Instrumental Activities Of Daily Living Scores Research Articles

Measuring the impact of hospitalisation for infectious diseases on the quality of life of older patients in four European countries: the AEQUI longitudinal matched cohort study (2020-2023).

To evaluate the impact of hospitalisation for infectious diseases on the Health-Related Quality of life (HRQOL), multidimensional frailty, and functioning of older patients, we conducted a longitudinal matched cohort study in four European countries. HRQOL, frailty, and functioning were assessed using validated questionnaires at inclusion, at discharge, and up to six months later (M6) in patients aged over 65years hospitalised for severe acute respiratory or bloodstream infections, and matched controls hospitalised for non-infectious conditions. Comparative analyses employed multilevel mixed-effect linear or logistic models to assess changes from inclusion. Between 2020 and 2023, 1,968 patients aged 65 to 100years (mean: 81) were included; 1,064 (54.1%) were male and 59 (3%) were institutionalised. Of these 1,968 patients, 826 were hospitalised for infectious diseases and 1,142 for non-infectious conditions. At inclusion, EQ-5D-3L (European Quality of life 5 Dimensions and 3 Lines) scores ranged from -0.7 to 1 (full HRQOL), with a median of 0.7 across all visits and groups. Compared to controls, patients hospitalised for infectious diseases had lower scores on the Activities of Daily Living (ADL) scale (median, 4.5 vs 5.0; p=0.020) and the Instrumental Activities of Daily Living (IADL) scale (median, 3.0 vs 4.0; p<0.001). At discharge, IADL scores were lower in patients hospitalised for infectious diseases than in controls (median, 4.0 vs 5.0, p=0.003), indicating reduced functioning. The proportion of frail patients, determined by a Multidimensional Prognostic Index (MPI) score between 0.67 and 1, was significantly higher among patients hospitalised for infectious diseases (n=113/801, 14.1%) than controls (n=108/1,111, 9.7%; p=0.012). At M6, no statistically significant differences were observed between groups in changes from inclusion in HRQOL (EQ-5D-3L, p=0.436), frailty (MPI, p=0.269), and functioning (ADL, p=0.993). Hospitalisation for infectious diseases and non-infectious diseases or conditions had a similar impact on HRQOL in non-institutionalised older adults. Clinical trials: NCT04825132.

The Association Between the Digital Divide and Health Inequalities Among Older Adults in China: Nationally Representative Cross-Sectional Survey.

Health inequalities among older adults become increasingly pronounced as aging progresses. In the digital era, some researchers argue that access to and use of digital technologies may contribute to or exacerbate these existing health inequalities. Conversely, other researchers believe that digital technologies can help mitigate these disparities. This study aimed to investigate the relationship between the digital divide and health inequality among older adults and to offer recommendations for promoting health equity. Data were obtained from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) scale, the Instrumental Activities of Daily Living scale, the Mini-Mental State Examination scale, and a 5-point self-rated health scale, respectively. The chi-square and rank sum tests were used to explore whether internet use and access were associated with health inequality status. After controlling for confounders, multiple linear regression models were used to further determine this association. Sensitivity analysis was conducted using propensity score matching, and heterogeneity was analyzed for different influencing factors. The 2018 analysis highlighted widening health disparities among older adults due to internet access and use, with statistically significant increases in inequalities in self-rated health (3.9%), ADL score (5.8%), and cognition (7.5%). Similarly, internet use widened gaps in self-rated health (7.5%) and cognition (7.6%). Conversely, the 2020 analysis demonstrated that internet access improved health disparities among older adults, reducing gaps in self-rated health (3.8%), ADL score (2.1%), instrumental ADL score (3.5%), and cognition (7.5%), with significant results, except for ADL. Internet use also narrowed disparities, with significant effects on self-rated health (4.8%) and cognition (12.8%). The robustness of the results was confirmed through propensity score-matching paired tests. In addition, the study found heterogeneity in the effects of internet access and use on health inequalities among older adults, depending on sex, age, education, and region. The impact of internet access and use on health inequalities among older adults showed different trends in 2018 and 2020. These findings underscore the importance of addressing the challenges and barriers to internet use among older adults, particularly during the early stages of digital adoption. It is recommended to promote equitable access to the health benefits of the internet through policy interventions, social support, and technological advancements.

Feasibility and Psychometric Properties of Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) Cognitive Screening Test

Background: Intrinsic capacity, a concept proposed by the World Health Organization, includes multidimensions to better understand older adults’ health conditions for successful healthy aging. One of the key dimensions of intrinsic capacity is cognition. The present study aimed to examine if the cognitive test in Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) is a suitable instrument for screening cognition impairment. Methods: Older adults from community or medical center settings in Tainan were recruited (n = 553; mean ± SD age = 75.80 ± 8.32; 60.8% females). All participants were administered the ICOPES-TW cognitive test, the Mini-Mental State Examination (MMSE), Lawton Instrumental Activities of Daily Living (IADL), and Barthel Index (BI) in an in-person interview conducted by a well-trained research assistant. Results: The ICOPES-TW cognitive test was highly correlated with the MMSE total score (r = −0.752) and moderately correlated with IADL (r = −0.426) and BI scores (r = −0.390). When using a cutoff score of 1 for the ICOPES-TW cognitive test, its accuracy to identify cognitive impairment defined by the MMSE was 60% (sensitivity = 0.98, specificity = 0.41). When using cutoff score of 2, the accuracy was 83% (sensitivity = 0.69, specificity = 0.90). Moreover, the ICOPES-TW cognitive test had similar properties to the MMSE in terms of known-group validity (distinguishing different age and educational level groups). Conclusions: Using ICOPES-TW cognitive test with appropriate cutoff point in different healthcare settings could help providers and researchers quickly identify if an older adult has a cognitive impairment. However, the screening ability of ICOPES-TW cognitive test was deemed fair but future studies are recommended to help improve it.

Higher Preoperative Serum Neuropeptide Y Concentration May Be Associated with a Better Prognosis After Surgery for Colorectal Cancer.

The early identification of patients at risk of peri-procedural complications and poor prognosis is particularly important. We conducted our study to determine whether serum orexigenic neuropeptide Y (NPY) concentration is associated with nutritional status and prognosis among patients undergoing surgery for colorectal cancer (CRC). A cohort study with a 3-month follow-up was conducted with 84 consecutive inpatients who underwent elective surgery in one center between 2016 and 2019 for primary CRC. The clinical characteristics and nutritional status of all patients were assessed. In long-term follow-ups (median; IQR: 1322; 930-1788 days; average 3.6 years), the patients' survival status was also checked during a telephone consultation. Before CRC surgery, patients with serum NPY concentrations equal to or higher than the median value (661.70 pg/mL) had higher scores in their Mini Nutritional Assessment, Barthel, and Instrumental Activities of Daily Living (IADL) questionnaires, greater handgrip strength, a lower score in the Patient-Generated Subjective Global Assessment, and almost a three-times lower risk of perioperative complications, as well as higher Barthel and IADL scores and larger calf circumference at the 3-month follow-up visit in comparison to individuals with lower serum NPY concentrations. A higher serum NPY concentration was predictive of a low Nutritional Risk Screening 2002 score at the 3-month visit, and this was also found to have significantly influenced the patients' survival during the 1200 days after CRC surgery. A higher preoperative serum NPY concentration may be related to lower nutritional risk, more favorable patient nutritional and functional status, and better survival, but further studies are required.

The connection between anemia and limitations in daily activities among older males: the critical role of dynapenia

AimThe aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older male patients.MethodsA total of 223 older males attending one geriatric outpatient clinic were included in this cross-sectional study. Anemia was defined as a hemoglobin level below 13 g/dL. Patients’ demographic characteristics, comorbidities, and comprehensive geriatric assessment parameters were also recorded. Handgrip strength of < 27 kg for males was accepted as dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity.ResultsThe mean age (standard deviation) of the participants was 80.17 (7.69) years. The prevalence of patients with anemia was 43.9%. There was differences between anemic and non-anemic groups in terms of presence of diabetes mellitus (DM), congestive heart failure (CHF), chronic kidney disease (CKD), malnutrition, dynapenia, geriatric depression, BADL and IADL scores (all p < 0.05). In multivariate analysis, after adjusting for all confounding variables except for dynapenia, patients with anemia were associated with reduced BADL and IADL (all p < 0.05). After adjusting for all confounding variables including dynapenia, deterioration in total BADL and IADL scores did not remain significant in the anemic group compared to the non-anemic group (p > 0.05).ConclusionClose to one in two older outpatient men had anemia. Anemic men had a higher incidence of DM, CHF, CKD, malnutrition, geriatric depression and dynapenia. Anemia was associated with dependence in both BADL and IADL in older men. However, comorbidities, nutritional status, depressive mood and, specifically muscle strength, were important contributors to this association.

Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment.

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51). In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.

Cognitive frailty in older adults: examining the impact of frailty criteria on neuropsychological profile, functional outcomes, activity levels, and quality of life.

Cognitive frailty (CF) is the co-existence of cognitive impairment and physical frailty without dementia, conferring greater risks of adverse clinical outcomes compared to either condition alone. However, the impact of physical frailty components on cognitive performance remains unclear. This study aims to evaluate CF by determining the neuropsychological profiles, functional outcomes, activity levels, and quality of life across the Fried Frailty Phenotype (FFP) and its components. Cross-sectional study involving 120 community-dwelling older adults without dementia, but with subjective cognitive complaints (SCC, defined as AD8 ≥ 1). Participants were stratified into three groups to assess CF: SCC-Robust, SCC-Prefrail, and SCC-Frail, and further categorized by individual FFP components. Cognitive performance was assessed by comparing neuropsychological test battery (NTB) Z-scores between CF and non-CF groups with Cohen's d for effect sizes. We performed linear regression to examine the relationships between both groups with NTB scores, Instrumental Activities of Daily Living (IADL), Frenchay Activities Index (FAI), and quality of life scores. NTB scores showed no differences between individuals with CF when classified according to FFP criteria. Individuals with SCC-slow gait speed exhibited reduced processing speed (d = 0.62) and memory (d = 0.61); SCC-fatigue was associated with decreased working memory (d = 0.55). Regression analyses, adjusted for demographic and clinical variables, identified significant associations: slow gait speed with logical memory (-0.42; 95% CI -0.79 to -0.038]) and symbol search (-0.28; 95% CI -0.56 to -0.006]); fatigue with digit span backwards (-0.66; 95% CI -1.19 to -0.14) and color trails 2 (-0.67; 95% CI, -1.15 to -0.20). SCC-slow gait speed and SCC-fatigue were associated with reduced quality of life scores, but not with IADL and FAI scores. Specific frailty components, notably slow gait speed and fatigue, influence cognitive function and quality of life. Our findings provide greater insights into characterizing CF. Further longitudinal studies are required to determine the cognitive and functional trajectories of CF.

Implications of cognitive and daily living capabilities on early type 2 diabetes management: a preliminary case–control study

BackgroundAdherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40–74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country.MethodsA case–control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson’s r.ResultsThe primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0–0.26). In linear regression analysis among MoCA-B and IADL scores, “delayed recall” and “orientation” domains from MoCA-B, and “managing medications” and “using the phone” from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B’s “orientation” with IADL’s “using the phone” and “managing medications” (p-values < 0.0001).ConclusionSuperior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients’ instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.

The subgroup analysis by age and geriatric assessment in a phase III study comparison of trastuzumab emtansine with trastuzumab, pertuzumab, and docetaxel in older patients with advanced stage HER2-positive breast cancer (JCOG1607 HERB TEA study).

1031 Background: The JCOG1607, HERB TEA Study, is a phase III trial that compared trastuzumab emtansine (T-DM1) with the HPD regimen (trastuzumab, pertuzumab, docetaxel) in older patients with advanced HER2-positive breast cancer. The primary objective was to confirm the non-inferiority of T-DM1 to HPD in overall survival (OS), with a margin of 1.35 for hazard ratio (HR). The trial was terminated early due to futility at the planned first interim analysis. T-DM1 didn't show non-inferiority to HPD in OS (HR 1.263; 95% confidence interval [CI], 0.677-2.357). Median progression-free survival (PFS) was 11.3 months for T-DM1 and 15.6 months for HPD (HR 1.373; 95% CI, 0.917-2.056). However, the condition of older patients varies widely, and we conducted a subgroup analysis to investigate the subgroup that could benefit from T-DM1 with fewer side effects as a first-line treatment. Methods: Subgroup analysis for OS and PFS involved 148 patients enrolled in JCOG1607, considering age and PS (&lt;75 years old and PS 0,1 or &lt;75 years old and PS 2 or ≥75 years old), Geriatric 8 (G8) score (≥15 or &lt;15), Instrumental Activity of Daily Living (IADL) score (8 or &lt;8), visceral/brain metastasis presence (with or without), and other factors. Results: Subgroup of &lt;75 and PS 2 was not evaluable. For OS, HR of T-DM1 arm to HPD arm was 0.749 (95% CI: 0.310-1.808) in the group aged &lt;75 years, while 2.867 (95%CI: 1.018-8.069) in the group aged ≥75 years (Table). G8 score and the IADL score did not show significant differences in HR for OS, although low G8 score group and low IADL score group tended to have higher OS in HPD arm than T-DM1 arm: HR of T-DM1 arm to HPD arm of 1.541 (95% CI: 0.755-3.142) in low G8 score group and 2.147 (95% CI: 0.656-7.025) in low IADL score group. For PFS, patients with visceral/brain metastasis had HR of T-DM1 arm to HPD arm of 1.794 (95% CI: 1.092-2.948). No other subgroup showed a significant difference in HR for PFS. Conclusions: No subgroups benefiting from T-DM1 as first-line treatment were identified. HPD remains the standard for advanced HER2-positive breast cancer, regardless of age (even in ≥75 years) G8 score, or IADL. Clinical trial information: UMIN000030783. [Table: see text]

Trajectories of activities of daily living according to dementia among middle-aged and older people in South Korea: a longitudinal study from 2006 to 2020 (14 years).

The aging population in South Korea faces numerous health challenges, one of which is the decline in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study aims to investigate the patterns of change in ADL and IADL among older adults and examines how these patterns vary between individuals with and without dementia. We conducted an analysis of data collected from the Korea Longitudinal Study of Ageing (KLoSA) between 2006 and 2022. Our cohort consisted of individuals aged 45 and older with non-dementia conditions, including mild cognitive impairment (N=6042), and a smaller group with dementia (N=91). Using Latent Growth Curve Models, we explored the developmental trajectories of ADL and IADL among our sample. Our findings indicate a linear decline in both ADL and IADL scores as individuals age. The decline in IADL was more pronounced in the dementia group, suggesting a greater sensitivity to sociocultural factors within this domain. The data revealed that individuals with dementia had consistently lower ADL and IADL scores. Notably, the variance in scores within the dementia group increased with age, signifying a worsening in daily living performance and an increase in individual variation (F=226.630, p<.001). The results of this study underscore the impact of dementia on both the self-regulation function and the social and cultural aspects of daily living performance, particularly reflected in IADL scores. These findings point to the necessity for comprehensive care strategies that address the multifaceted needs of older adults with dementia, including support for complex daily activities that are influenced by sociocultural factors.

Home-based supportive and health care services based on functional ability in older adults in Iran.

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Risk factors of dementia cognitive symptoms among older patients in Vietnam: A cross-sectional study

Background. Dementia has emerged as a significant contributor to declining quality of life and stands as a prominent factor in the increase of disability and dependency among elderly populations globally. This study aimed to explore the relationship between cognitive symptoms of dementia and their risk factors in individuals aged 60 years and older among Vietnamese outpatients who visited Geriatrics Clinic at University Medical Center of Ho Chi Minh city, Vietnam. Methods. 387 participants who were aged ≥ 60 years old were included in the cross-sectional study. Cognitive impairment was assessed by using the Mini Mental State Evaluation (MMSE) questionnaire. The functional limitations in activities of daily living (ADL) and Instrumental Activities of Daily Living (IADL), multimorbidity, and polypharmacy were also evaluated. Frailty was determined by The Canadian Study of Health and Aging Clinical Frailty Scale. Suffering dementia was determined when MMSE score was below 24 and IADL score less than 8. Results. People with dementia cognitive symptoms accounted for 22.74 % of the cohort. The percentage increased with age, and was higher in women than in men. Factors that increased the odds of having dementia symptoms were of older age, female, multimorbidity, Frailty Scale &gt; Grade 4 and ADL dependency. Conclusions. Age, female gender, multimorbidity, frailty and ADL dependency were considered as risk factors of dementia cognitive symptoms among the Vietnamese people aged 60 years and older.

Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study.

This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling. Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001). Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.

Efficacy and safety of combining ginkgolide diterpene glucosamine injection with dual antibodies in elderly patients with acute ischemic stroke

Purpose: To investigate the clinical effects and safety of ginkgo biloba diterpene lactone glucosamine injection, combined with dual antibiotic therapy for acute ischemic stroke in elderly individuals within a hyper thrombolytic time window. &#x0D; Methods: 100 elderly patients with acute ischemic stroke at Changsha First Hospital, Changsha, China from March 2022 to March 2023 were randomly and equally assigned to study and control groups (50 patients each). Study group received aspirin and clopidogrel, while control group received ginkgo biloba diterpene lactone glucosamine injection along with dual antibodies. Clinical efficacy, National Institutes of Health Stroke Scale (NIHSS) score, Instrumental Activities of Daily Living (IADL) score, cerebral hemodynamics, and safety were compared between the two groups. &#x0D; Results: There was no significant difference in effective rate between the two groups (p &gt; 0.05). However, following treatment, study group showed superior NIHSS and IADL scores compared to control group, with greater statistical significance as the disease progressed. Doppler ultrasound revealed that study group had smaller Pulsatility index (PI) values and larger mean cerebral artery blood flow velocity (Vm), and systolic value (Vs) compared to control group (p &lt; 0.05). In study group, three adverse reactions were reported (gastrointestinal discomfort, abnormal liver/kidney function, and skin itching), whereas the control group experienced five adverse reactions (gastrointestinal discomfort, abnormal liver/kidney function, dizziness, and skin itching). &#x0D; Conclusion: The combination of Ginkgo biloba diterpene lactone glucosamine injection and dual antibodies in elderly individuals with acute ischemic stroke within a super thrombolytic time window enhances intracerebral blood flow levels, effectively promotes neurological recovery, improves daily living abilities, and safety. Further research is needed to elucidate the exact pathways involved.

Fragility fractures of the pelvis: First 48 cases of surgical treatment at a level 1 trauma center in France

IntroductionLonger life expectancy is accompanied by a higher incidence of fragility fractures of the pelvis (FFP), which has repercussions on mortality and nursing home admissions. Given the paucity of data at French healthcare facilities, we carried out a retrospective study to (1) evaluate how surgical treatment of FFP with posterior displacement (type III and IV according to Rommens and Hofmann) affects a patient's pain, functional status and ability to stay at home and (2) evaluate the postoperative complications and mortality rate. HypothesisSurgery for posteriorly displaced FFP will relieve pain and preserve the patient's independence. MethodsAll the patients over 65 years of age who were operated on for a posterior FFP between January 2015 and August 2020 were included in this prospective, single-center study. The demographics, fracture type, details of the surgical treatment, complications and mortality were analyzed. Pain (visual analog scale, VAS), functional status (Activity of Daily Living [ADL] and Instrumental Activity of Daily Living [IADL]), mobility (Parker score) and rates of nursing home admissions were compared before the fracture, after surgery and at a mean follow-up of 28 months (minimum follow-up of 1 year). ResultsForty-eight patients with a mean age of 75 years were included. Twenty-four of these patients (50%) had at least two comorbidities. The FFPs were either type IV (31/48; 65%) or type III (17/48; 35%). The mean VAS for pain was significantly lower on the first day postoperative (3.5 versus 4.8; p=0.02). This significant reduction continued upon discharge from the hospital (1.95; p=0.003) and persisted at the mean follow-up of 28 months (2.2; p=0.64). The complication rate was 15% (7/48) and the mortality rate at the final review was 15% (7/48). Among the surviving patients, 81% (29/36) returned to living at home. The ADL (5.1 versus 5.8; p=0.09), IADL (5.9 versus 6.9; p=0.15) and Parker score (6.8 versus 8.2; p=0.08) at the final review were not significantly different from the values before the fracture. ConclusionThis is the first French study of patients operated on for an FPP. Fixation of posteriorly displaced fractures allows surviving patients to retain their mobility. Pain relief is achieved quickly and maintained during the follow-up period. Thus, our initial hypothesis is affirmed. The complication rate is not insignificant; given the complexity of this surgery, percutaneous treatment is preferable. Level of evidenceIV; retrospective study.

Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study.

The purpose of this study was to investigate the relationship between anticholinergic burden (ACB), and cognitive and functional alterations in patients with dementia of Lewy bodies (DLB) during a 1-year follow-up period. This cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0. A total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (all P<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment. Our study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.

Instrumental activities of daily living in older patients with metastatic prostate cancer: results from the meet-URO network ADHERE prospective study

Instrumental activities of daily living (IADL) are significant health indicators closely related to executive functions and able to detect mild cognitive impairment. A decline in IADL usually precedes ADL limitation, including taking medications, and may therefore predict a cognitive decline. We aimed to investigate the association of patients’ IADL score with other clinical factors, with a particular focus on the presence of a caregiver, and the impact on adherence to androgen receptor pathway inhibitors (ARPIs) and survival outcomes within the Meet-URO 5—ADHERE study. It was a large prospective multicentre observational cohort study monitoring adherence to ARPIs in 234 metastatic castrate-resistant PC (mCRPC) patients aged ≥ 70. We observed an association between impaired IADL and lower geriatric G8 scores (p < 0.01), and lower adherence to ARPIs whether assessed by pill counting (p = 0.01) or self-reported by the patient himself (p = 0.03). The combination of an IADL < 6 and the absence of a caregiver resulted in a significantly high risk of non-adherence to the ARPIs at the multivariable analysis (HR 9.23, 95% confidence interval 2.28–37.43, p = 0.01). IADL alongside the geriatric G8 scales represent essential tools to identify frail and less auto-sufficient patients who are extremely vulnerable particularly if not supported by a caregiver and have the highest risk of nonadherence to ARPIs.

Effects of physical activity participation on cognitive impairment in older adults population with disabilities.

Existing research on the association between cognitive function and physical activity in the older adults population with disabilities is limited. Additionally, there is a need to explore avenues for enhancing the longevity and quality of life among these individuals. This study aimed to investigate the independent and joint associations between cognitive function and levels of physical activity in the older adults population with disabilities. A total of 315 older adults adults (men = 182, women = 133), identified with disabilities based on medical evaluation, were recruited from the first survey of the Korean Longitudinal Study of Aging (KLoSA). Participants underwent assessments for cognitive function, physical activity (PA), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and grip strength. ADLs (p < 0.001) and IADLs (p < 0.001) scores were significantly higher in the male normal cognitive group compared to both the male and female cognitive impairment groups. In an unadjusted model, disabled older adults individuals who did not meet the recommended PA guidelines showed an increased odds ratio for cognitive dysfunction (OR = 2.29, 95% CI = 1.32-3.97). Those participating in PA at least 1 day per week also demonstrated an elevated odds ratio (OR = 1.22, 95% CI = 1.08-1.38) for cognitive dysfunction compared to those who engaged in regular PA. A negative correlation was observed between K-MMSE scores and grip strength (r = 0.448, p < 0.001). This study provides robust evidence that disabled older adults individuals who do not meet the recommended guidelines for PA or who do not participate in PA at least once a week have an increased likelihood of cognitive impairment compared to those who are regularly active.

Utility values and electronic device use in low-vision people attending rehabilitation services: Data from a nation-wide registry in Italy.

To estimate utility values associated with visual loss using EuroQol (EQ-5D) questionnaire, the impact of low-vision (LV) device use on utilities and the contribution of Instrumental Activities of Daily Living (IADL) score in patients attending vision rehabilitation (VR) services enrolled in the Italian Device & Aids Register (D.A.Re). This is a multicenter, prospective, cross-sectional study. D.A.Re. collects general and clinical information, vision-specific variables, use of electronic devices and quality of life questionnaires. A total of 442 patients (75.0±16.6 years, 275 female) were included, 88 (19.9%) used specialised electronic LV devices, and 116 (26.2%) used smartphones and tablets. Users of smartphones and tablets were younger than non-users (67.5 vs. 77.6 years, p<0.001), but overall, their age ranged between 20 and 93. Stronger associations were found between vision-specific variables and IADL score compared to EQ-5D score. In multivariable age-adjusted models, the utility value of using smartphones and tablets on EQ-5D score was 0.12 (p<0.01), slightly larger than that of 1.0 logMAR difference (-0.09, p<0.01) or visual field damage within 10° of fixation (-0.10, p<0.01). Use of portable low-vision electronic devices and being employed or student (vs. retired) was also associated with better utility values (0.12 and 0.15, respectively, p<0.05). Visual loss is associated with loss of utilities in Italian patients attending VR services, whereas special-purpose electronic aids, and smartphone and tablet use are associated with better utility values. We found that IADL may be more sensitive to visual loss than EQ-5D and could be a valid health-related quality of life outcome in trials on VR.

HIGHER STRESS AMONG ETHNIC MINORITY ADULT-CHILD CAREGIVERS COMPARED TO SPOUSAL CAREGIVERS IN DEMENTIA CARE

Abstract Ethnic minority family caregivers of persons with dementia (PWD) suffer from negative health conditions resulting from continuous care responsibility for PWD. While adult-child caregivers have additional family care and job responsibilities, cultural and linguistic needs in ethnic minority families further compound caregiving challenges. Little research examines ethnic minority caregivers’ health statuses. This study aimed to understand the emotional health status and dementia care experiences of minority caregivers, between spouses and adult-children. The study collected cross-sectional survey data on perceived stress and utilizations of caregiving resources: Alzheimer’s agencies, state-funded in-home supportive service, adult-day service, support groups, and caregiving education. Recruitment focused on diverse communities with special emphasis on minority caregivers who speak Spanish, Vietnamese, or Korean in California. Seventy-six caregivers participated in surveys in their respective language; 42% Korean, 38% Vietnamese, 20% Spanish; 49% spouses/partners vs 51% adult-children/grandchildren; 78% females; 55% PWD with Medicaid; Mean English Proficiency (EP) of 3/5(1.3). Sixty-four percent of adult-child caregivers were employed (full-time or part-time) compared to 5% of spousal caregivers (P&amp;lt;.05). Adult-child caregivers showed higher stress compared to spousal caregivers (P&amp;lt;.05) despite no differences in PWD’s activities of daily living (ADL) scores and instrumental ADL scores. Although EP of adult-child caregivers was higher than spousal caregivers (P&amp;lt;.05), both caregivers underutilized care resources and showed little awareness of Alzheimer’s agencies. Findings demonstrated higher caregiving stress of adult-child caregivers compared to spousal caregivers of PWD among minority groups. Tailored interventions with appropriate language and cultural aspects should consider the caregiver’s relationship to the PWD.