Instrumental Activities Of Daily Research Articles

The effects of mood and cognition on daily functioning and quality of life in older people living with HIV and people with Parkinson’s disease.

In light of the increased longevity of people living with HIV infection (PLWH) undergoing antiretroviral therapy (ART), the present study aimed to determine the effects of mood disturbances alongside cognitive and motor symptoms on activities of daily living (ADLs) and quality of life (QOL) in older PLWH in comparison to an aging control sample without notable medical history (CTL) and individuals with Parkinson's disease (PD). Forty-one PLWH, 41 individuals with PD, and 37 CTL, aged 45-79 years, underwent neuropsychological, psychological, and neurological assessment including depressive and anxiety symptoms, physical (ADL-p) and instrumental (ADL-i) daily activities, Unified Parkinson's Disease Rating Scale motor ADLs (ADL-UPDRS-II), QOL, and cognitive and motor functions. Hierarchical regression analyses assessed the relative contribution of predictors including demographics, disease-related factors, comorbid conditions, and mood-related factors for ADL and QOL scales. PLWH and PD participants reported more depressive symptoms and higher anxiety and worse QOL and ADL-i than CTL. The PD group had greater ADL-p and motor-related ADL-UPDRS-II difficulties than PLWH and CTL groups. In PLWH, medical comorbidities and alcohol use disorder (AUD)/substance use disorder (SUD) histories significantly contributed to poor physical and motor ADLs. Mood scores, particularly depressive symptoms, were independent predictors of poor QOL and most ADLs in both clinical groups, above the contribution of cognitive compromise. Mood symptoms contribute significantly to poor ADLs and QOL in people aging with chronic diseases such as long-term HIV infection and PD. Comprehensive assessment and treatment of mood symptoms are recommended for ensuring optimal functional independence and life quality. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Video-delivered emotion-focused mindfulness therapy for late- life anxiety: study protocol for a feasibility randomized controlled trial

BackgroundThe worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%. In Canada, adults 65 and older experience anxiety at a rate of 6.4%, affecting more than 300,000 people. Anxiety in older adults has been linked to difficulties retaining new information and engaging in instrumental daily activities of living. Due to COVID-19 restrictions, novel methods of delivering therapy programs remotely are needed; however, data is limited. There is some evidence that older adults prefer non-pharmacological approaches for anxiety that can be delivered in the community. Emotion-focused mindfulness therapy (EFMT) is a mindfulness-based intervention that emphasizes meditation and observing thoughts and emotions as they arise. This emphasis has been demonstrated to reduce symptoms of anxiety in general populations. This study aims to evaluate the feasibility of EFMT with older adults.MethodsThis pilot feasibility randomized controlled trial will use a wait list control trial design. Due to COVID-19 restrictions, we will use telehealth delivery via Zoom rather than in-person delivery. The first 48 people to meet the eligibility criteria will be randomly allocated to either receive EFMT immediately, or in approximately 8 weeks time from enrollment (1:1 allocation ratio). Data will be collected at baseline, 8 weeks following baseline, and 16 weeks following baseline. The primary outcomes will determine the feasibility of the intervention based on recruitment, enrolment, retention, and adherence to all components of the intervention. The secondary outcome will be changes to anxiety over time.DiscussionThe results of this trial will determine the feasibility and potential effectiveness of video-delivered EFMT for late-life anxiety compared to no treatment. If the results are promising, a larger randomized controlled trial may be conducted.Trial registrationClinicalTrials.gov, NCT04415528. Registered on June 4, 2020Protocol versionProtocol version 2, January 2, 2021

Impact of Cognitive Reserve and Premorbid IQ on Cognitive and Functional Status in Older Outpatients.

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients’ cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = −0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults.

Health risks of natural hazards and resilience resources: Evidence from a U.S. nationwide longitudinal study

BackgroundAlthough natural disasters can threaten health and well-being, some people show greater resilience to their effects than others. Identifying the characteristics related to resilience has important implications for reducing the health risks in the aftermath of a disaster. ObjectiveUsing the Conservation of Resources Theory as a framework, we study the role of resources in moderating the adverse effects of natural disasters on people's health and coping behaviors. MethodWe match 20,658 unique individuals aged 50 or older from the 2012–2016 waves of the Health and Retirement Study to the county-level annual natural hazard data provided by the Federal Emergency Management Agency. Using individual-fixed effect models, we first model whether the experience of natural disasters can predict people's health and coping behaviors. We then explore heterogeneity in such effects by interacting individual- and county-level resilience resources with the number of natural disasters. ResultsThe results show that with increased exposure to natural disasters, older adults are more likely to experience difficulties performing instrumental daily activities. They also tend to have fewer overnight hospital stays, higher out-of-pocket medical expenses, and increased alcohol dependency. However, older adults with certain socio-economic characteristics ‒ white, higher education, higher income, and homeownership ‒ are better able than others to mitigate any adverse health effects of natural disasters. One significant community-level resource is a robust healthcare capacity in a county with a high ratio of healthcare practitioners, where older adults are more likely to seek hospital care and have lower alcohol dependency. ConclusionsHealth resilience can be improved by strengthening community-level healthcare capacity, with a particular focus on residents with lower socio-economic resources. Failing to address healthcare provision inequalities may exacerbate health disparities.

Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities.

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms.

to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

Evolution in geriatric syndromes and association with survival over 5years in the GERODIAB cohort of older French diabetic patients.

Although one in three patients with diabetes in Western countries is over 70years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy. We performed a prospective, observational study over 5years in patients with diabetes aged 70years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77years, range 70-94years, 65.2% were 75years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan-Meier method and proportional hazards regression models. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77-3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19-2.13; p = 0.0016), associated with HbA1c ≥ 70mmol/mol (HR = 1.62; CI = 1.12-2.36; p = 0.011). Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals. Registered at clinicaltrials.gov (21/01/2011): NCT01282060.

Función sensorial y dependencia en adultos mayores con enfermedad crónica

Introducción: Con el envejecimiento se presentan cambios en los sentidos y en consecuencia, alteraciones en la función del gusto y olfato que influyen en la descompensación de enfermedades crónicas. Objetivo: conocer la función sensorial y su asociación con la dependencia para realizar Actividades básicas de la vida diaria e Instrumentales en adultos mayores con enfermedad crónica. Metodología: studio correlacional en una muestra de 96 participantes. Instrumentos utilizados: Carta Snellen, Audiómetro Manual, monofilamento de Semmes-Weinstein, prueba de aromas de Gustos Básicos e Índice de Barthel. El análisis estadístico implicó estadística descriptiva e inferencial, correlación de Spearman, U de Mann-Whitney. Resultados: El 71% de los participantes presentó alteración visual. 48% obtuvo audición normal en oído izquierdo y 43% oído derecho, 24% calificó con alteración táctil del pie izquierdo y 30% en pie derecho. Alteración de olfato y gusto en 77%. Presentaron dependencia en actividades Básicas (ABVD) 40%, 24 % en Instrumentadas (AIVD). Se identificó relación entre el tacto en ambos pies y agudeza auditiva con ABVD (p= &lt;.05). La edad y AIVD (p=&lt;.001) agudeza tacto pie izquierdo(p=&lt;.031), auditiva(p=&lt; .005), olfato (p=.018) y gusto (p= &lt;.047). La dependencia en ABVD no presentó diferencia en la prueba con anteojos (U=146.000; p= &lt;.754) y sin anteojos (U=127.500; p=.079); de igual manera en AIVD con anteojos (U=115.000; p= &lt;.079) y sin anteojos (U=160.000; p=.202). Conclusión. A mayor función en los sentidos de tacto y oído, menor dependencia para realizar las ABVD y a mayor función del tacto, oído, olfato y gusto menor dependencia en las AIVD.

Occupational therapy assessment and treatment approach in patients with subacute and chronic stroke: A single-blind, prospective, randomized clinical trial

Objectives The aim of this study was to examine the effects of occupational therapy (OT) combined with standard rehabilitation (SR) on the activities of daily living, quality of life, and psychological symptoms of hemiplegic patients.Patients and methods Between August 2014 and February 2016, a total of 35 hemiplegic patients with post-diagnostic periods (19 males, 16 females; mean age 58.3 years; range 37 to 77 years) were included. The patients were randomized into two groups as OT+SR group (n=17) and SR only group (n=18). The study was completed by 16 patients in each group. The patients in the OT group were given 45-min SR five days a week plus 45-min OT three days a week over an eight-week period, while the patients in the SR group received SR only (of the same duration and frequency as the OT group). The patients were assessed at enrolment (pre-treatment), and again after eight weeks of treatment using the Pinch and Grip Strength and the Purdue Pegboard tests, Global Daily Living Activities Scale, Performance Assessment of Self-care Skills (PASS), Nottingham Extended Activities of Daily Living (NEADL) Scale, Quality of Life Short Form (SF-36) Questionnaire, and Hospital Anxiety and Depression Scale (HAD) for their psychological state.Results Significant improvements were observed in within-group scores for PASS, Pinch and Grip Strength Test, NEADL Scale, and Purdue Pegboard test (p<0.05). After treatment, a significant increase was found in the SF-36 physical function, general health and physical total in-group scores of the OT group, whereas a significant increase was observed only in the physical total scores of the SR group (p<0.05). There was no significant improvement in the HAD scores within both groups (p>0.05). Inter-group comparisons revealed a further significant improvement in PASS instrumental daily activity index-physical subscale and Purdue Pegboard Test scores of the OT group (p<0.05). However, there was no significant difference in PASS activity, self-care and instrumental daily activity cognitive subscale, SF-36, HAD and hand grip and pinch strength scores between the groups (p>0.05).ConclusionOccupational therapy combined with SR applications has a beneficial impact on certain daily living activities and hand functions. Occupational therapy does not have any additional benefits on the quality of life, pinch and grip strength, and the psychological state.

Continuous Compared to Accumulated Walking-Training on Physical Function and Health-Related Quality of Life in Sedentary Older Persons.

The present study aimed to analyze the impact of overground walking interval training (WIT) in a group of sedentary older adults, comparing two different dose-distributions. In this quasi-experimental and longitudinal study, we recruited twenty-three sedentary older adults (71.00 ± 4.10 years) who were assigned to two groups of WIT. The continuous group (CWIT) trained for 60 min/session in the morning, while the accumulated group (AWIT) performed the same duration and intensity of exercise, but it was distributed twice a day (30 min in the morning and 30 more in the afternoon). After 15 weeks of an equal external-load training (3 days/week), Bonferroni post-hoc comparisons revealed significant (p < 0.050) and similar large improvements in both groups in cardiorespiratory fitness and lower limb strength; even larger gains in preferred walking speed and instrumental daily life activity, which was slightly superior for CWIT; and improvements in agility, which were moderate for CWIT and large for AWIT. However, none of the training protocols had an impact on the executive function in the individuals, and only the AWIT group improved health-related quality of life. Although both training protocols induced a general significant improvement in physical function in older adults, our results showed that the accumulative strategy should be recommended when health-related quality of life is the main target, and the continuous strategy should be recommended when weakness may be a threat in the short or medium term.

The role of continuity of systematic treatment and rehabilitation in patients with metastatic colorectal cancer in elderly and senile age.

e16041 Background: The concomitant pathology, cancer and geriatric status affect the organism of a sick elderly person. In routine clinical practice elderly patients require comprehensive geriatric assessment (CGO). Despite many treatment strategies for elderly patients with metastatic colorectal cancer (mCRC), there are no use of rehabilitation programs and the assessment of their impact on the treatment tolerability and survival. Methods: The study includes patients with newly diagnosed mCRC stage IV, receiving the first line of chemotherapy (FOLFOX). Patients are given CGO before starting chemotherapy and in dynamics.The following scales are used for geriatric examination: Cumulative Illness Rating Scale for Geriatrics (CIRS-G); Activities of Daily Living (ADL); Daily instrumental activity scale (IADL); Mini nutritional assessment (MNA); Clock Drawing Test (CDT); Geriatric depression scale (GDS). Results: At the moment 29 patients are included in the study. According the results of CGO we determined that elderly and middle-aged patients are similar in cognitive, mental, and nutritional status, but they have statistically significant differences on the MMSE scale (P=0,014). In both groups patients have a decrease in IADL and cognitive functions, the presence of depression. Elderly patients (&gt; 60 years old) are more likely to experience chronic pain (P&lt;0.05) and increased blood pressure (P&lt;0.05) (Table). Conclusions: The management tactics of patients with mCRC in elderly age shouldn't be based only on chronological age, ECOG or the Karnovsky index, that don't reflect functional disorders in patients of the older age group. It is necessary to define algorithms for medical rehabilitation in cancer patients of the older age group. A CGO is aimed at developing a medical rehabilitation plan together with an elderly patient and his environment, and an algorithm for supporting his health status during and after specialized treatment. [Table: see text]

Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age

The aim of this study was to analyse in particular dependence in instrumental daily life activities (I-ADLs) and its association with physical impairments and functional limitations in the elderly. The study was based on cross-sectional data on 70-year-olds (n = 602) and longitudinal data on subjects followed up to the age of 76 (n = 371). Persons dependent in ADL had lower values in maximum walking speed, grip strength, knee extensor strength, stair climbing capacity and in forward reach, compared with those who were independent in ADL. Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL. Possible critical levels for disability in ADL are discussed, as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL.

Discharge Planning and Home Care Needs Assessment for Older Patients in a Nursing Hospital.

Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90–120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing.

Factors that Increase Risk of Falling in Older Men according to Four Different Clinical Methods

ABSTRACTBackground: Falling is an important health problem for older men. In this study, we aim to identify factors that increase risk of falling in only older men using four different fall risk assessment methods.Method: 334 men, who attended a geriatric outpatient clinic and underwent comprehensive geriatric assessment, were included in the study. History of falling last year, the Timed Up and Go test, Performance-Oriented Mobility Assessment, and 4-meter walking speed test were carried out on all patients.Results: The mean age (SD) of patients were 74.99 (7.26) years. According to all of the four clinical assessments to predict risk of falling the following risk factors for falling were identified (all p < .05): cerebrovascular disease, urinary incontinence, dizziness and imbalance, high Geriatric Depression Scale (GDS) scores, low Mini-Mental State Examination (MMSE), and The Lawton-Brody Instrumental Daily Living Activity Scale (IADL) and Barthel index (BI) for daily living activities scores, Significant correlations were found between all the assessment methods (p < .001).Conclusion: There is a strong relationship between fall risk and cerebrovascular disease, urinary incontinence, dizziness and imbalance, high GDS scores, low MMSE, BADL and IADL scores in older men. Therefore, older men should be screened for these risk factors to prevent falls.

How do impairments in cognitive functions affect activities of daily living functions in older adults?

The assessment of daily living activities could provide information about daily functions and participation restrictions to develop intervention strategies. The purposes of this study were to assess the scores of the Barthel Index (BI) and Lawton Instrumental Activities of Daily Living (IADL) scale in older adults with cognitive impairment and to explore the different effects that levels of cognitive functions have on changes in IADL functions. We recruited 31 participants with dementia, 36 with mild cognitive impairment (MCI), and 35 normal controls (NCs) from the neurology outpatient department of a regional hospital. The results of the demographic and clinical characteristics through the Lawton IADL scale, BI, Quick Mild Cognitive Impairment (Qmci) screen, Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE), were collected on the same day and compared with the Kruskal–Wallis test, Wilcoxon rank-sum test, Fisher’s exact test, and a multiple linear regression analysis, as appropriate. In the BI, bathing was the most discriminating activity to differentiate patients with MCI and dementia; in the Lawton IADL scale, medication responsibility and shopping were the most discriminating activities to differentiate NCs and patients with MCI, and patients with MCI and dementia, respectively. In addition, the predictors of changes in Lawton IADL scale scores were the problem-solving score of the Clinical Dementia Rating scale, a Qmci score of > 20.4 and an age of ≤ 81.2 years, a MoCA score of < 9.4 and an age of > 81.2 years, and the MMSE score and an age of > 81.2 years. This study adds to the evidence that the description of basic and instrumental daily activities is integrated in older adults with cognitive impairment. Notably, the Qmci is the most significant predictor of changes in IADL function for “young” older adults, as are the MoCA and MMSE for “old” older adults.

A prospective study of comprehensive geriatric assessment in elderly patients with acute myeloid leukemia

Objective To evaluate the performance on comprehensive geriatric assessment(CGA)in elderly patients with acute myeloid leukemia(AML)and to investigate the differences between Eastern Cooperative Oncology Group(ECOG)performance status(PS)and CGA scoring. Methods Patients aged 60 years or over diagnosed with AML at Beijing Hospital from September 2008 to April 2018 were enrolled in this study.CGA was performed during staging procedures through application of age, activities of daily living(ADL)/instrumental activities of daily living(IADL)and the comorbidity score based on the cumulative illness rating scale for geriatrics(CIRS-G). According to CGA scores, patients were classified into a not-applicable group, an applicable group and a frail group.The difference between ECOG-PS and CGA scoring was compared. Results A total of 73 patients were enrolled in this study.There were 37(50.7%), 14(19.2%)and 22(30.1%)patients in the applicable, not-applicable and frail groups, respectively.Comorbidities were observed in the majority of patients, with cardiovascular disease, diabetes mellitus and hypertension among the most common disorders.In patients aged 60 to 64 years, 16.7%(1/6)were considered as frail, and the percentage of frail patients increased to 36.4%(8/22)in patients aged 80 years and over.Moreover, functional impairment evaluated by CGA was observed in 36.5%(19/52)of patients with ECOG-PS ≤1. Conclusions According to CGA scoring, approximately half of AML patients aged 60 years or over have functional impairment.Functional impairment is observed in some patients with ECOG-PS ≤1, indicating that ECOG-PS may underestimate functional impairment in elderly AML patients. Key words: Leukemia, myeloid; Comprehensive geriatric assessment

In geriatric evaluation, some iadl (Katz) scale items are more predictive of efficacy and toxicity than ADL (Lawton) scale or Charlson Comorbidity Index in metastasic castration-resistant protate cancer (mCRPC) patients treated with cabazitaxel in a weekly schedule.

176 Background: Cabazitaxel (CBZ) improves overall survival in mCRPC that progresses during or after docetaxel treatment. CABASEM is a phase II study to evaluate the efficacy and safety of a weekly schedule of CBZ for 'unfit' (ECOG2, previous neutropenic fever with docetaxel, or radiotherapy to &lt;25% of areas of bone marrow reserve) mCRPC patients after docetaxel failure. Fragility scales were performed to patients included before treatment and results are described. Methods: All 70 patients were treated with CBZ 10 mg/m2/wk 4 administration every 5 weeks. Geriatric fragility scales performed were Lawton daily day activities (ADL), BPI score, Katz instrumental daily day activities (IADL) and Charlson index. General and specific items have been analyzed in relation with toxicity and efficacy (clinical benefit (OR+SD), PSA response, composite PFS, PSA-PFS, and overall survival) in all patients and in older than 70 years. Results: Median age 73 (range 54-85). Charlson index and ADL scale had not relationship with any toxicity observed and any efficacy outcome in the whole group nor in older than 70. IADL independence grade was related to survival in the whole group (p=0,025) and older than 70 (p=0,02). In the whole group, some IADL items were associated with PSA response (buying, p=0.003; cooking, p=0.06; and IADL independence grade p=0.01), PSA PFS (telephone use, p=0.01; handle finances, p=0.06), composite PFS (telephone use, p=0.013; housekeeping, p=0.03; handle finances, p=0,06) and OS (telephone use p=0.001; laundry, p=0.008; handle finances, p=0.02 and IADL dependence grade, p=0.003). Only any grade diarrhea and grade 2 neutropenia was associate with buying (p=0.025) and cooking (p=0.05) IADL items respectively, in patients older than 70 years. Conclusions: IADL scale and items seem to be more related to efficacy (OS, PSA response, PFS, clinical benefit and PSA PFS) than ADL and Charlson scales in mCRPC older than 70 years treated with weekly cabazitaxel. No clear association of scales and items with toxicity were observed in this group of patients. Clinical trial information: NCT01518283.

Carbohydrate nutrition variables and risk of disability in instrumental activities of daily living.

We aimed to examine the prospective association between dietary glycemic index (GI) and glycemic load (GL) of foods consumed, intakes of carbohydrates and fiber, and the ability to perform activities of daily living (ADL) in older adults. A total of 844 participants from the Blue Mountains Eye Study aged 60years or older were examined from 2002-2004 to 2007-2009. Dietary information was collected using a validated, semi-quantitative food-frequency questionnaire. The Older Americans Resources and Services activities of daily living scale were administered to assess the functional status of participants. Multivariable logistic regression analysis was performed. After multivariable adjustment, participants who were in the second and third quartiles of energy-adjusted total fiber intake compared to those in the first quartile of intake (reference group) at baseline had reduced risk of incident impaired instrumental activities of daily living (IADL) 5years later: OR, 0.39 (95% CI 0.22-0.70) and OR 0.54 (95% CI 0.30-0.95), respectively. Analyses that involved dichotomized total fiber intake showed that participants in the upper three quartiles of total fiber intake (> 19g/day), compared to those in the lowest quartile of intake (≤ 19g/day) or reference group, had reduced IADL disability risk 5years later: OR 0.49 (95% CI 0.31-0.79). Non-significant associations were observed with total carbohydrates, GI, and GL and with risk of impaired total and basic ADL at 5-year follow-up. Habitual fiber consumption might be beneficial in leading to improved health status subserving performance of instrumental daily activities, needed to function in the community.

Occupational performance in the basic and instrumental daily activities of persons with low vision who received rehabilitation services

Introduction The objective was to describe the occupational performance in basic and instrumental daily activities of persons living in the community who have received comprehensive interdisciplinary low vision rehabilitation services. Method The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (a measure of the impact of visual impairment in daily activities) was administered at home to 102 individuals who participated in a comprehensive low vision rehabilitation program. Performance in 16 near-vision activities was measured with the person's aids and strategies; nine more global tasks were questionnaire-based. Handicap scores were obtained by multiplying performance × importance ratings. Results Average performance was satisfactory or very satisfactory for 21/25 items, even if 92% of the participants had a moderate or severe visual impairment. A severe or total handicap was present in at least one activity for 79% of the subjects. The most handicapping activities required visual searches of finely printed information on a complex or visually crowded document, or shopping and mobility. Conclusion People with low vision who took part in a comprehensive rehabilitation program generally face no or slight handicap situations in their basic and instrumental daily activities. However, major handicap situations may remain in some important activities.

Disease progression in relation to age at onset in a population with Alzheimer's Dementia.

One thousand and 679 Alzheimer's Disease patients (early onset EO: 152 and late onset LO: 1527) were evaluated after 12, 36 and 60months. At baseline EO patients have higher Mini Mental State examination (MMSE) and fewer comorbidities in respect to LO group. The MMSE score did not significantly differ after 12, 36 and 60 months; a more marked worsening in instrumental daily activities was observed after 36months in the EO compared with the LO group. These data allow to conclude that EO patients may have a slight faster progression in the disease within the first 3 years after the diagnosis, but in a longer follow-up no differences exist in respect to LO group. The literature failed to identify specific factors capable to influence the disease progression in AD. Our data are in substantial agreement with the literature and seem to confirm the great heterogeneity of AD patients.