Independence In Basic Activities Research Articles

Impact of Social Isolation Due to COVID-19 on Daily Life Activities and Independence of People over 65: A Cross-Sectional Study.

A cross-sectional study. Private's health insurance Hospital, Córdoba, Argentina. A total of 193 participants with mean age of 76.56 years (121 women and 72 men) who met inclusion criteria were included in the study. A personal interview was conducted between July and December 2020. Sociodemographic data were collected, and perceived independence was assessed. The Barthel index and the Lawton and Brody scale were used to assess independence of basic and instrumental activities of daily living. Minimal limitations were noted with function. The activities that represented the greatest difficulties were going up and down stairs (22%) and moving around (18%), and the greatest difficulties in instrumental activities of daily living were shopping (22%) and preparing food (15%). COVID-19 has caused isolation, leading to functional limitations for many, especially older adults. Perceived declines in function and mobility may lead to decreased independence and safety for the older adult; therefore, preventative planning and programming should be considered.

Assessing independence in activities of individuals affected by leprosy

Background The abilities required to perform the fundamental physical needs of an individual and instrumental activities required for independent living in a community are reduced in individuals affected by leprosy, due to various medical and psychological factors. Objective To assess basic life activities, identify critical sociodemographic factors influencing these and ascertain opportunities to improve the independence levels of individuals affected by leprosy. Material and methods A survey of 71 participants was conducted from a residential leprosy facility in Srinagar, in the Jammu and Kashmir region of northern India, between 2019–2020. Data were collected via face-to-face interviews of individuals affected by leprosy who were asked questions about sociodemography. The standardised instruments Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were used. Statistical methods, t-test, ANOVA, correlation and multivariant regression were used to analyse the data. Results Among the entire sample (n = 71), 3% of study participants showed complete independence in basic activities and 1% of study participants showed complete independence in instrumental activities. For activities of daily living, dependency was found in physical ambulation (8%), grooming (10%) and bathing (13%). In instrumental activities of daily living, dependency was found in shopping (18%), food preparation (24%), responsibility for own medication (34%) and ability to use a phone (34%). Statistically, a significant correlation was recorded between disease categories, age, employment, and activity independence. Conclusion This study concludes that individuals affected by leprosy are severely constrained in carrying out basic and instrumental activities. Dependency increases with age and level of disability. However, being in some kind of employment increases independence levels in both activities of daily living and instrumental activities of daily living; marriage increases independence in activities of daily living, but not in instrumental activities.

Assessing Relationships between Physically Demanding Work and Late-Life Disability in Italian Nonagenarian Women Living in a Rural Area.

As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.

Resilience and Its Association With Activities of Daily Living 3 Months After Stroke.

Independence in basic activities of daily living (ADL) is an important outcome after stroke. Identifying factors associated with independence can contribute to improve post-stroke rehabilitation. Resilience, which is the ability of coping with a serious event, might be such a factor. Still, the impact of resilience and its role in rehabilitation after stroke is poorly investigated. Hence, the purpose of this study was to assess whether resilience assessed early after stroke can be associated with independence in basic ADL 3 months later. Hospitalized patients with a diagnosed acute stroke and a modified Rankin Scale score ≤ 4 were included. Bivariate and multivariate linear regression were applied to assess whether resilience as measured by the Brief Resilience Scale within the first 2 weeks after stroke was associated with basic ADL measured by Barthel Index at 3-month follow-up. Age, sex, fatigue, stroke severity at admission and pre-stroke disability were added as covariates. Sixty-four participants (35 (54.7%) male), aged 75.9 (SD 8.6) years were included 4.3 (SD 2.8) days after stroke. There was no significant change in resilience from baseline 3.1 (SD 0.3) to 3 months later 3.2 (SD 0.5). Resilience was not associated with basic ADL in neither the bivariate (b = 2.01, 95% CI −5.21, 9.23, p = 0.580) nor in the multivariate regression models (b = 0.50, 95% CI −4.87, 6.88, p = 0.853). Our results showed that resilience remained stable during follow-up. Early measurement of resilience was not associated with independence in basic activities of daily living 3 months after stroke. These results, indicate that resilience is a personal trait not associated with the outcome of physical adversity. However, future research should investigate whether resilience is related to the outcomes of psychosocial adversity after a stroke.

Quality of life related to functional dependence, family functioning and social support in older adults.

to determine the relationship between quality of life and functional dependence, family functioning and social support in older adults in northeastern Mexico. this is a quantitative, descriptive and analytical study, with 205 older adults. The Barthel Index, Lawton and Brody Scale, APGAR test, Multidimensional Scale of Perceived Social Support and WHOQOL-BREF were applied. the physical, psychological and social dimensions of quality of life are related to functional capacity, family functioning and social support (p< 0.05). Functional capacity and social support predict physical and psychological quality of life. Basic activities, family function and social support predict social quality of life. Instrumental activities and social support predict environmental quality of life. quality of life depends on functional independence, family function and positive perceived health. Independence in basic activities and adequate social support improve physical quality of life. Being independent in basic activities and social support improve psychological quality of life. When presenting a decrease in independence in instrumental activities, perceived quality of life decreases.

Evaluation of improvement of functional independence in a multicentre cohort of rehabilitation outpatients with neurological conditions

Purpose The objectives were to examine: (1) the changes in independence in basic activities of daily living (ADL) following an outpatient occupational therapy (OT) intervention in people with neurological conditions; (2) the factors associated with good relative functional gain (RFG) and with good OT efficiency; (3) and the effects on instrumental activities of daily living (IADL) and caregiver assistance. Materials and methods A prospective observational study examining changes in a multicentre cohort (three urban hospitals). Ninety-eight adults were assessed on admission and after intervention. Barthel Index was the primary outcome (ADL). Results Acquired brain damage (ABI) was the most frequent diagnosis (84.7%). There was an improvement in ADL (p < 0.001); the effect size (r) was large (r = 0.59). RFG was good for 88.8% of participants. A good RFG was significantly associated with ABI, a lower number of hours of caregiver assistance, and a greater intensity of OT. The OT efficiency was good for 43.9% of participants. Factors significantly associated with good efficiency were being young and male patients, and receiving fewer hours of caregiver assistance. Secondary measures were improved: IADL (p < 0.001) and hours of caregiver assistance (p < 0.001). Conclusions This study suggests that the intervention is an effective approach to improve functional independence. Implications for rehabilitation Little is known about the outcomes of outpatient occupational therapy intervention in neurorehabilitation services for the adult population with neurological diseases. In a multicentre cohort of neurorehabilitation outpatients, the occupational therapy intervention can lead to improvements in the level of independence in basic and instrumental daily activities, as well as reducing the hours of caregiver assistance. A good relative functional gain is associated with acquired brain injury, a lower number of hours of assistance, and a greater intensity of occupational therapy. The factors associated with good efficiency are being younger, male patients, and receiving fewer hours of assistance.

Concurrent validity and responsiveness of Traffic Light System-BasicADL (TLS-BasicADL)

Purpose To test validity and responsiveness of Traffic Light System-BasicADL (TLS-BasicADL). Method Validity: Data according to TLS-BasicADL, modified Functional Independence Measure (FIM) and Barthel Index (BI) were collected from 50 patients with mixed medical diagnoses. Responsiveness: 106 patients following hip fracture assessed according to TLS-Basic ADL and modified Katz Index. Percentage change in TLS-BasicADL from pre-fracture status, to post-operatively, discharge and 1 month follow-up was calculated. TLS-BasicADL and modified Katz Index were also correlated at discharge and 1 month. For analysis of responsiveness, Spearman’s rho coefficient (rs) was used and for distribution at item level, percentage change and sign test. Results Validity: Strong-excellent correlations between TLS-BasicADL and modified FIM (0.65–0.95), TLS-BasicADL and modified BI (0.77–0.97) for individual items. Analysis of total scores revealed excellent correlations between instruments (0.96–0.98). Responsiveness: Significant differences between assessments for each item of TLS-BasicADL except upper hygiene, dressing and eating. Excellent correlation was found between TLS-BasicADL and modified Katz Index between pre-fracture – discharge (0.897) and moderate-strong (0.597) discharge − 1 month. Conclusion TLS-BasicADL is shown to have acceptable concurrent validity for measuring basic mobility and self-care in elderly patients with mixed medical diagnoses and responsive for patients following hip fracture surgery. Trial registration Investigation of responsiveness is registered in ClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017). KEYPHRASES Traffic Light System-BasicADL (TLS-BasicADL) provides a simple assessment scale that highlights level of independence in basic activities of daily living. TLS-BasicADL gives the multi/inter-disciplinary team a baseline showing the persons previous and present level of function and visual aid for discussing rehabilitation goals and need for future care. TLS-BasicADL is shown to have acceptable concurrent validity for measuring basic mobility and self-care in elderly patients with mixed medical diagnoses and responsive for patients following hip fracture surgery.

Functional capacity, risk of falling and chronic pain in older adults during the COVID-19 pandemic: a telemonitoring study

OBJECTIVE: To compare active and sedentary older adults regarding functional capacity, risk of falling, and chronic pain in a population assisted by telemonitoring during the pandemic lockdown. METHODS: This analytical, cross-sectional study included 104 older adults who were telemonitored during the COVID-19 lockdown by a team from a Brazilian Unified Health System outpatient clinic specializing in geriatrics and gerontology. A structured interview was used to collect data. Following normality testing with the Shapiro-Wilk test, Student’s t-test was used for group comparisons. Associations were analyzed using the χ2 test, and the odds ratio was calculated in a 2x2 table of sedentarism and falls in the last six months. The data were analyzed using SPSS version 26.0, with p ≤ 0.05 considered significant. RESULTS: The 57 active older adults had a lower rate of continuous medication use (24.84 vs 27.62%), fewer falls (50 vs 32.11%), less pain (12.31 vs 3.83%), and greater independence in basic activities of daily living (44.39 vs 26.46%). CONCLUSIONS: Older adults who were physically active in the midst of social distancing had better functional capacity in basic activities of daily living, fewer falls, and less pain than their sedentary peers. Independence in instrumental activities of daily living did not differ significantly between the groups.

Predictive factors of functional independence in basic activities of daily living during hospitalization and after discharge of stroke patients

ABSTRACT Objective: The aim of this study was to identify the predictive factors of functional independence in the basic activities of daily living during hospitalization, on the 10th and 28th day after stroke. Methods: A total of 433 patients (204 men and 229 women) took part. Functional independence data were collected using the Step 1 from an instrument called Stepwise. Analysis was conducted by logistic regression. Results: Due to the OR values below 1.0 we can verify that the age of 59 years or less and the presence of physiotherapy in the hospital were protective factors of functional independence. Other predictive factors were the number of stroke risk factors (bathing: OR = 0.4; p = .005, transfer: OR = 0.487; p = .025), the amount of medication used before stroke (bathing: OR = 1.7; p = .013), sex (grooming: OR = 1.6; p = .026); type of stroke (continence: OR = 2.2; p = .003–10th day; OR = 1.9; p = .013–28th day), previous strokes (eating: OR = 0.5; p = .036). Conclusions: According to the results, the risk of impaired functional independence decreased in bathing and eating and increased for dressing, grooming and transfer during clinical recovery suggesting the need for greater therapeutic intervention in different basic activities of daily living.

Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial.

Background:Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit.Methods:This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge.Results:There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001).Conclusions:N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.

Analyzing functional status and its correlates in Chinese centenarians: A cross‐sectional study

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.

FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

Determinants of ADL and IADL disability in older adults in southeastern Poland

BackgroundThe extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland.MethodsThis cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined.ResultsThe research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47).ConclusionsThe study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.

Impact of loss of independence in basic activities of daily living on caregiver burden in patients with Alzheimer's disease: A retrospective cohort study.

To investigate the association between decline of basic activities of daily living (ADL) in each dimension and change in caregiver burden in patients with mild-to-moderate Alzheimer's disease. This retrospective study included 117 outpatients with Alzheimer's disease who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology in Japan between September 2010 and April 2014 (mean age 77.3 ± 6.4 years; 68.6% women). Patients and their caregivers completed comprehensive geriatric assessment at baseline and at the 3-year follow up. Caregiver burden was assessed using the Japanese version of the Zarit Burden Interview. ADL were assessed by the Barthel Index. Among patients with full points on each subitem of the Barthel Index at baseline, incident ADL decline was defined as a loss of at least 5 points at the 3-year follow up. Other confounding factors including demographic data, cognitive function, vitality, and behavioral and psychiatric symptoms of dementia were also assessed. The longitudinal relationship between incident ADL decline and changes in caregiver burden was evaluated by multivariate linear regression, adjusted for confounding variables. In descending order, declines in ADL at 3 years were noted in bathing (25.4%), bowel control (25.4%), grooming (22.9%) and bladder control (22.9%). On multivariate analyses, ADL declines in feeding (b = 17.2, P < 0.01) and bathing (b = 11.0, P = 0.02) were significantly associated with increased caregiver burden. Incident ADL declines in feeding and bathing are significant risk factors for increased caregiver burden in patients with Alzheimer's disease. Geriatr Gerontol Int 2019; 19: 1243-1247.

Well-Being, Self-Efficacy and Independence in older adults: A Randomized Trial of Occupational Therapy

ObjectiveThe main objective of the research was to analyze whether there were differences in the effects of individual and group occupational therapy (OT) treatment on psychological well-being, self-efficacy and personal independence. MethodA randomized clinical trial (N = 70; age = 85 years, SD = 4) comparing individual versus group occupational therapy treatment for 6 months was conducted. The evaluation was performed with the Barthel Index (Personal Independence), the Ryff Wellness Index (Well-being), the Global Self-Efficacy Scale (Self-efficacy) and the Geriatric Depression Scale (Affective state Scale). ResultsResults showed a decrease in individual treatment scores in the variables autonomy, environmental mastery, personal growth and purpose in life, reflecting worse self-acceptance and negative well-being as well as a lower ability to maintain stable relationships. By contrast, group treatment users maintained more stable social relationships and exhibited a greater ability to resist social pressure, to develop their potential skills and to define their goals in life. There were statistically significant differences in overall self-efficacy (p < 0.001), emotional well-being (p < 0.001) and personal independence (p = 0.013), with better scores in group versus individual treatment. ConclusionsGroup occupational therapy interventions in older adults could be the treatment of choice in people with depressed state, improving their emotional well-being, sense of self-efficacy and level of personal independence in basic activities of daily living.

Prevalence and factors associated with cognitive impairments in the elderly of charity asylums: a descriptive study.

The current transversal and descriptive study evaluates the prevalence and factors associated with cognitive liabilities in a sample of 98 elderly people residents of philanthropic institutions. The sociodemographic and clinical data were retrieved from the patients´ clinical charts. The cognition was assessed by the Mental State Mini-Exam, while the maintenance of independence regarding basic activities (such as bathing, putting on clothes, and others) was evaluated using the Katz Index. The Short Physical Performance Battery exam assessed their physical performance. Non-parametric tests were employed for the statistical analysis. Cognitive impairment was registered in 27.6% of the elderlies and was not associated with sociodemographic variables, independence in basic activities, and physical performance. We verified a high prevalence of endocrine diseases, mental disorders, and psychiatric treatment in the elderlies with cognitive impairments. The percentage of elderly with cognitive alterations is similar to those found in the literature. We identified no significant risk factors associated with cognition among the evaluated variables.

Executive functioning and daily living of individuals with chronic stroke: measurement and implications.

Deficits in executive functioning (EF) are often still present at the chronic stage after stroke, which may negatively impact independent living. The objectives of this study were (a) to characterize the EF and independence in daily living of community-dwelling individuals with chronic stroke by using pen-and-paper and performance-based EF assessments, (b) to explore correlations between scores detected by different EF assessments and (c) to assess the correlations between EF and independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL). This cross-sectional study included 50 (30 men and 20 women) community-dwelling individuals [mean (SD) age 59.8 (9.3)] with chronic stroke. Participants were overall independent in basic activities of daily living, without significant cognitive impairment. Participants underwent EF assessment using two pen-and-paper tools: Trail Making Test, Zoo Map subtest from the Behavioral Assessment of Dysexecutive Syndrome and two performance-based tools; EF Route-Finding Task and bill-paying subtest from the Executive Functions Performance Test. BADL, IADL, depressive symptoms, gait speed and upper extremity motor impairment were also assessed. Participants demonstrated mild to moderate EF deficits with moderate significant correlations between the scores of various EF assessments. Participants varied in their independence in IADL, and EF was significantly correlated to independence in BADL and IADL (-0.31<r<0.48; -0.37<r<-0.42; P<0.05, respectively, depending on the assessment). EF deficits with varying severity are still present at the chronic stage after stroke among independent community-dwelling individuals. These findings can guide the choice of an appropriate assessment tool for the specific needs of individuals with chronic stroke.

A Comparison of the Relation of Depression, and Cognitive, Motor and Functional Deficits in Chronic Stroke Patients: A Pilot Study

Aim and background: One of the most important psychological disorders after stroke is depression, which leads to reduced quality of life, optimal rehabilitation failure, loss of cognitive tasks and decrease in the recovery process. In this research, relation between patterns of depression and cognitive, motor and function deficits in people with chronic stroke was studied. Methods and materials: In a pilot cross-sectional study, 40 patients with chronic stroke (more than 6 months) were enrolled. Depression (Beck Depression Inventory), cognition (attention test TMT-A &amp; B and Wechsler memory), motor (Motorcity index), basic activities of daily living (Barthel scale) and instrumental activities of daily living (Lawton scale) were evaluated. Results: The results of the study revealed a significant positive correlation between post stroke depression and verbal memory (r=0.440،P&lt;.05), attention (r=0.615،P&lt;.05), motor function(r-0.368،P&lt;.05), independence in basic activities of daily living (r=0.781،P&lt;.05) and instrumental activities of daily living (r=0.741, P&lt;.05). Conclusion: According to the findings, further studies of factors affecting post stroke depression (PSD) clinical and practical aspects are necessary. Cognitive rehabilitation programs with motor rehabilitation can decrease depression and gain independence in activities of daily living and more participation in society activities.

Elder abuse within the family environment in the Azores Islands

ABSTRACTObjectives:to dimension abuse against vulnerable adults within the family and community environment in the Azores Islands, identify risk factors for abuse and describe the profile of an abused elder. Method:descriptive cross-sectional study. Random sampling. The instruments used were: clinical histories of the users, Mini-Mental State Examination, Index of Independence in Basic Activities of Daily Living, Family APGAR Scale, Elder Abuse Suspicion Index and Social Work Assessment Form. Descriptive statistical analysis was used for qualitative and quantitative variables and multiple logistic regression was used to identify factors associated with elder mistreatment. Results:abuse suspicion was identified in 24.5% of elderly participants. Psychological abuse was the most common type of abuse and sons were the main abusers. Conclusion:being a woman and belonging to a dysfunctional family is associated with an increased risk of becoming a victim of abuse; the high level of domestic violence against the elderly in the Azores Islands is in line with the rest of Portugal.

The impact of malnutrition on health outcomes and healthcare cost among Chinese older adults

Objective This study used multivariate regression analysis to study the prevalence of malnutrition and the impact of malnutrition on independence in activities of daily living, health outcomes, chronic disease and healthcare cost among older Chinese adults. Methods This study was based on data from the 2013 China Health and Retirement Longitudinal Survey(CHARLS). The CHARLS data covers information on demographics, family, health status and functional limitations, health insurance, employment and earnings among mid-aged and older community-dwelling Chinese.This research focused on older Chinese adults aged 60 years and over.As a result, over 5, 900 subjects were included.This study defined malnutrition based on body mass index, weight loss and reduced handgrip strength.Functional status was assessed via adapted versions of the Katz index of independence in basic activities of daily living(ADL)and the Lawton-Brody index of independence in instrumental activities of daily living(IADL). Health outcomes included self-reported health status.Then multivariate regression analysis was used to investigate the relationship between malnutrition and various health outcomes. Results Thirty percent of older Chinese adults were malnourished.Malnutrition was associated with significantly lower IADL(OR=0.868, P<0.05), poorer health status(OR=0.675, P<0.001), as well as higher probability of having stroke(OR=1.399, P<0.05)and chronic stomach disease(OR=1.241, P<0.001). As a significant contributor of poorer self-reported health status, malnutrition, in turn, increased hospital cost by ￥214(14% increase, P<0.01)per person per year. Conclusions Malnutrition leads to functional limitations and worse health outcomes among community-dwelling older Chinese adults.These results imply that nutrition interventions such as nutrition screening and assessment, making scientific and personal nutrition support plans, and providing timely adequate nutrition support therapy can improve the health status and lower the healthcare cost of older adults living in the community. Key words: Malnutrition; Health outcomes; Activities of daily living