Indicator Of Functional Status Research Articles

Factors associated with home environmental problems among community-living older people

Purpose : This paper describes the types of difficulties older people have with their home environments and the factors associated with having such difficulties. Method : Data were used from 296 study participants of the University at Buffalo's Consumer Assessments Study that examines the home modification needs and environmental difficulties of older people. A combination of socio-demographic variables, health and functional status indicators and measures of psychosocial well-being were used to predict environmental problems. Results : An average of 13 problems with the environment that posed as a barrier to safe and independent performance was observed in homes. It was found that most difficulties occurred in bathrooms, kitchens, bedrooms and access to entryways and rooms. Hierarchical multiple regression analysis showed that having home environmental problems was most strongly associated with younger age, being female, being of minority status, having pain, and greater physical disability. Conclusion : The findings show that a combination of conditions that include demographic and functional conditions place older people at risk for problems with the home environment that impede performance of daily living activities.

Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy

Treatment-related factors that influence quality of life (QOL) for women who are diagnosed with breast carcinoma require study. This study was designed to examine the convergent validity of objective and subjective indices of cosmetic and functional status after patients undergo breast-conserving treatment (BCT) and to test the relations of the objective indicators with QOL. Women (n = 54 patients) who had received BCT and radiotherapy for Stage 0-II disease for whom the diagnosis duration ranged from 9 months to 18 years completed assessments of background information, perceived cosmetic and functional outcomes, and QOL. They also were administered a clinical breast examination, including objective ratings of arm edema and breast cosmesis. The patients were a subsample from the study reported by the authors in an accompanying article that is presented in this issue. The findings revealed positive cosmetic and functional treatment outcomes, such that 82% of patients had no or minimal arm edema, and 70% of patients evidenced good or excellent cosmetic results. Convergent validity was demonstrated for the objective and subjective assessments of cosmetic and functional treatment outcomes. In addition, women who had more arm edema reported poorer QOL with regard to depressive symptoms (P < 0.05) and fear of disease recurrence (P < 0.05). The findings from this study and those reported in the accompanying article reveal that functional treatment outcomes, such as arm edema and breast specific pain, are important correlates of QOL even many years after patients undergo BCT and radiotherapy. Both subjective and objective indicators of treatment outcomes are useful predictors of QOL.

Functioning and well-being at 24 weeks postpartum of women with postnatal depression

Background: Postnatal depression, an episode of major depression occurring within six months postpartum, occurs in 10–15% of mothers. Previous research has focussed on prevalence, risk factors, treatment, and impact, with little emphasis on assessment of functioning and well-being in women with this depression. Our aim was to examine the effect of postnatal depression, age, and parity on eight indicators of functional status, using the SF-36 self-report questionnaire, at 24 weeks postpartum. Methods: The study used a prospective cohort design. 424 postpartum women, recruited from Nepean, Cowra, Dudley and Orange Hospitals (New South Wales, Australia) completed questionnaires assessing functioning and well-being (SF-36), and postnatal depression (EPDS). Results: Compared to age-appropriate Australian normative data, women with postnatal depression (n = 54, 12.7%) were impaired on five of eight SF-36 dimensions at twenty four weeks postpartum (i.e. Role Limitations due to Physical and Emotional Problems, Social Functioning, Mental Health, and Vitality), while women without this depression (n = 370) were impaired on two dimensions only (i.e. Role Limitations due to Emotional Problems and Vitality). Women with and without postnatal depression differed on six SF-36 dimensions (i.e. Role Limitations due to Physical and Emotional Problems, Social Functioning, Bodily Pain, Mental Health, and Vitality). Role Limitations due to Physical Problems were more impaired in depressed first-time than multiparous mothers, with no parity difference for women without postnatal depression. Conclusion: Some declines in functioning and well-being are associated with the postpartum period generally, but postnatal depression detrimentally effects other specific aspects of the postpartum women's functional status.

Functional Status and Survival Following Pulmonary Rehabilitation

Functional exercise capacity has been shown to be a strong predictor of survival following pulmonary rehabilitation. This study evaluated whether questionnaire-rated functional status is also predictive of survival. Following pulmonary rehabilitation, patients with advanced chronic lung disease were evaluated for survival, 6-min walk distance, and questionnaire-rated functional status. The latter was measured using the pulmonary functional status scale, which has subscores of functional activities, psychological status, and dyspnea. Information on survival was available on 149 patients. The mean age was 69 years, and 45% of patients were male. Eighty-nine percent had a diagnosis of COPD, and their FEV(1) was 37+/-18% of predicted. Ninety-one (61%) were married. The 3-year survival for the group was 85%. Age, gender, body mass index, and primary diagnosis were not related to survival. Variables strongly associated with increased survival following pulmonary rehabilitation included a higher postrehabilitation Functional Activities score, a longer postrehabilitation 6-min walk distance, and being married (vs widowed, single, or divorced). Disease severity variables associated with survival included an initial referral to outpatient pulmonary rehabilitation, no supplemental oxygen requirement, and a higher percent-predicted FEV(1). Indicators of functional status are strong predictors of survival in patients with advanced lung disease.

Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument.

Acute illness causes considerable morbidity and mortality in nursing home residents but is often difficult to recognize early. Nursing assistants often notice early signs of acute illness but do not methodically document or communicate their observations with medical staff. To enhance nursing assistants' observation and documentation of signs of acute illness by developing a validated, standardized instrument for communication with medical staff. Observational cohort study. Urban not-for-profit nursing home. Candidate instrument items were generated in focus group interviews with nursing home staff. Twenty-three nursing assistants completed the instrument on 74 nursing home residents over 4 weeks. Acute illness, the primary outcome, was identified by nurse report and chart review and determined according to preset criteria. Predictive validity was assessed by determining the relationship between instrument responses and development of acute illness within 7 days. Interobserver agreement was calculated between morning and afternoon nursing assistants' responses. Convergent validity was assessed by comparing instrument responses with three standard status indicators. The instrument consisted of 12 items that assessed behavioral and functional status changes. Residents with an instrument-recorded change were more likely to develop an acute illness within 7 days than those with no change (risk ratio 4.1, 95% confidence interval 2.6, 6.3). A final five-item instrument had a sensitivity of 53% and a specificity of 93% for acute illness. Nursing assistants' documentation of signs of illness preceded chart documentation by an average of 5 days. Interobserver agreement between morning and afternoon nursing assistants was 76%. Correlation of responses with standard indicators of functional, mental, and global status was high. A new instrument developed for nursing assistants to document behavioral and functional status changes in nursing home residents demonstrates fair sensitivity and high specificity for acute illness. Close monitoring of patients with a positive instrument might avert morbidity and mortality from acute illness by allowing earlier treatment.

The factor structure of the behavioral rating scale and its relationship to indicators of functional status

The factor structure of the behavioral rating scale and its relationship to indicators of functional status

Subjective health and health behavior of children and adolescents--a survey of Hamburg students within the scope of school medical examination

The subjectively perceived health of children and adolescents has received little attention in Public Health research so far. In co-operation with school physicians of Hamburg, Eimsbuettel, 1,501 children and adolescents (grades 4 and 8, as well as their parents) were questioned with regard to health-related quality of life and health behaviour, using among others the short form of the KINDL Quality of Life Questionnaire and established psychosocial instruments. High values in the KINDL scale were found in 75% of the students, the mean value of the 0-100 transformed KINDL total scale was around 80. Adolescents--and in this group specifically the girls--reported significantly lower quality of life scores. Psychosocial strain, presence of disease and school absenteeism were negatively associated with quality of life ratings. Health-related behaviours in terms of resources in the area of food intake and risk behaviours in terms of addiction, obesity and stressors correlated with subjective health as expected. In multiple regressions these factors explained 20% of the KINDL-score variance in the total group. Taking into account indicators of functional status and life satisfaction, the percentage of explained variance increased to over 50%; here these predictors yielded a correct classification of high vs. low self-reported quality of life in 90% of the cases. The study shows that subjective health is a methodologically adequate and scientifically interesting indicator which in the public health area can be used in epidemiological research, in health reporting and in school physicians' practice to identify young persons with quality of life impairments in order to provide early and in-focus support to this group.

Comparison of usefulness between exercise capacity and echocardiographic indexes of left ventricular function in cardiac amyloidosis

In patients with primary systemic amyloidosis (AL), the echocardiographic assessment of ventricular function alone does not always correspond to patients’ symptoms and functional status. Peak oxygen uptake and anaerobic threshold (AT), in contrast, constitute 2 objective, reliable and reproducible indicators of functional status in patients with circulatory failure. Thirty-two consecutive patients (mean age 50 ±13 years) with histologic evidence of systemic primary AL were studied (29 AL, 3 hereditary). There were 16 with echocardiographic features of cardiac infiltration (group I) and 16 without (group II). Twenty age- and gender-matched healthy subjects were also studied for comparison. Of the 32 patients, 12 were in New York Heart Association functional class I, 9 were in class II, and 11 were in class III. Each subject underwent 2-dimensional and Doppler echocardiography and cardiopulmonary exercise testing using a modified Bruce protocol. Left atrial (LA), left ventricular (LV) dimensions, wall thickness, and LV fractional shortening, as well as transmitral flow velocities and their E/A ratio were measured. Peak oxygen consumption (VO 2max [ml/kg/min]), AT (ml/kg/min), and exercise duration (seconds) were also measured. VO 2max and AT were lower in patients with AL than in controls (20.8 ± 7.0 vs 35.0 ± 8.5, p <0.001 and 13.1 ± 3.7 vs 27.0 ± 4.2, p <0.001, respectively). As a group, symptomatic patients had lower VO 2max, AT, and exercise duration than those without symptoms (17.1 ± 3.6 vs 27.0 ± 6.9, p = 0.0001, 11.1 ± 2.1 vs 16.2 ± 3.6, p = 0.0001, and 489 ± 235 vs 843 ± 197, p = 0.0001, respectively), whereas LV dimensions only showed a small difference (p = 0.03). VO 2max, AT, and exercise duration of patients in functional class I were higher than those in functional classes II and III (p = 0.01, p <0.05, and p = 0.007, respectively). Asymptomatic patients had lower VO 2max, AT, and exercise duration than controls (p <0.0001). VO 2max, AT, and exercise duration were poorly related to LA diameter, LV dimensions, fractional shortening, wall thickness, peak velocities of E and A waveforms, and E/A ratio. Patients with VO 2max >15 ml/kg/min had a better survival than patients with VO 2max <15 ml/kg/min. Thus, in patients with primary systemic AL, cardiorespiratory exercise testing is the preferred way of assessing functional capacity. Echocardiographic Doppler indexes at rest are not predictive of a patient’s symptoms and exercise capacity. Furthermore, VO 2max is a strong independent predictor of survival in these patients.

Abnormal folate metabolism and mutation in the methylenetetrahydrofolate reductase gene may be maternal risk factors for Down syndrome

Down syndrome, or trisomy 21, is a complex genetic disease resulting from the presence of 3 copies of chromosome 21. The origin of the extra chromosome is maternal in 95% of cases and is due to the failure of normal chromosomal segregation during meiosis. Although advanced maternal age is a major risk factor for trisomy 21, most children with Down syndrome are born to mothers <30 y of age. On the basis of evidence that abnormal folate and methyl metabolism can lead to DNA hypomethylation and abnormal chromosomal segregation, we hypothesized that the C-to-T substitution at nucleotide 677 (677C-->T) mutation of the methylenetetrahydrofolate reductase (MTHFR) gene may be a risk factor for maternal meiotic nondisjunction and Down syndrome in young mothers. The frequency of the MTHFR 677C-->T mutation was evaluated in 57 mothers of children with Down syndrome and in 50 age-matched control mothers. Ratios of plasma homocysteine to methionine and lymphocyte methotrexate cytotoxicity were measured as indicators of functional folate status. A significant increase in plasma homocysteine concentrations and lymphocyte methotrexate cytotoxicity was observed in the mothers of children with Down syndrome, consistent with abnormal folate and methyl metabolism. Mothers with the 677C-->T mutation had a 2.6-fold higher risk of having a child with Down syndrome than did mothers without the T substitution (odds ratio: 2.6; 95% CI: 1.2, 5.8; P < 0.03). The results of this initial study indicate that folate metabolism is abnormal in mothers of children with Down syndrome and that this may be explained, in part, by a mutation in the MTHFR gene.

Equivalent effects on functional status and hematologic indicators of epoetin alfa in patients (PTS) treated with platinum (P) or non-platinum (NP) chemotherapy (CT) regimens independent of disease response

Equivalent effects on functional status and hematologic indicators of epoetin alfa in patients (PTS) treated with platinum (P) or non-platinum (NP) chemotherapy (CT) regimens independent of disease response

Circadian rhythms of salivary electrolytes as an indicator of functional status during professional activity

Circadian rhythms of salivary sodium and potassium were studied during a week in subjects engaged in heavy physical and intellectual work. A decrease in the content of salivary sodium did not depend on the type of work but on its difficulty and intensity. The amplitude of daily fluctuations and the index of daily adaptation, which were decreased in both professional groups in comparison with the norm, were the informative parameters of rhythms for the diagnosis of functional status. By the end of the week, the rhythm of salivary sodium excretion was disordered and the strain of regulatory system increased.

Functional status and health service planning.

Functional status indicators have been proposed as instruments to aid health service planning for patients. This study examines functional status at three points surrounding an acute health episode: admission, discharge and 3 months post discharge from a community hospital. The aim of the study is to determine the most appropriate time to measure functional status to assist health service planning. A longitudinal cohort study was conducted at Manly Hospital, Australia. Four hundred patients aged 65 years and over representing a 10% random sample of all hospital admissions in a 10-month period were interviewed on admission, discharge and 3 months post discharge. Repeated measure multiple analysis of variance identified a decline in functional status between admission and discharge. At 3 months post discharge functional status had improved to levels higher than admission. Functional status assessment at discharge can assist consumers, clinicians, health planners and health insurers to make effective decisions to maximize health outcomes.

The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older

Purpose: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older. Methods: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision. Results: Of the respondents, 27% rated their vision as fair or poor, whereas 25% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function. Conclusions: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

Consequences of MRSA carriage in nursing home residents.

A prospective cohort study with 1 year follow-up evaluated the relation between MRSA carriage and mortality, likelihood of hospitalization and functional status in residents of a nursing home for the elderly. Included were all 447 residents living in the home in early June 1994. From all patients, swabs were taken from nose, throat and perineum. Additional swabs (sputum, urine or wounds) were taken when indicated. The relative risk (RR) of dying within 6 months in MRSA carriers compared to non-carriers was 2.29 (95% CI = 1.04-5.04). This RR remained stable (1.57-2.40) after adjustment for co-variables using Mantel-Haenszel stratified analysis. After I year, the RR was reduced to 1.30 (95% CI = 0.65-2.58). Univariate survival analysis confirmed a difference in survival between carriers and non-carriers after 6 months (log-rank P = 0.04) and no difference after 1 year. Cox regression analysis resulted in a hazard ratio for dying within 6 months of 1.73 (95% CI = 0.72-4.17). No relation was found between carriage and either likelihood of hospitalization or indicators of functional status. These results are compatible with a possible relation between 6 months mortality and MRSA carriage in nursing home patients. It calls for a large scale, multicentre cohort study in order to either confirm or refute these findings.

The associations between self-rated vision and hearing and functional status in middle age

Objectives To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans. Design Cross-sectional. Participants A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated. Methods Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed. Main outcome measure A global index of functional status based on self-reported limitations in 17 activities was measured. Results Approximately 3% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke. Conclusions Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

Diagnosis and detection of vitamin deficiencies.

Vitamin deficiencies can be detected in several ways, none of which is entirely unambiguous. Evidence of several types is, therefore, required. For instance, it is rare for clinical signs to result from a single cause, except in controlled experiments. Natural diets are rarely deficient in only a single nutrient, and individual requirements vary considerably. Biochemical and functional status indices can help bridge the gap between inadequate diet and resulting pathology. Some indices are very specific for individual vitamins; others, although only semi-specific, are useful if closely linked to tissue malfunction and hence to pathology. Ideally, biochemical indices should separate severe deficiency, mild subclinical deficiency, normal status and overload toxicity. Vitamin concentrations in plasma, serum, red cells, urine, and other accessible tissues have been used, and metabolic products of vitamin-dependent metabolic pathways have been exploited. However, many of the assays are difficult to perform and interpret, and are limited to few laboratories, world-wide. There is a need for simpler and more 'portable' tests, for routine laboratories and for the medical profession.

Dietary implications of oral health decrements among African‐American and white older adults

Objective. Older African‐Americans are at disproportionate risk of chronic, nutritionally‐related diseases. To begin to understand factors that may contribute to the disproportionate prevalence of life‐threatening illnesses among African‐Americans, this study investigates ethnic differences in the prevalence of oral health decrements. Design. The Florida Dental Care Study (FDCS), a longitudinal study of changes in the oral health of 873 subjects age 45 +, was used to explore a broad range of oral health status differences between African‐American and White adults in the United States. The FDCS consists of clinical and self‐reported measures of oral health, sociodemographic information, and other indicators of oral functional status. Results. The prevalence of oral health decrements in this sample using a broad range of clinical and self‐reported measures was substantial. African‐American elders were at a heightened risk of poor oral health profiles, including having fewer teeth and being more likely to have a carious surface, fractured cusp or incisai edge, severely mobile teeth and severe periodontal levels than their White counterparts. Furthermore, the African‐American respondents in our sample were significantly more likely to report a lower self‐rated oral health and functioning than their White counterparts. These findings persist regardless of poverty status or educational level, two factors commonly thought to confound racial differences in health outcomes. Conclusion. Our study provides evidence that the widespread prevalence of oral health decrements and accompanying functional disability among this sample of dentate older adults impacts their daily lives. Of particular concern is the oral health status of older African‐Americans who may be nutritionally vulnerable due, in part, to these oral health decrements and disabilities. We suggest enhancing the access of health services in order to prevent those oral health decrements that presumably undermine adequate dietary intake.

The role of objective health indicators and neuroticism in perceived health and psychological well-being among patients with chronic heart failure

A total of 119 clinically stable patients with symptomatic congestive heart failure (34 females, 85 males) were recruited from an outpatient hospital practice to explore the role of objective health indicators and neuroticism in subjective health (physical limitations) and psychological well-being. Patients were grouped according to the New York Heart Association functional class criteria (NYHA: indicator of functional status) and proatrial natriuretic factor (proANF), a cardiac hormone that maintains normal fluid balance and vascular resistance. Scores on these two objective indicators of disease severity were generally unrelated to psychological measures, whereas neuroticism scores (EPQ-N) were significantly correlated with indicators of subjective health (perceived disease-related physical limitations) and psychological well-being (depression, general life-satisfaction). Significant interactions between proANF and neuroticism appear due to low physical limitation score among subjects with elevated level of proANF and low scores on neuroticism. High physical limitation was reported by subjects with high level of proANF as well as high scores on neuroticism. Moreover, a marginal significant interaction between NYHA and EPQ-N scores in relation to severity of depression was detected by analyses from two-way ANOVA. Gender differences were due to higher proANF scores in males than females, whereas females scored higher than males on EPQ-N, perceived physical limitation and depression. Results from path analyses supported an indirect effect of neuroticism via perceived physical limitation for males. Possible mechanisms involved in these relations are discussed.

The structure of health status among Hispanic, African American, and white older adults.

Activities of daily living (ADLs), instrumental ADLs, and disability markers have traditionally been the most common indicators of functional status. The study on Asset and Health Dynamics Among the Oldest Old (AHEAD) is used to replicate a five-dimensional measurement model composed of these observable indicators among the older adult self-respondents. The items available to measure upper body disability were found wanting, but the lower body disability, and the basic, household, and advanced ADL constructs were confirmed. Analyses of the measurement model separately among subgroups of women, men, Hispanics, Mexican Americans, African Americans, and Whites found no meaningful differences. Two structural models linking the lower body disability, and the basic, household, and advanced ADL constructs to perceived health and depression were also replicated among the older adult self-respondents, as well as separately among African Americans and among Whites. These models reaffirmed the dominant role of lower body disability on the everyday activities of older adults, and on their perceived health and depression.

Psychometric validation of the revised Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) quality of life instrument.

The revised Functional Assessment of Human Immunodeficiency Virus Infection (FAHI) quality of life (QoL) instrument has been updated and expanded to provide more complete and accurate coverage of human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related QoL. Factor analysis and the Rasch measurement model were used to determine a new subscale structure for the FAHI. The content of these subscales, including physical well-being (ten items, alpha = 0.91), function and global well-being (13 items, alpha = 0.86), emotional well-being/living with HIV (10 items, alpha = 0.82), social well-being (eight items, alpha = 0.73), and cognitive functioning (three items; alpha = 0.75), reflect both general illness- and HIV/AIDS-specific QoL concerns: a total QoL score can also be calculated for the FAHI (44 items, alpha = 0.91). Psychometric evaluation revealed good internal consistency reliability for the FAHI and its subscales. In addition, construct validity, known groups validity and sensitivity to change were demonstrated by significant associations between the FAHI and additional indicators of functional status, psychological symptoms, stress and illness severity. In summary, the FAHI is a psychometrically sound instrument that captures multiple important dimensions of HIV/AIDS-related QoL. It is brief, easy to administer and score, has been translated into nine languages other than English and is appropriate for use in clinical trials and clinical practice.