Katz Activities Of Daily Living Research Articles

#2303 Evaluating symptom burden and decision making in older people with advanced chronic kidney disease (CKD): a cross-sectional service evaluation

Abstract Background and Aims The benefits of dialysis compared with conservative management (CM) are less certain in older people with advanced chronic kidney disease (CKD) living with frailty and multimorbidity. Symptom burden and quality of life can worsen following dialysis initiation; studies have reported that patients can experience dialysis decisional regret. We conducted a cross-sectional service evaluation to understand symptom burden, experience of shared decision making and decisional regret for older people receiving haemodialysis (HD) and CM at our trust. Method People from our trust aged 65 and older receiving HD (for 3 to 12 months) or CM were recruited between April and May 2023. Patients were approached on HD units or via telephone. Baseline demographic and clinical characteristic data were obtained from electronic patient records. A Clinical Frailty Scale (CFS) assessment was performed for each patient using the CFS app. Patients with a CFS score ≥5 were categorized as frail. Activities of daily living (ADL) were assessed using the KATZ ADL index. Patients completed questionnaires evaluating symptom burden (IPOS-Renal), experience of shared decision making (SHARED questionnaire) and decisional regret (Decision Regret Scale). Information about advance care planning (ACP) was recorded. Mann-Whitney U, independent samples T-tests, Chi-squared, and Pearson's correlation coefficient were calculated using Statistical Package for Social Scientists (SPSS). Results Twenty-five HD and 25 CM patients were included with mean age of 74.7 (SD=5.9) and 83.2 (SD=5.2) years old, respectively. Eleven (44%) HD patients and 9 (36%) CM patients were female. The most common co-morbidities were hypertension (n=32, 64%), diabetes (n=16, 32%) and ischaemic heart disease (n=14, 28%). There was no significant difference in frailty (HD n=15 [60%], CM n=17 [74%], p=0.307) or KATZ ADL score between the two groups (p=0.124) There was no significant difference between mean total IPOS-renal scores (HD 13 [SD=8.5], CM 15 [SD=8], p=0.395). CM patients were significantly more affected by dyspnoea (p=0.014) and drowsiness (p=0.036). HD patients experienced more wasted time for appointments (p=0.001), mostly related to transportation issues. CM patients had more discussions about other treatment options aside from the one chosen (p=0.036), had their opinions sought more (p=0.038) and felt welcome to consider different options (p=0.018). HD patients felt more informed that there was a preferred medical treatment for their advanced CKD (p=0.006). HD patients regretted their treatment option more than CM patients (p=0.028). A moderately-negative correlation was found between shared decision making and regret (r=-0.455, p<0.001). Finally, CM patients had more ACP decisions documented than HD patients (CM n=14 [58%], HD n=6 [26%], p=0.025). Conclusion Symptom burden was similar between CM and HD patients (see Fig. 1). HD patients felt less involved during decision making than CM patients and experienced more regret about their treatment choice. It is vital that all treatment options, including CM, are openly and impartially discussed with patients to truly ensure shared decision making and minimise the likelihood of decisional regret.

A study to assess the health care utilization and the activities of the daily living status amongst the geriatric population residing in urban and rural field practice areas of a medical college in Tamil Nadu

Background: The prevalence of disability in the activities of daily living (ADL), could probably have a significant impact on the healthcare utilization amongst the geriatric population with disability. Methods: A cross-sectional study in the urban and rural field practice areas of a medical college in Tamil Nadu, using a sample size of 402 elderly individuals. Using the pre-tested, semi-structured questionnaire; the socio-demographic variables, healthcare utilization variables and a comprehensive Katz ADL assessment were used. Results: The overall prevalence of ADL limitation amongst the elderly was seen in 49 (12.2%) elderly individuals mostly with a score of 5 (mildest form) was found in 36 (74%) of the elderly. There was an association found between the follow-up care at health centres, frequency of visits, distance from home to health centres and the ADL limitation with a P- value less than 0.05 (C.I.-95%) using the Pearson chi-square test using SPSS v.26.0. Conclusions: The association between ADL limitation and healthcare utilization calls for initiatives at the family and community level.

The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years

BackgroundPremorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival.MethodsProspective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients ≥ 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS).ResultsOverall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3–6). Frailty (CFS ≥ 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving > 6 months were slightly younger (median age survivors 84 with IQR 81–86) than patients dying within the first 6 months (median age 84, IQR 82–87, p = 0.013), were less frequently frail (CFS > 5 in 19% versus 34%, p < 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5–6 versus 6 points, IQR 3–6, p < 0.01).ConclusionsWe found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making.ClinicalTrials.gov: NCT03370692.

Undernutrition in obese older adults by fat percentage

ObjectiveThe prevalence of obesity by fat percentage has seen a steady increase in older adults in recent years, secondary to increases in fat mass in body composition, even in healthy aging. Malnutrition is a common geriatric syndrome with serious clinical outcomes. Increases in fat mass and waist circumference with healthy aging should not prevent the risk of malnutrition from being masked. Malnutrition is often ignored in obese older people due to low BMI cut-off values in many screening tests. The present study seeks to raise awareness of the need to assess the frequency of undernutrition and related factors in obese older adults.MethodsThe data of 2013 community-dwelling patients aged ≥ 60 years who applied to a university geriatrics outpatient clinic between April 2012 and November 2022 were analyzed retrospectively, of which 296 were found to be obese based on fat percentage and were included in the study. Demographic data and the presence of any geriatric syndromes were obtained retrospectively from the patient files, functional status was assessed using the KATZ Activities of Daily Living (ADL) Scale and the LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL); frailty was screened using FRAIL-scale; and the sample was assessed for malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF), with undernutrition defined as an MNA-SF score of ≤11.\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le 11.$$\\end{document} The patients’ fat percentage and weight were measured using a bioimpedance analyzer. Fatty obesity was defined using the Zoico methodology (fat percentage ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 27.3% for males, ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document} 40.7% for females),\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$,$$\\end{document} handgrip strength (HGS) was measured using a hand dynamometer, and probable sarcopenia was defined as low HGS based on regional cut-off values (35 kg for males, 20 kg for females).ResultsThe mean age of the 296 fatty obese older adults (102 males/194 females) was 74.4 + 6.5 years, and the median fat was 42.2% (27.4–59.5). Undernutrition was detected in 19.6% of the patients based on MNA-SF screening. A univariate analysis revealed age, sex, educational status, daily physical activity status, depression, difficulty in swallowing, chewing difficulty, probable sarcopenia, number of chronic diseases, and IADL to be associated with undernutrition, while a multivariate logistic regression analysis revealed depression [OR = 3.662, 95% CI (1.448–9.013), p = 0.005] and daily physical activity status [OR:0.601, 95% CI (0.417–0.867), p = 0.006] to be independently associated with malnutrition in obese older adults based on fat percentage.Conclusion The present study clarifies the significance of undernutrition in obese older adults also in our country, and recommends undernutrition screening to be carried out, by fat percentage, on obese older adults, especially with depression and low daily physical activity.

Effectiveness of a combined lifestyle intervention for older people in long-term care: A randomized controlled trial

PurposeLifestyle medicine interventions combining physical, nutritional, and psychological components have been found effective in general older population. However, evidence from the long-term care (LTC) is scarce. MethodsWe conducted a pragmatic, two-arm, parallel group, superiority randomized controlled trial. Residents living in a LTC facility for one or more years, able to discern and to express informed consent, and requiring nursing care were considered eligible. The three-months intervention combined bi-weekly physical exercise groups, a healthy diet, and weekly psychological wellbeing sessions. Patients of the control group were subjected to routine care. At the end of the study participants were assessed using Barthel Index, Katz Activities of Daily Living, and Tinetti scales. ResultsA total of 54 patients with a mean age of 84 years took part to the study. Physical exercise and psychological wellbeing sessions were mostly attended by all the subjects of the intervention group. Both groups took less calories than planned in the diets; in addition, the intervention group showed a lower energy and carbohydrates intake than the control group. At the end of the study, the intervention group showed a significant improvement in the total scores of all the scales. ConclusionsThis intervention was effective in improving functionality in older people living in the LTC setting. Results were achieved in a short timeframe, likely due to synergistic interactions between components. However, a further exploration of underlying factors is needed, to better understand the barriers that hampered a complete intervention delivery in this context.

Patient-reported sleep and physical function during and after hospitalization

PurposePoor sleep is associated with morbidity and mortality in the community; however, the health impact of poor sleep during and after hospitalization is poorly characterized. Our purpose was to describe trends in patient-reported sleep and physical function during and after hospitalization and evaluate sleep as a predictor of function after discharge. MethodsThis is a secondary analysis of trial data with 232 adults followed for 3months after hospital discharge. Main measures were patient-reported surveys on sleep (Pittsburgh Sleep Quality Index) and physical function (Katz Activities of Daily Living, Lawton Instrumental Activities of Daily Living, and Nagi Mobility Scale) were collected during hospitalization and at 1, 5, 9, and 13weeks postdischarge. ResultsPatient-reported sleep declined significantly during hospitalization and remained worse for 3months postdischarge (median Pittsburgh Sleep Quality Index=8 vs. 6, p < .001). In parallel, mobility declined significantly from baseline and remained worse at each follow-up time (median Nagi score=2 vs. 0, p < .001). Instrumental activities of daily living similarly decreased during and after hospitalization, but basic activities of daily living were unaffected. In adjusted time-series logistic regression models, the odds of mobility impairment were 1.48 times higher for each 1-point increase in Pittsburgh Sleep Quality Index score over time (95% CI 1.27-1.71, p < .001). ConclusionsPatient-reported sleep worsened during hospitalization, did not improve significantly for 3months after hospitalization, and poor sleep was a significant predictor of functional impairment over this time. Sleep dysfunction that begins with hospitalization may persist and prevent functional recovery after discharge. Trial registrationThe primary study was registered at ClinicalTrials.gov NCT03321279.

IMPACTS OF ACCULTURATION ON HEALTH OF US OLDER CHINESE IMMIGRANTS

Abstract Acculturation from Asian- to Western-oriented values and cultural practices is a key aspect of social experience for many Asian Americans. The growing body of literature on this topic shows mixed findings on health impacts of acculturation and is largely relied on cross-sectional studies, preventing to draw definitive conclusions on the health impact of acculturation. The study aimed to examine long-term effects of acculturation on mental, physical, and cognitive health in U.S. older Chinese immigrants. Data were drawn from 2,811 participants (aged from 60 to 104 years) from the Population Study of Chinese Elderly in Chicago study. Acculturation was measured using a 12-item Acculturation Scale assessing language use, ethnic social relations, and media use. Health outcomes included depression assessed using the Patient Health Questionnaire-9, activities of daily living (ADL) assessed using the adapted Katz ADL Scale, and global cognition indexed by a composite score of episodic memory, working memory, executive function, and mental status. Results from latent growth curve models showed that high levels of acculturation were not associated with depression at baseline but predicted a faster decline in depression during the 6-year follow-up. Similarly, acculturation was not related to ADL at baseline but predicted a slower decline over time. Contrarily, acculturation was associated with better global cognition at baseline but was not related to long-term changes in cognition. These results suggest the long-term benefits of acculturation on mental and physical health among U.S. older Chinese immigrants. The health advantages related to acculturation, however, seem not to generalize to cognitive function.

Comparison between Elderly Attenders and Non-Attenders of Pusat Aktiviti Warga Emas in Sarawak

Malaysia is not left behind as it is going towards becoming an aging nation. Currently, there are 10.7% of the population who are above 60 years old which is equivalent to 3.5 million of elderly people and this is expected to rise in the near future. The objective of this research is to compare the quality of life, activities of daily living, cognitive function and depression between elderly attenders and non-attenders of Pusat Aktiviti Warga Emas (PAWE). In this cross-sectional study, a total of 735 elderly participated where 101 elderly who attended PAWE and the remaining 634 elderly did not attend PAWE. Older People’s Quality of Life (OPQOL), Prospective Retrospective Memory Questionnaire (PRMQ), Geriatric Depression Scale (GDS), Katz Activities of Daily Living and Lawton Instrumental Activities of Daily Living were used as study instruments. The statistical analysis involved were Pearson’s correlation, independent t-test, Partial Least Square Structural Equation Modeling (PLS-SEM) and multiple group analysis. Household income and activities of daily living have shown positive correlation with quality of life. Cognitive function and depression correlated negatively with quality of life. Based on PLS-SEM, there was better quality of life, activities of daily living, cognitive function, and lesser depressive symptoms among elderly PAWE attenders. The findings obtained from this study will be able to support the planning and future programs of expanding senior activity centres such as PAWE as it promotes healthy ageing among elderly people.

Hospital Associated Disability Among Older Adults with Plasma Cell Disorders Receiving Autologous Stem Cell Transplant

Background: An increasing number of older adults with Plasma Cell Disorders (PCDs) are receiving autologous stem cell transplant (ASCT) in the US. Hospital associated disability (HAD) is a loss in independence in one or more activities of daily living associated with acute care hospitalization and is a common complication among older adults. The prevalence and prognostic significance of HAD among older adults with PCDs undergoing ASCT is unknown. Methods: This retrospective cohort study used consecutive adults receiving ASCT at a large U.S. comprehensive medical center between 1/2013 and 5/2023. Trained nursing staff assessed Katz Activities of Daily Living (ADL) at admission and every 3 days thereafter under our Virtual Acute Care for Elders program. The primary outcome was development of HAD defined as ≥1 point decline on the Katz ADL scale from hospital admission to discharge. We also examined the association between development of HAD and various predictors including age, Karnofsky Performance Status (KPS), and Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) using modified Poisson regression models with robust variance estimators. Using similar models, we studied the impact of HAD on unplanned 30-day readmission rates. Results: Of 870 patients undergoing ASCT during the study period, 778 had at least two Katz ADL assessments and were included. The study population was comprised of 56% Caucasian/white ethnicity and 56% male with a median age of 62y (IQR 55-68y). In the overall population, 112 (14.4%) developed HAD. The incidence of HAD was much higher among adults ≥65y compared to their younger counterparts (22% vs. 9%; p=&amp;lt;0.01). In multivariate analysis, age ≥65y (RR 2.22; 95% CI 1.56-3.15; p=&amp;lt;0.001) and baseline KPS &amp;lt;=70 (RR 1.83; 95% CI 1.15-2.92; p=0.011) was associated with increased risk of developing HAD; HCT-CI scores did not have a significant association with HAD. Those with HAD had a two-fold higher risk of 30-day readmission as compared to those without HAD (RR 2.18; 95% CI 1.20-3.66; p=0.003). Conclusions: Nearly 1 in 4 adults ≥65y developed HAD while undergoing ASCT, which was associated with a two-fold increased risk of 30-day readmission. Interventions to prevent HAD and its downstream consequences are critically needed.

Abstract 19041: The Role of Social Support in Functional Status and Physical Activity in Patients With Coronary Heart Disease: A 20-Year Analysis From the Heart and Soul Study

Introduction: Living with coronary heart disease (CHD) significantly impacts patients’ daily activities and physical exercise. Social support influences functional status and physical activity in patients with CHD. Multiple dimensions of social support may be associated with activities of daily living (ADL) and physical activity (PA) outcomes in patients with CHD. Hypothesis: Is higher perceived social support positively associated with ADLs and PA in patients who have lived with CHD for over 20 years? Methods: We analyzed data from the Heart and Soul prospective cohort study from 3-time points: 2000-2002, 2005-2007, and new data that were collected in 2022 among survivors of the original cohort. We measured social support using the Interpersonal Support Evaluation List (ISEL) with appraisal, belonging, and tangibility dimensions. Functional status was assessed using the Lawton (instrumental ADLs [IADLs]) and Katz scales (ADLs) and self-reported PA. Logistic mixed-effects models were employed, adjusting for ISEL dimensions, age, gender, socioeconomic status, ethnicity, marital status, and time. Results: Among 680 patients [(mean age at baseline 65.9 (SD10.2); 121 females (17.8%)], higher levels of appraisal (OR: 1.08; CI: 1.01-1.16) and belonging support (OR: 1.12; CI: 1.05-1.20) were significantly associated with higher IADL scores in the Lawton scale. Only belonging was significant in the Katz ADL scale (OR: 1.11; CI: 1.00-1.29). The tangible dimension was not significant in both scales. All dimensions exhibited significant positive associations with PA, with belonging support showing the strongest association (OR: 1.11; CI: 1.05-1.18) (P &lt;.05 &amp; 95% CI). A positive trend was observed between ADL and PA with ISEL dimensions, warranting further investigation of potential time-dependent effects. Conclusions: In this study examining 3-time points over 20 years, social support dimensions emerged as predictors of improved ADL and increased PA in patients with CHD. Results emphasize the need to foster social support as part of long-term care strategies.

Health-Related Quality of Life (HRQoL) in Fit, Unfit and Frail Patients Enrolled in Fitness (UK-MRA Myeloma XIV): A Cross Sectional Study

Introduction In the UK in 2016-2018, more than 4 in 10 new diagnoses of multiple myeloma (MM) were in people aged at least 75 years old. Transplant-ineligible (TNE) patients are a heterogeneous group that is not well-defined by age, but by the interplay of age, physical function, cognition and comorbidity better defined as ‘frailty’. There is little evidence on the effect of frailty on HRQoL in patients with MM. We examined patient-reported outcomes from participants enrolled in the FiTNEss study to understand HRQoL according to frailty group and the contribution of different elements of the International Myeloma Working Group (IMWG) frailty score (FS) to HRQoL. Methods FiTNEss (UK-MRA Myeloma XIV, NCT03720041) is a phase III, multi-centre, randomised controlled trial for newly diagnosed TNE MM patients. Patients receive lenalidomide, ixazomib, and dexamethasone induction and maintenance, comparing frailty score-adjusted up-front dose reductions and standard up-front dosing followed by toxicity dependent reactive dose adjustments. Frailty was defined using the IMWG FS. It includes age (&amp;lt;75y, 75-80y, &amp;gt;80y), Katz Activity of Daily Living (ADL&amp;lt;=4), Lawton Instrumental Activity of Daily Living (IADL&amp;lt;=5), and the Charlson Comorbidity Index (CCI&amp;lt;=1). The UK-MRA Myeloma Risk Profile (MRP) 1 was scored using age, performance status (PS), ISS and CRP. HRQoL was measured by EORTC QLQ C30 and MY20 completed at trial entry. We used a one-way ANOVA and two-sample unequal variance t-tests to compare subscales in different frailty groups. We sought minimally important differences that were at least medium size 2, and adjusted p-values using the Bonferonni correction for the 19 subscales (adjusted P = 0.05/19 = 0.0026). Results Baseline HRQoL was available for 559 trial participants. Median age was 77y (&amp;lt;75y: 183 [32.7%], 75-80y: 248 [44.4%], &amp;gt;80y 128 [22.9%]), 307 (54.9%) were male and 427 (76.2%) ECOG PS0-1. 160 (28.6%) patients were classified as Fit, 182 (32.6%) were Unfit and 217 (38.8%) were Frail according to IMWG FS. 105 (18.8%) patients had CCI &amp;lt;=1, 60 (10.7%) had ADL&amp;lt;=4 and 115 (20.6%) had IADL &amp;lt;=5. 167 (31.0%) patients were classified as low risk, 180 (33.5%) were intermediate risk and 191 (35.5%) were high-risk according to MRP. Contrasting IMWG fit, unfit and frail patients, significant differences were evident in 7 of 15 C30 subscales (Global Health Status [QL], Physical [PF], Role [RF], Cognitive [CF] and Emotional Functioning [EP], Appetite loss [AP], Dyspnoea [DY]) and 1 of 4 MY20 subscales (Side Effects [MYSE]) (Figure A). The largest differences in subscales were between the Fit/Unfit and Frail groups with only a single nominally different subscale (PF) between Fit and Unfit. When comparing the frailty score elements, age group and CCI were not significantly different using C30 or MY20 subscales. However, when considering ADL: 11 of 15 C30 (QL, PF, RF. CF, Social Functioning [SF], Fatigue [FA], Pain [PA], AP, Constipation [CO], DY, Financial Problems [FP]) subscales and 2 of 4 MY20 subscales (Disease Symptoms [MYDS], MYSE) were significantly different. Similarly, when considering IADL: 10 of 15 C30 subscales (QL, PF, RF, CF, SF, FA, PA, AP, CO and DY) and 4 of 4 MY20 subscales (MYDS, MYSE, Body Image, Future Perspective Worries) were significantly different (Figure B). When comparing between MRP risk groups, 10 of 15 C30 subscales (QL, PF, RF, CF, SF, FA, PA, AP, CO and DY) and 2 of 4 MY20 subscales (MYDS, MYSE) were significantly different. Unlike IMWG FS, 5 subscales were nominally significantly different between low and medium risk groups (QL, PF, RF, SF, DY). Conclusion The IMWG FS is associated with several domains from EORTC QLQ-C30 and MY20 at baseline with worse function and symptomatology among frail patients. Examining FS elements show that age and comorbidities do not contribute to heterogeneity in HRQoL. However, ADL and IADL are significantly associated with HRQoL. ADL elements may identify components of frailty that are potentially modifiable through supportive care and rehabilitation and could enhance HRQOL and treatment tolerability in older patients. The MRP risk profile is associated with baseline HRQoL as shown previously and with a number of other subscales as shown here. There is evidence that the MRP can delineate subscales, including QL better than the IMWG FS. 1. Cook G, et al, The Lancet Haematology, 6(3): E154-E166. 2. Cocks K, et al, Journal of Clinical Oncology, 29(1): 89-96.

Associations of postoperative delirium with activities of daily living in older people after major surgery: A prospective cohort study.

To assess the association of postoperative delirium developed in the post-anaesthetic care unit (PACU) with older patients' ability to perform activities of daily living (ADL) during the first five postoperative days. Previous studies have focused on the association between postoperative delirium and long-term function decline, however the association between postoperative delirium and the ability to perform ADL, particularly in the immediate postoperative period, needs further investigation. A prospective cohort study. A total of 271 older patients who underwent elective or emergency surgery at a tertiary care hospital in Victoria, Australia, participated in the study. Data were collected between July 2021 and December 2021. Delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The Katz Index of Independence in Activities of Daily Living (KATZ ADL) scale was used to measure ADL. ADL was assessed preoperatively and daily during the first five postoperative days. The STROBE checklist was used to report this study. Results showed that 44 (16.2%) patients developed new episode of delirium. Postoperative delirium was independently associated with decline in ADL (RR = 2.83, 95% CI = 2.71-2.97; p < 0.001). Postoperative delirium was associated with a decline in ADL among older people during the first five postoperative days. Screening for delirium in the PACU is essential to identify delirium during the early stages of postoperative period and implement a timely comprehensive plan. Delirium assessment of older patients in the PACU, and for at least the first five postoperative days, is strongly recommended. We also recommend engagement of patients in a focused physical and cognitive daily activity plan, particularly for older patients undergoing major surgery. Patients and nurses helped in data collection at a tertiary care hospital.

An exploratory factor analysis and reliability analysis among Malaysian elderly

Low awareness and underdeveloped instruments evaluating elderly Malaysians’ well-being, social support, and independence necessitate lubben social network scale (LSNS), social provisions scale (SPS), Katz activities of daily living (ADL), and life satisfaction index (LSI) development and evaluation involving 201 60-year-old males and females (purposive samples) in Kuching and Bintulu participated (June to August 2022). Exploratory factor analysis (EFA) examined the construct validity of LSNS, SPS, Katz ADL, and LSI, whereas principal axis factoring (paf) and orthogonal (varimax) rotation with Kaiser Normalisation validated their psychometric properties and internal consistency reliability using Cronbach’s alpha. Social integration (0.94), reassurance of worth (0.91), attachment (0.90), sense of reliable alliance (0.78), and guidance (0.74) have eigenvalues &amp;gt;1 in the SPS-10 EFA; good Cronbach’s alpha reliability values. Family (0.77) and friends (0.73) of LSNS-6 factors have eigenvalues &amp;gt;1, good Cronbach’s alpha reliability values. Acceptance-contentment (0.87) and Achievement-fulfilment (0.72) had eigenvalues &amp;gt;1 in the Life Satisfaction Index-Z EFA, good Cronbach’s alpha reliability values. In the EFA of Katz ADL, single items with factor loadings ≥0.5: bathing, dressing, toileting, transferring, and feeding; loadings &amp;lt;0.3: Continence; Cronbach’s alpha reliability value was 0.95. LSNS, SPS, Katz ADL, and LSI were valid and reliable instruments measuring elderly well-being, social support, and independence. Confirmatory factor analyses will revalidate it in different populations.

Evaluation of fall risk and associated factors in patients with dementia

AbstractBackgroundFalling, which is common in the elderly and leads to negative consequences, can also be seen in dementia patients. The aim of this study is to determine the risk of falls in patients with dementia and to evaluate the factors associated with falls.MethodThe sample of this cross‐sectional study consisted of 95 patients with a diagnosis of definite dementia who attended a dementia outpatient clinic in a university hospital in Istanbul between January and March 2020. Patients using assistive devices while walking were not included in the study. A sociodemographic form, DENN Fall Risk Assessment Scale, Mini Mental State Test (MMSE), Neuropsychiatric Inventory (NPI), Apathy Assessment Scale (AES), Clinical Dementia Rating Scale (CDR), Cornell Depression in Dementia Scale (CSDD), Lawton and Brody Instrumental Activities of Daily Living (Lawton IADL), and Katz Activities of Daily Living (Katz ADL) Scale were used for data collection.ResultsIt was determined that 53.7% of the patients were female and the mean age was 73.1±11.4. Most of the patients (64.2%) had Alzheimer’s type dementia, 49.5% had mild or moderate dementia, 75.8% had an additional chronic disease, 22.1% were semi‐dependent in movement activity. 47.4% of the individuals had a history of fall in the last month, 48.9% had fallen at least 2 times, the average number of falls was 1.5±0.5, 70.5% of the patients had injuries after falling, and the mean DENN Fall Risk score was found to be 10.4±3.4. In the group with a history of falling non‐Alzheimer dementias were more common (p = 0.018), NPI symptom (p&lt;0.001) and bother (p&lt;0.001) scores were higher, Lawton IADL scores were lower (p = 0.009), AES clinician (p = 0.054) and caregiver (p = 0.052) scores and Cornell depression score (CSDD) (p = 0.005) were higher.ConclusionFalling, which is the most common geriatric syndrome in dementia patients, can lead to negative patient outcomes. Most dementia patients have a history of falling and post‐fall injury. Factors associated with falls in dementia patients should be known, and appropriate nursing interventions should be made to prevent falls by recognizing the risk of falling. More work is needed on this subject.

Risk Assessment of Osteoarthritis Among Geriatric Population in Perambalur District Using the Western Ontario and McMaster Universities Arthritis Index and Katz Index of Independence in Activities of Daily Living: A Cross-Sectional Study.

Osteoarthritis (OA) is a degenerative joint disease that occurs resulting from tear and progressive loss of articular cartilage. It is one of the leading causes of disability in elderly people. This study aims to assess the risk of OA and the ability to perform activities of daily living (ADL) independently among the geriatric population using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale and Katz Index of Independence in Activities of Daily Living (Katz ADL) scale, respectively. This cross-sectional study was conducted among the geriatric population in Perambalur district, Tamil Nadu from November 2022 to January 2023. Around 415 geriatric populations above 60 years of age were included by using a simple random sampling method. A semi-structured questionnaire was used to collect sociodemographic profiles, personal and medical details, OA risk (WOMAC), and ADL (Katz ADL scale). Descriptive statistics and the chi-square test were used to investigate the relationship between sociodemographic characteristics and the Katz ADL scale and the WOMAC index score for assessing OA risk. The mean age of participants was 69.62 ± 6.86 years. The mean ± SD score for the WOMAC scale and the Katz ADL scale among the geriatric population was 20.997 ± 14.69 and 4.821 ± 2.37, respectively. The OA risk among the geriatric population using the WOMAC scale waslow in 98 (23.6%), moderate in 216 (52%), andhigh risk in 101 (24.3%) participants. Using the Katz ADL scale, 332 (80%) participants were found to beindependent and 83 (20%) were dependent. The high-risk factors for developing OA were age ≥ 70 years, female sex, living in a rural area, employment status, Muslim religion, the habit of betel nut chewing, diabetes mellitus, hypertension, thyroid diseases, family history of knee OA, history of previous surgery, and ADL, significantly associated with WOMAC (p < 0.05). As per the WOMAC scale, approximately 24.3% of the geriatric population is at high risk of developing OA and 20% of them are dependent on performing ADL as assessed using the Katz ADL scale. The WOMAC and Katz ADL scales are simple questionnaire-based screening tools used to detect high-risk individuals for OA at an early stage in the geriatric population.

ADL/IADL limitations and related factors in older adults in 3 Northern provinces Vietnam

This cross-sectional study aimed to identify the prevalence and factors related to the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) among elderly people in Ha Noi, Ninh Binh, and Quang Binh in 2018. In total, 2448 participants were interviewed and measured using an adapted short version of Katz ADL Index and Lawton IADL Scale. The study showed a high prevalence of ADL and IADL disability (29.1% and 33.1%, respectively) in older adults. The risks of ADL and IADL limitations increased with age, gender ( higher in females), individuals withlower incomes, who had a history of chronic diseases, who self-rated poor health status, reported a moderate or severe somatic pain and who had weak grip strength. People who were still employed and regularly performed heavy physical activities had a lower chance of ADL and/or IADL limitations. We suggest that ADL/IADL limitations should be taken in account for any potential health care strategies and interventions for elderly population.

The Significance of the Treatment for Elderly Severe Trauma Patients Who Required Intensive Care.

Purpose Elderly trauma patients have a higher risk of severe disability and death, and this outcome burden in elderly trauma patients must be addressed in countries in which the population is aging. The clarification of the unique clinical features of elderly people who have experienced trauma is important. The purpose of this study is to evaluate the significance of the treatment for elderly severe trauma patients based on the prognosis and total hospital cost. Methods Trauma patients transferred to our emergency department (ED) and admitted to our intensive care unit (ICU) directly or through emergency surgery between January 2013 and December 2019 were examined. We divided patients into three groups: <65 years old (Group Y); 65-79 years old (Group M); and ≥80 years old (Group E). We compared the pre- and post-trauma American Society of Anesthesiology Physical Status (ASA-PS) scoreand the Katz Activities of Daily Living (ADL) questionnaire at arrival among the three groups. In addition, the duration of ICU and hospital stays, hospital mortality, and total treatment costs were compared. Results There were 1,652 patients admitted to ICU through the ED from January 2013 to December 2019. Of those patients, 197 trauma patients were analyzed. There was no significant difference in injury severity scores between the groups. Significant differences in both the ASA-PS and Katz-ADL scores in posttrauma status were observed among the three groups (posttrauma ASA-PS, 2.0 (2.0, 2.8) in Group Y, 3.0 (2.0, 3.0) in Group M, 3.0 (3.0, 3.0) in Group E, p < 0.001*, posttrauma Katz-ADL,10.0 (3.3, 12.0) in Group Y, 5.5 (2.0, 10.0) in Group M, 2.0 (0.5, 4.0) in Group E, p < 0.001). The duration of both ICU and hospital stay was significantly longer in Group E compared to the other groups (ICU stay, 4.0 (3.0, 6.5) days in Group Y, 4.0 (3.0, 9.8) days in Group M, 6.5 (3.0, 15.3) days, p = 0.006, hospital stay, 16.9 (8.6, 33.0) days in Group Y, 26.7 (12.0, 51.8) days in Group M, 32.5 (12.8, 51.5) days in Group E, p = 0.005). ICU and hospital mortality were highest in Group E compared with the other groups, but the differences were not significant. Finally, the total hospital cost in Group E was significantly higher than the other groups. Conclusions In elderly trauma patients who required intensive care, PS and ADL in posttrauma status were worse, ICU and hospital stays were longer, and ICU and hospital mortality were higher compared with younger patients. In addition, medical costs were greater in elderly patients. It is supposed that the therapeutic effect observed in young trauma patients cannot be expected in elderly trauma patients.

Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults.

To examine whether delirium predicts occurrence of hospital-associated disability (HAD), or functional decline after admission, among hospitalized older adults. Retrospective cross-sectional study. General inpatient (non-ICU) units of a large regional Southeastern US academic medical center, involving 33,111 older adults ≥65years of age admitted from January 1, 2015, to December 31,2019. Delirium was defined as a score ≥2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission. HAD was defined as a decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations with multiple admissions. We performed multivariate and mediation analyses to examine strength and direction of association between delirium and HAD. One-fifth (21.6%) of older adults developed HAD during hospitalization and experienced higher delirium rates compared to those not developing HAD (24.3% vs 14.3%, P < .001). Age, presence of delirium, Elixhauser Comorbidity Score, admission cognitive status, admission ADL function, and length of stay were associated (all P < .001) with incident HAD. Mediational analyses found 46.7% of the effect of dementia and 16.7% of the effect of comorbidity was due to delirium (P < .001). Delirium significantly increased the likelihood of HAD within a multivariate predictor model that included comorbidity, demographics, and length of stay. For dementia and comorbidity, mediation analysis showed a significant portion of their effect attributable to delirium. Overall, these findings suggest that reducing delirium rates may diminish HAD rates.

Intertrochanteric Femoral Fractures: A Comparison of Clinical and Radiographic Results with the Proximal Femoral Intramedullary Nail (PROFIN), the Anti-Rotation Proximal Femoral Nail (A-PFN), and the InterTAN Nail

Background and Objectives: The aim of this study was to evaluate retrospectively the radiological and functional outcomes of closed reduction and internal fixation for intertrochanteric femoral fractures (IFF) using three different proximal femoral nails (PFN). Materials and Methods: In total, 309 individuals (143 males and 166 females) who underwent surgery for IFF using a PFN between January 2018 and January 2021 were included in the study. Our surgical team conducted osteosynthesis using the A-PFN® (TST, Istanbul, Turkey) nail, the PROFIN® (TST, Istanbul, Turkey), and the Trigen InterTAN (Smith & Nephew, Memphis, TN, USA) nail. The PFNs were compared based on age, gender, body mass index (BMI), length of stay (LOS) in intensive care, whether to be admitted to intensive care, mortality in the first year, amount of transfusion, preoperative time to surgery, hospitalisation time, duration of surgery and fluoroscopy, fracture type and reduction quality, complication ratio, and clinical and radiological outcomes. The patients' function was measured with the Harris Hip Score (HHS) and the Katz Index of Independence in Activities of Daily Living (ADL). Results: Pain in the hip and thigh is the most common complication, followed by the V-effect. The Z-effect was seen in 5.7% of PROFIN patients. A-PFN was shown to have longer surgical and fluoroscopy durations, lower HHS values, and much lower Katz ADL Index values compared to the other two PFNs. The V-effect occurrence was significantly higher in the A-PFN group (36.7%) than in the InterTAN group. The V-effect was seen in 33.1% of 31A2-type fractures but in none of the 31A3-type fractures. Conclusions: InterTAN nails are the best choice for IFFs because they have high clinical scores after surgery, there is no chance of Z-effect, and the rate of V-effect is low.

Drug Burden Index in Older Adults with Psychiatric Illnesses: A Cross-Sectional Study.

Medications with anticholinergic and/or sedative properties are commonly used in the management of psychiatric illnesses. The burden of anticholinergic and sedative medication use has been measured by the Drug Burden Index (DBI) score tool. A higher DBI score has been associated with increased risk of falls, bone and hip fractures, and functional and cognitive impairment, among other serious health outcomes, especially in older adults. We aimed to describe the drug burden in older adults with psychiatric illnesses using DBI, determine the factors that are associated with the drug burden measured by DBI, and examine the association between DBI score and Katz for activities of daily living (ADL) index. A cross-sectional study was conducted in the psychogeriatric division of an aged-care home. The study sample comprised all inpatients, aged ≥ 65 years, diagnosed with psychiatric illness. The data obtained included demographic characteristics, duration of hospital stay, primary psychiatric diagnosis and comorbidities, functional status using the Katz ADL index, and cognitive status using the Mini-Mental State Examination (MMSE) score. DBI score was calculated for each anticholinergic and sedative medication used. Of the 200 patients eligible for analysis, 106 (53.1%) were females and the mean age was 76 ± 9 years. The most commonly encountered chronic disorders were hypertension 102 (51%) and schizophrenia 94 (47%). The use of drugs with anticholinergic and/or sedative effects was seen in 163 (81.5%) patients; the mean DBI score was 1.25 ± 1. The results of the multinomial logistic regression showed that schizophrenia (odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.57-4.45), p = 0.01), level of dependency (OR = 3.50 (95% CI 1.38-5.70), p = 0.001), and polypharmacy (OR = 2.99 (95% CI 2.15-4.29), p = 0.003) were significantly associated with DBI score ≥ 1 compared to DBI score 0. The study showed that anticholinergic and sedative medication exposure measured by DBI was associated with higher levels of dependency on the Katz ADL index in a sample of older adults with psychiatric illnesses from an aged-care home.