Instrumental Activities Of Daily Living Ability Research Articles

Latent Classification Analysis of Leisure Activities and Their Impact on ADL, IADL and Cognitive Ability of Older Adults Based on CLHLS (2008-2018).

This study aimed to research the trajectory of leisure activity and the health status of older adults and analyze the effects of leisure activity on the health status of older adults. Based on the longitudinal data of CLHLS (2008-2018), the latent growth curve model (LGCM) was used; we found that the leisure activities (LA), activities of daily living (ADL) ability, instrumental activities of daily living (IADL) ability, and cognitive ability (COG) of older adults show a nonlinear downward trend over time. Furthermore, the panel binary regression analysis is used to find that leisure activities have significant inhibitory effects on ADL disorder, IADL disorder, and cognitive impairment in the older population. In addition, by using latent profile analysis (LPA), the older population is classified into three groups according to the homogeneity of the older adults' choice of leisure activities, namely the types of relaxation, entertainment, and intellectual-learning, respectively. Based on the classification results, the analysis of one-way ANOVA shows that the rates of ADL disorder, IADL disorder, and cognitive impairment of older adults with different types are significantly different. Moreover, the inhibitory effect of leisure activities on the rate of ADL disorder, IADL disorder, and cognitive impairment of older adults is more significant in the middle-aged and high-aged groups. Therefore, older adults should be encouraged to increase leisure activities, especially those who are middle-aged and high-aged.

Performance-Based vs Informant-Reported Instrumental Activities of Daily Living in Predicting Dementia.

Identifying individuals at risk of developing dementia may be aided by early detection of functional impairments. The aims of the present study were to examine differences in informant-reported and performance-based measures of instrumental activities of daily living (IADL) and to assess whether a performance-based IADL measure contributes additional unique variance over informant reports in predicting incident dementia over 4years. Prospective cohort study (Sydney Memory and Ageing Study). Eastern Suburbs, Sydney, Australia. 307 community-dwelling individuals (60.6% female) aged between 76 and 96years with normal cognition (NC; n= 190) or mild cognitive impairment (MCI; n= 117). IADL ability was assessed with the performance-based Sydney Test of Activities of Daily Living in Memory Disorders (STAM) and the Bayer-Activities of Daily Living (B-ADL) informant report, at baseline and 4-year follow-up. Covariates included age, sex, education, Mini-Mental State Examination and Geriatric Depression Scale scores, arthritis, vision impairment, cardiovascular risk, and number of medications. Logistic regressions were conducted to examine the longitudinal association between the 2 types of IADL measures and incident dementia. Logistic regressions showed that performance-based IADL impairment at baseline [odds ratio (OR)= 0.83, 95% confidence interval (CI) 0.77, 0.90; P < .001] and decline in performance-based IADL function (OR= 0.82, 95% CI 0.73, 0.91; P < .001) were associated with incident dementia over 4years, with the association provided by the STAM being statistically significant over and above the B-ADL. Performance-based measures of IADL can predict progression to dementia over 4years beyond that provided by an informant report of IADL. Performance-based IADL measures are promising tools for clinical practice to identify individuals at greater risk of developing dementia.

The impact of HCBS use patterns on older aduts’ physical function among continuous service users

Background Taiwan, one of the fastest aging countries in the world, provides home-and community-based services (HCBS) care recipients through the second 10-Year Long-Term Care Plans (LTC Plans 2.0). The current study aimed to examine the impact of continuous use of HCBS offered by LTC plan 2.0 on older adults’ physical function change overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 157,682 clients who had applied for and were evaluated for LTC services for the first time from 2018 through 2020 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were measured by activities ofdaily living (ADLs) and instrumental activities of daily living (IADLs) between baseline assessment and the assessment after the six months of serivce utilization. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 111,976; 71.01%), professional care services (n = 31,584; 20.03%), and community care services (n = 14,122; 8.96%) were identified. When compared to care recipients in the community care group, those in the home-based PC group improved more in IADL scores, and the professional care group improved more ADL scores. Conclusion Those receiving more professional services made more progress in ADL ability, but those in home-based PC made more progress in IADL ability.

Association of Instrumental Activities of Daily Living, Physical Function, and Mental Health among Older Returnees after the Fukushima Daiichi Nuclear Power Station Accident.

The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20–30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson’s product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.

Mediating role of instrumental activities of daily living ability on cognitive function of older adults living alone: A 4-year longitudinal study from the Kasama study.

The aim of this study was to clarify the effect of living alone on the cognitive function of older people and the mediating effect of instrumental activities of daily living (IADL) ability.The data for a final sample of 3276 participants aged 65 years and above who did not require long-term care at the baseline were used from a 4-year prospective cohort study conducted in Kasama City, Japan. Demographic data including age, sex, and depression at baseline were used as covariates. The Kihon checklist evaluated the IADL ability at baseline and cognitive function at follow-up. The characteristics of those living alone and with others were compared using the student t test and χ2 test. The effect of living alone on cognitive function was analyzed using logistic regression analysis. Mediation analyses determined the mediating effects of IADL.A total of 325 participants were living alone; they were significantly older than those living with others, more likely to be female, not provide emotional support, and have low physical function, more severe depression, and lower IADL disability. Living alone had a significantly lower risk of cognitive decline at follow-up than living with others. The mediation analysis revealed that IADL disability at follow-up was significantly associated with cognitive decline. Thus, greater IADL ability decreased cognitive decline risk.Older people living alone had a significantly lower risk of cognitive decline, and cognitive function significantly mediated IADL ability. Health support for enhancing IADL abilities may help older people living alone maintain good cognitive function.

Predictive Validity of a New Instrumental Activities of Daily Living Scale for Detecting the Incidence of Functional Disability among Community-Dwelling Older Japanese Adults: A Prospective Cohort Study.

We examined the predictive validity of a newly developed scale—the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL)—to measure instrumental activities of daily living (IADL) ability. We tested the scale for detecting new incidences of functional disability among community-dwelling older Japanese adults. Participants were 2708 older adults (mean age = 79.0 years, 51.6% women) living in the community who had no functional decline at baseline. We assessed IADL ability using the NCGG-ADL scale, comprising 13 self-report questions. Next, we assessed their functional disability monthly for 24 months, based on the national long-term care insurance (LTCI) system. Among all participants, 430 (15.9%) had an IADL limitation at baseline, and 289 (10.7%) were newly certified as functionally disabled. Participants scoring ≤ 12 of 13 points in the NCGG-ADL showed a significantly higher risk of functional disability than did those scoring 13 points, even after adjusting for covariates (hazard ratio [95% confidence interval] = 1.58 [1.19–2.09]). We thus validated the NCGG-ADL as a screening tool for assessing the risk of functional disability among community-dwelling older Japanese adults. We conclude that IADL limitations, as measured by the NCGG-ADL, could be useful predictors of functional disability.

Early- versus late-onset Alzheimer\u2019s disease in clinical practice: cognitive and global outcomes over 3\xa0years

BackgroundWhether age at onset influences Alzheimer’s disease (AD) progression and the effectiveness of cholinesterase inhibitor (ChEI) therapy is not clear. We aimed to compare longitudinal cognitive and global outcomes in ChEI-treated patients with early-onset Alzheimer’s disease (EOAD) versus late-onset Alzheimer’s disease (LOAD) in clinical practice.MethodsThis 3-year, prospective, observational, multicentre study included 1017 participants with mild to moderate AD; 143 had EOAD (age at onset < 65 years) and 874 had LOAD (age at onset ≥ 65 years). At baseline and semi-annually, patients were assessed using cognitive, global and activities of daily living (ADL) scales, and the dose of ChEI was recorded. Potential predictors of decline were analysed using mixed-effects models.ResultsSix-month response to ChEI therapy and long-term prognosis in cognitive and global performance were similar between the age-at-onset groups. However, deterioration was significantly faster when using the Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS-Cog) over 3 years in participants with EOAD than in those with LOAD; hence, prediction models for the mean ADAS-Cog trajectories are presented. The younger cohort had a larger proportion of homozygote apolipoprotein E (APOE) ε4 allele carriers than the older cohort; however, APOE genotype was not a significant predictor of cognitive impairment in the multivariate models. A slower rate of cognitive progression was related to initiation of ChEIs at an earlier stage of AD, higher ChEI dose and fewer years of education in both groups. In LOAD, male sex, better instrumental ADL ability and no antipsychotic drug use were additional protective characteristics. The older patients received a lower ChEI dose than the younger individuals during most of the study period.ConclusionsAlthough the participants with EOAD showed a faster decline in ADAS-Cog, had a longer duration of AD before diagnosis, and had a higher frequency of two APOE ε4 alleles than those with LOAD, the cognitive and global responses to ChEI treatment and the longitudinal outcomes after 3 years were similar between the age-at-onset groups. A higher mean dose of ChEI and better cognitive status at the start of therapy were independent protective factors in both groups, stressing the importance of early treatment in adequate doses for all patients with AD.

Association among activities of daily living, instrumental activities of daily living and health-related quality of life in elderly Yi ethnic minority

BackgroundThe health-related quality of life (HRQoL) of the elderly population of Yi ethnic minority, which is the seventh largest nationality in China, has been rarely reported. This study was designed to explore the HRQoL of the elderly Yi ethnicity and association between their HRQOL and functional abilities.MethodsA total of 291 Yi ethnic residents were randomly recruited from 12 rural counties in Yunnan province and divided into different age groups. Local residents in Yunnan province and the elderly from Hangzhou were enrolled as controls. The MOS 36-Item Short Form Health Survey (SF-36), activities of daily living (ADL), instrumental activities of daily living (IADL) scales were utilized to evaluate the HRQoL and functional ability. One-way ANOVA was used to statistically compare the ADL and IADL among different age groups. The influential variables on HRQOL were analyzed by multiple linear regression analysis. Pearson correlation analysis was used to analyze the association among HRQoL, ADL and IADL.ResultsThe HRQoL of the elderly Yi minority was significantly lower than those of local residents in Yunnan province and the elderly counterparts in Hangzhou. The IADL ability of the elderly Yi minority was low, whereas they could perform most items of ADL. ADL, IADL, and education level were positively associated with HRQoL, whereas age, chronic diseases, and the frequency of medication use were negatively correlated with HRQoL.ConclusionThe HRQoL and functional capacity of the elderly Yi ethnic minority were lower compared with their counterparts in Yunnan province and Hangzhou. The low level of IADL indicated that the elderly Yi participants had a high risk of cognitive impairment. Much attention should be diverted to influential factors of the HRQoL.

Factors Associated With Self-reported and Medically Diagnosed Urinary Incontinence Among Community-Dwelling Older Women In Korea.

Purpose:The purpose of this study was to examine the prevalence of urinary incontinence (UI) in community-dwelling Korean women 60 years or older, and to identify factors associated with self-reported and medically diagnosed UI.Methods:This study was a secondary analysis of data from the 2008 Actual Living Condition of the Elderly and Welfare Need Survey, which used a stratified two-stage cluster sampling method to select a representative sample of 8,961 elderly Korean women.Results:Of the 8,961 women in this study, 579 (6.5%) had self-reported UI, and 209 (2.3%) were medically diagnosed with UI. As patient age and exercise ability of the upper extremities increased, risk for self-reported UI decreased (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–0.99; OR, 0.99; 95% CI, 0.98–0.99, respectively). In contrast, as the number of limited instrumental activities of daily living (IADL) increased, the risk for self-reported UI increased (OR, 1.30; 95% CI, 1.24–1.35). Overweight women were 1.94 times more likely to have self-reported UI compared to underweight women. Women with a history of stroke or asthma were more likely to have self-reported UI compared to women with no history. Also, women who reported being in good health were less likely to have UI, compared to women who reported being in poor health (OR, 0.47; 95% CI, 0.31–0.70). Medically diagnosed UI was negatively associated with the number of limited IADL and exercise ability scores for the lower extremities (OR, 0.86; 95% CI, 0.80–0.92; OR, 0.98; 95% CI, 0.97–0.99, respectively). In contrast, as the exercise ability score for the upper extremities increased, so did the risk for medically diagnosed UI (OR, 1.02; 95% CI, 1.01–1.03).Conclusions:An interventional program for home visit health services is needed for incontinent women who are highly dependent on others for IADL.

Is expressed emotion related to estimates of ability made by older people with cognitive impairments and their partners?

Objectives: Discrepancies in ratings of ability are used to assess awareness in people with cognitive impairments, and previously have been found to be associated with comorbid depression and carer distress. This study explored how the degree of discrepancy between self-ratings of ability made by older people with a cognitive impairment and informant ratings made by their partners relates to aspects of their relationship quality. It was hypothesised that discrepancies between self- and partner ratings would be associated with partner's expressed emotion (EE), and replicate previous findings for associations with depression and carer distress. Method: Forty-six people aged over 65 with mild cognitive impairment or early-stage dementia were recruited through NHS mental health services for older people. In a semi-structured interview, they and their partners gave separate ratings of cognitive abilities and instrumental activities of daily living (IADL). Partners also completed a 5-minute speech sample task to assess the type of EE. Depression in cognitively impaired participants and partner distress were also measured. Results: High EE, depression and carer distress were associated with larger discrepancies in ratings of ability on the cognitive measure. EE was not associated with self-ratings or partner ratings of cognitive or IADL ability. Conclusion: The findings suggest that where disagreement about the abilities of an older person with cognitive impairments is greater, the affective environment around that person is more likely to be characterised by criticism and/or emotional over-involvement. The implications of this for assessment, diagnosis, and helping couples adjust to cognitive deterioration are discussed.

A longitudinal study of risk factors for community-based home help services in Alzheimer&amp;rsquo;s disease: the influence of cholinesterase inhibitor therapy

BackgroundTo investigate the long-term effects of cholinesterase inhibitor (ChEI) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS) by patients with Alzheimer’s disease (AD).MethodsThis 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used.ResultsDuring the study, 332 patients (38%) used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS.ConclusionsHigher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The “silent group” of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization.

Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies

IntroductionKnowledge of longitudinal progression in mild Alzheimer’s disease (AD) is required for the evaluation of disease-modifying therapies. Our aim was to observe the effects of long-term cholinesterase inhibitor (ChEI) therapy in mild AD patients in a routine clinical setting.MethodsThis was a prospective, open-label, non-randomized, multicenter study of ChEI treatment (donepezil, rivastigmine or galantamine) conducted during clinical practice. The 734 mild AD patients (Mini-Mental State Examination (MMSE) score 20 to 26) were assessed at baseline and then semi-annually over three years. Outcome measures included the MMSE, Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), Clinician’s Interview-Based Impression of Change (CIBIC) and Instrumental Activities of Daily Living (IADL) scale.ResultsAfter three years of ChEI therapy, 31% (MMSE) and 33% (ADAS-cog) of the patients showed improved/unchanged cognitive ability, 33% showed improved/unchanged global performance and 14% showed improved/unchanged IADL capacity. Higher mean dose of ChEI and lower educational level were both predictors of more positive longitudinal cognitive and functional outcomes. Older participants and those with a better IADL score at baseline exhibited a slower rate of cognitive decline, whereas younger participants and those with higher cognitive status showed more preserved IADL ability over time. Gender and apolipoprotein E (APOE) genotype showed inconsistent results. Prediction models using the abovementioned scales are presented.ConclusionsIn naturalistic mild AD patients, a marked deterioration in IADL compared with cognitive and global long-term outcomes was observed, indicating the importance of functional assessments during the early stages of the disease. The participants’ time on ChEI treatment before inclusion in studies of new therapies might affect their rate of decline and thus the comparisons of changes in scores between various studies. An increased understanding of expected disease progression in different domains and potential predictors of disease progression is essential for assessment of future therapies in AD.

Cognitive and Noncognitive Determinants of Everyday Activities in a Racially Diverse Population of Older Persons Receiving Health Services

We examined the relationship of cognitive, medical, psychological, and behavioral factors with everyday functioning in a racially diverse older community population recruited from health service agencies. Everyday functioning was characterized as a latent variable composed of 15 instrumental activities of daily living (IADL). The mean (SD) age of the participants (N = 237) was 78.3 (8.1) years; 67% were women, 34% were African-American, 18 (7.6%) met criteria for a depressive disorder, and 61 (27.0%) met criteria for dementia. Worse verbal memory, older age, depression, and number of medical conditions were independently associated with worse IADL ability. The final model explained 60% of the variability. As the population ages and the prevalence of impaired cognition and disability rises, identifying cognitive and noncognitive determinants of disability becomes increasingly important. Interventions to optimize episodic memory, medical status, and treatment of depression may slow down the pathway to disability in older persons.

The Validation of the Hong Kong Chinese Version of the Lawton Instrumental Activities of Daily Living Scale for Institutionalized Elderly Persons

The Lawton Instrumental Activities of Daily Living (IADL) scale is the assessment tool most commonly used by occupational therapists in Hong Kong. However, there has been no cross-cultural validation study of the Lawton IADL-Chinese Version (IADL-CV) scale as applied to Hong Kong's older adults. This was the first study of content validity, construct validity, and reliability of the Lawton IADL-CV. A total of 155 institutionalized older adults were recruited from three different hostels and one care-and-attention home by using a convenience sampling method. Expert panel review and pilot testing on the subjects established the linguistic and content validity of the Hong Kong Chinese version. The content of the scale, the scoring criteria, translation, and level of rating scale were examined. It was shown that all nine IADL items apart from “handyman work” were culturally relevant (more than 78% agreement). Nine items altogether had good representation in assessing the IADL ability of Hong Kong older adults (73% agreement). The scoring criteria were refined with reference to the local culture. Both panel review and the related psychometric properties supported the change of the level of rating scale from a three-point to a four-point scale. The inter-rater and test-retest reliability estimated by intraclass correlation coefficient (ICC) gave a value of 0.99 and 0.90, respectively. The Cronbach's alpha estimating the internal consistency was 0.86. In the study of the construct validity, the factor analysis and known-groups methods were used. The construct validity was examined by factor analysis of the Lawton IADL scores of 111 hostel subjects. The result showed that one factor was extracted from the nine items of the Lawton IADL-CV scale. The known-groups method was performed using the Lawton IADL-CV to separate 146 institutionalized subjects into their corresponding living institutions: hostel or care-and-attention home. An overall prediction ability of 78% was achieved so as to correctly discriminate between residents in the hostel and care-and-attention home. In conclusion, the Lawton IADL-CV scale is a valid and reliable instrument to assess the older adults' IADL ability to live independently in the community.

Subjective quality of life, health, I-ADL ability and adaptation strategies in fibromyalgia.

To describe subjective quality of life and health, self-perceived instrumental activities of daily living (I-ADL) ability and adaptation strategies, and to explore possible relationships between these variables in fibromyalgia patients. Two instruments were used with fibromyalgia patients: the Fibrositis Impact Questionnaire and 'Living with fibromyalgia - adaptation to chronic disease and handicap', and correlative analyses were performed. A sample of 34 patients undergoing rehabilitation (in a specific programme). The majority of the patients used many adaptation strategies, demonstrating some significant relationships with perceived I-ADL ability and subjective quality of life and health. Different symptoms correlated highly significantly with self-perceived ability in I-ADL. The significant relationships between adaptation strategies and I-ADL ability and health demonstrated deserve clinical awareness and further research efforts.

Housing Changes and Moves into Supportive Housing Among Adults with Disabilities

About one fifth of the adult population with disabilities living in the community moved during a 12-to 24-month period between 1994 and 1996. This article examines the extent to which the ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) was associated with these moves. Data are from the 1994-1995 National Health Interview Survey (NHIS), the 1994-1995 Supplement on Disability, and the Disability Followback Survey. Analyses controlled for gender, income, living alone, racelethnicity, health status, and selected mental conditions. Decreased IADL ability had little association with the likelihood of moving, whereas increased difficulty with the ADL tasks of bathing, dressing, eating, and toileting generally increased this likelihood. These effects were more evident among those age 65+ than among those ages 18 to 64, and more common among house than apartment residents. For older persons, increases in ADL difficulties were associated with moves into supportive housing.

The vocational situation in cases of memory deficits or younger‐onset dementia

The aim of the study was to describe how persons with memory deficits or younger‐onset dementia perceived and met their problems, with particular reference to their present and future vocational situation, including describing the parallel observations and attitudes of other significant persons in the vocational context. Data were collected through 16 interviews, one with each of nine subjects and seven respondents from the subjects' work‐places. All interviews were analysed with a comparative method, searching for themes. In addition, subjects' IADL (instrumental activities of daily living) ability and cognition were assessed. The findings demonstrated that the subjects themselves experienced extensive difficulties before their predicament was defined. The difficulties were met by spontaneous and planned strategies on the part of the subjects and by adaptations at the workplaces, but with limited success. The situation also profoundly affected fellow workers. Overall, both the subjects and the work‐place respondents had a positive attitude to continued work as long as the subjects made useful contributions. The possibility of remaining in work seemed to depend on multiple factors, including the individual's apprehension of his or her own ability and the length of the sick‐leave.

The Relationship Between Cognition and Daily Activities in Cases of Mild Alzheimer's Disease

The purpose of this study was to investigate the relationship between cognitive functions, assessed by neuropsychological tests, and instrumental activities of daily living (IADL) ability, assessed by the Assessment of Motor and Process Skills (AMPS) in persons with mild Alzheimer's disease. Fifty-two participants were included in the study. We found significant relationships between the AMPS IADL process ability and Factors 1 (perceptual speed, visuoconstructive ability) and 4 (secondary memory). The AMPS IADL motor ability showed a significant relationship to Factors 1 and 3 (logical memory). The cognitive factors explained 24 26% of the variability in AMPS IADL ability. The results indicate that cognitive functions had a significant impact on IADL ability in this population. However, as 74–76% of the variability in the IADL ability was left unaccounted for by the cognitive functions, it is important to assess both cognitive functions and IADL ability when investigating persons with mild dementia. Further study of the complex interaction between a variety of influencing factors is needed to better understand the consequences of dementia on everyday life functioning.

Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor.

Chronic thalamic stimulation (CTS) has a documented good effect on tremor in patients with Parkinson's disease (PD) and essential tremor (ET). This study evaluates whether the alleviation of impairment, i.e., tremor, translates into improvement of the patient's ability in performing instrumental activities of daily living (IADL). Thirteen patients were assessed with an occupational therapy tool called Assessment of Motor and Process Skills (AMPS). This observation-based scale rates the patient's motor and process skills needed to perform a given task. The evaluations were done at a mean of 13 months after surgery in the patient's home, and included assessments of IADL with the CTS activated and switched off, respectively. The results showed that most patients improved to variable degrees in their IADL ability when the thalamic stimulation was on. The improvement was more marked in patients operated on for tremor of their dominant hand. The improvement concerned mainly the skill items related to the patients' abilities of coordination, calibration, endurance, and accommodation during IADL task performance. The authors concluded that for some patients with tremor, CTS can improve independence in domestic activities of daily living.