric patients with nervous system diseases. Caregiver burden is determined by the following factors: the age of the caregiver, the place of care, the caregiver’s self-assessment of health and the experience of providing care. Caregivers feel a negative overload due to caring for patients with functional deficits, vascular disease and dementia. (JNNN 2023;12(2):84–91)

Functionality according to frailty and cognitive status: Differences between scoring procedures for the Lawton‐Brody IADL scale

AbstractBackgroundFrailty is the state of physiological vulnerability that hindered age‐related decline that precedes disability. However, some functional decline in IADLs is expected, particularly when co‐occurring with Mild Cognitive Impairment (MCI). Our aim was to analyze differences in IADLs between prefrailty and frailty participants with or without MCI. Three scoring procedures for the Lawton &amp; Brody Scale administered to informants were used to analyze IADL differences: 1) Raw scoring: percentage calculation of the raw scores considering all the items; 2) Gender‐corrected scoring: percentage calculation of the IADLs that continue to be carried out but excluding in men the 3 elements traditionally associated with the female gender role (i.e., housekeeping, food preparation, and laundry); 3) Past‐performance corrected scoring: percentage calculation of the IADL activities that the person could perform in the past but now performs with greater difficulty or no longer performs.MethodThe sample comprised 285 Spanish community‐dwelling older adults, without diagnosis of dementia nor disability. MoCA test was used to objectively measure cognitive functioning. Participants were classified using the frailty phenotype: No‐frailty (i.e., met no criteria), pre‐frailty (i.e., met one‐two criteria), and frailty (i.e., met three or more criteria). Presence of MCI were considered to further classify the participants considering cognitive status.ResultsDifferences between No‐frailty (N = 80), (Pre)frailty without MCI (N = 123), and (Pre)frailty with MCI (N = 62) groups were tested using non‐parametric tests (see Figure 1). Group differences (Kruskal‐Wallis tests) were found using Raw (H = 11.30, p&lt;0.01) and Past‐performance corrected scores (H = 10.57, p&lt;0.01). For both, lower IADL scores were found in the (Pre)frailty with MCI compared with the No‐frailty group (Raw scoring: Z = ‐3,37, p&lt;0.01; Past‐performance corrected scoring: Z = ‐1,97, p&lt;0.05) and compared with (Pre)frailty without MCI group (Raw scoring: Z = ‐2,86, p&lt;0.01; Past‐performance corrected scoring: Z = ‐2,65, p&lt;0.01).ConclusionDifferences in IADLs were found between groups with and without MCI using raw and proportional scores considering past performance skills. Between‐group differences in participants without cognitive impairment did not reach significance regardless of their frailty status. Results using the gender‐corrected score suggest a lower sensitivity for detecting functional impairment in men when this procedure is used.

Geriatric syndromes and nutrition status of elderly osteoarthritis patients

This study describes numerous characteristics of comorbidities and geriatric syndromes in elderly osteoarthritis patients at the National Geriatrics Hospital. A cross-sectional study on 184 knee osteoarthritis (OA) patients aged ≥ 60 years old treated at the National Geriatrics Hospital. The mean age of the patients was 73.12 ± 8.62 years, male patients accounted for 83.7%. Most participants (85.9%) had experienced 2 sides of knee OA, more than half of these participants (63.6%) were experiencing moderate pain. There were 73 patients with reduced mobility accounting for 39.7%. The dependency ratio of functional activities on the ADL scale was 32.6%, and on the IADL scale it was 35.9%. The number of participants using less than 5 drugs was 45.7%. More than half of the survey participants used polypharmacy accounting for 54.3%. There was a significant association between nutritional status and reduced physical function (ADLs and IADLs), impaired cognitive function, depression status and sleep disorder. Geriatric syndromes and risk of malnutrition are common in older OA patients, and assessment for them should be done routinely in these patients to early detect impaired physical activities, impaired cognitions, depression problems, sleep disturbances and progressive symptoms of knee osteoarthritis.

Гипотиреоз у долгожителей: благо или вред?

Aim. To analyze the relationship of thyroid hormones with various clinical and laboratory parameters in centenarians with coronary artery disease (CAD) based on the determination of the blood concentration of thyroid-stimulating hormone (TSH), free triiodothyronine (T3) and free thyroxine (T4). Materials and methods. This work was a cross-sectional study conducted on the basis of the Hospital for War Veterans No. 3. The study enrolled 262 patients [195 (74.4%) women and 67 (25.6%) men] aged 90 to 101 years (mean age 92.9±2.5 years) hospitalized with a diagnosis of coronary artery disease. The concentration of thyroid-stimulating hormone (normal 0.27–4.2 μIU/ml), the level of free T4 (12–22 pmol/l) and free T3 (3.1–6.8 pmol/l) in the blood were determined. Results. The mean level of TSH was 3.1±3.1 μIU/ml (0.005–108), free T3 – 3.7±0.65 pmol/l (1.9–5.3), free T4 – 14.1±5.5 pmol/l (4.1–32). In 18.9% of patients, the level of TSH was elevated, in 3.9% it was reduced, in 77.2% of patients it was normal. In patients with increased TSH lower functional activity was noted, assessed using the Barthel index (66.9±23.0 compared to 75.0±16.4 points in patients with normal TSH; p=0.02) and the IADL scale (3.46±2.3 and 4.6±2.0 points, respectively; p=0.006). Direct correlations were registered between free T4 concentration and uric acid (r=0.28; p=0.05), cholesterol (r=0.35; p=0.01), triglycerides (r=0.37; p=0.08), hemoglobin (r=0.23; p=0.07) and Morse fall scale (r=0.34; p=0.05). Significant inverse correlations were established between the blood concentration of free T4 and absolute indicators of bone mineral density in the lumbar spine (r=-0.36; p=0.03), in the proximal left (r=-0.44; p=0.006) and right (r=-0.43; p=0.009) femur. Conclusion. The study results demonstrate the relationship between the concentration of thyroid hormones and various clinical and laboratory parameters in centenarians with coronary heart disease.

Association Between Neuropsychological Functions and Activities of Daily Living in People with Mild Cognitive Impairment

ABSTRACT Objective The aim of this study was to explore the relationship between performance in neurocognitive variables and daily functioning (basic or b- and instrumental or i-ADL) in people with mild cognitive impairment (MCI). Methods A sample of 157 participants with MCI (73.65 ± 7.58 years) completed a battery of tests for assessing ADL and cognitive functions. t-test, Pearson’s correlation and multiple linear regression (backward stepwise selection) were used for data analyses. Results Significant correlations were found between b- and i-ADL, and several neuropsychological tests (p < .01). Multivariate analysis showed that difficulties in Blessed Rating Scales (BLS) explained 33.2% of the variation in b-ADL and that this variation rises to 42.9% when BLS is associated with Frontal Assessment Battery Flexibility, Trail Making Test A (TMT-A) and BLS Personality. For i-ADL, BLS and Dementia Rating Scale Total (DRS-T) explained 47.7% of the variation and the inclusion in the model of BLS, DRS-IP (Initiation/Perseveration), TMT-A and BLS Personality explained 53.5% of this variation. Executive functions explained 24.8% of the variation in i-ADL. Conclusions Cognitive functions are related to i- and b-ADL in people with MCI. The general indicators and those that assess executive functions and verbal- or visual-spatial memory should be considered to predict i-ADL.

Assessment of functional capacity of the elderly.

Ageing is a continuous, progressive process of functional reserve loss. Physical fitness and mental state have a significant impact on the functionality level of the elderly population. Assessing the degree elderly people's of independence regarding self-care is an important aspect of the Comprehensive Geriatric Assessment (CGA). The aim of the study was to assess the functional capacity of people over 65 years of age. The study involved 312 patients in hospital wards across Lower Silesia, south-west Poland. The criteria for participation were as follows: providing informed consent to participate in the study, intellectual capacity to be interviewed, and age over 65. The study applied the diagnostic survey method, together with the use of the VAS, Barthel, IADL and GDS scales. Among the respondents, 59.94% were in a moderately severe condition according to the Barthel scale, average IADL score - 20.56 points; according to the GDS scale, 58.97% had no symptoms of depression. Respondents suffered from multiple chronic diseases, the most common of which were hypertension (71.47%); they also reported some medical issues, mainly back pain (47.44). Assessment of the correlation of the Barthel and GDS scales, as well as the IADL and GDS, revealed a significant and negative correlation at -0.49 and -0.50. Assessment of the correlation between the number of diseases and the Barthel scale was -0.49, the number of symptoms and the Barthel scale -0.4; pain severity and the Barthel scale -0.41, number of diseases and IADL -0.58, and number of symptoms and IADL -0.52. The greater the seniors' independence regarding instrumental activities of daily living, the weaker the symptoms of depression. Multimorbidity and experiencing pain impaired independence among the elderly.

Patterns of improvement in functional ability and predictors of responders to dual-task exercise: A latent class analysis.

Exercise is the pillar for healthy aging. "Non-responders" may be due to a mismatch in exercise prescription. A latent cluster analysis (LCA) profile can be useful to uncover subpopulations sharing similar profiles or outcomes. We aim to use the LCA to develop a response prediction model for older adults who would benefit from The Healthy Aging Promotion Program for You, a community-embedded dual-task exercise program. A total of 197 participants completed the 3-month follow-up, and the complete data were available for 136 community-dwelling older adults. Inclusion criteria were age ≥60 years, pre-frail or frail and ambulant, mild cognitive impairment, and ability to provide consent. Data collected include demographics, education, falls, physical function (Katz ADL scale and Lawton's IADL scale), physical activity (rapid assessment of physical activity), cognition (Montreal Cognitive Assessment; MoCA), frailty (FRAIL scale), and perceived health, pain, anxiety/depression, fear of falling, and social isolation (Lubben Social Network Scale). The body mass index (BMI), handgrip strength, and short physical performance battery (SPPB) were measured. Those who improved in frailty, anxiety/depression, pain, Lubben, MoCA, SPPB, fear-of-falling, physical activity, falls, and HGS were classified as responders. The mean age was 74.7 years, BMI 23.5 kg/m2, 23.5% were male, 96.3% were of Chinese ethnicity, 61% were pre-frail, education level of 4.3 years, and the MoCA score of 23.3 ± 4.8. Two clusters were identified: non-responders (61.8%) and responders (38.2%). Responders had significant improvement in cognition (44.2% vs. 0, p < 0.001) and SPPB (gait:28.8% vs. 0, p < 0.001; balance:42.3% vs. 15.5%, p = 0.001; chair-stand:65.4% vs. 4.8%, p < 0.001). Responders were significantly older (76.9 vs. 73.3 years, p = 0.005), had higher BMI (24.8 vs. 22.8 kg/m2, p = 0.007), lower education (3.4 vs. 4.9 years, p = 0.021), lower MoCA scores (21.8 vs. 24.3, p = 0.002), and lower SPPB scores (8.7 vs. 10.6, p < 0.001). The predictive variables for the responder cluster were age ≥75 years, BMI ≥23 kg/m2, robust, no anxiety, pain, fear of falling, MoCA ≤22, Lubben ≤12, SPPB score: chair-stand ≤2, balance ≤2, gait >2, handgrip strength <20 kg, no falls and RAPA >3. With an optimal cut-off of ≥12, this prediction model had sensitivity of 76.9%, specificity of 70.2%, positive predictive value 61.5%, and negative predictive value of 83.1%. Response to dual-task exercise was influenced by age, SPPB, BMI, and cognition. Prospective longitudinal studies are needed to validate this LCA model and guide the development of public health strategies.