Katz Activities Of Daily Living Index Research Articles

Leveraging independence and mental fitness - keys to reducing in-hospital mortality among geriatric COVID-19 patients in the intensive care unit: A cross-sectional study in Poland.

Coronavirus disease 2019 (COVID-19) quickly reached the pandemic status, with 765.22 million confirmed cases of COVID-19 and 6.92 million COVID-19 deaths reported worldwide by May 2023. Due to its sudden and global nature, the COVID-19 pandemic has had a significant impact on the emotional and mental health of many people. A group of COVID-19 patients who frequently require intensive care are geriatric patients. The cognitive performance of these patients and their independence in instrumental activities of daily living (IADL) may be crucial to their prognosis and risk of in-hospital death. The present study aimed to assess the level of independence in activities of daily living (ADL), mental fitness, the level of fear of COVID-19, and cognitive functions to determine their impact on in-hospital mortality in geriatric COVID-19 patients. A total of 300 intensive care unit (ICU) patients with COVID-19 were included in the cross-sectional study, using the following questionnaires: the Lawton IADL scale, the Katz ADL index of independence, the fear of COVID-19 scale (FCV-19S), the abbreviated mental test score (AMTS), and the 15-item geriatric depression scale (GDS15). Patients aged 64 or below reported significantly greater independence on the IADL scale and the basic ADL scale, and showed a significantly higher level of mental fitness (Mann-Whitney U test; p = 0.001). Patient survival and in-hospital mortality were influenced by independence in basic and complex ADL. The level of independence is an important prognostic indicator for in-hospital mortality in geriatric COVID-19 patients. The higher the level of mental fitness, the higher the level of independence in basic and instrumental activities of daily living. Patients aged ≥65 years are less independent in basic and instrumental activities of daily living. Moreover, they show a significantly lower level of cognitive functions.

#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.

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.

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.

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.

Sociodemographic Determinants, Health Conditions, and Mental Status as Predictors of the Functional Status of Older Saudi People

The increasing population of Saudi elderly demands adequate assessment of their functional health status and mental status to improve their health and quality of life. This study aimed to determine the functional status of older Saudi people in performing basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and its influencing factors. This quantitative, descriptive-correlational study surveyed a total of 203 participants using the Mini-Mental State Examination, Katz Index of ADL, and Lawton IADL. Overall, the participants had moderate cognitive impairment and were able to perform basic ADLs and IADLs independently, but they needed assistance in doing housework. Functional status was sensitive to their sociodemographic characteristics, presence of health problems, and mental status. Mental status, education, employment, marital status, and source of support were significantly associated with their ability to perform basic ADLs and IADLs. This study suggests that more efforts are needed to understand the sociodemographic characteristics, presence of health problems, and mental status that support the development of evidence-based public health policy on the functional status among older Saudi people. The findings can be utilized by hospital and nursing administrators to initiate educational and training programs for healthcare professionals including nurses and to create healthcare policies so that the health concerns and functional difficulties of older patients are adequately addressed.

Association of Lifetime Traumatic Brain Injury and Military Employment with Late-Life ADL Functioning: A Population-Based Prospective Cohort Study

<h3>Research Objectives</h3> To determine associations of lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and military employment with activities of daily living (ADL) in late life. <h3>Design</h3> A population-based prospective cohort study of older adults with a baseline visit and up to 10-years of biennial follow-up visits. <h3>Setting</h3> Seattle-area integrated healthcare delivery system. <h3>Participants</h3> Male (n=2066) and female (n=2887) participants of the Adult Changes in Thought (ACT) study, aged 65+ and dementia-free. <h3>Interventions</h3> We fitted repeated-measures Poisson mixed effects regression models. Military employment and TBI with LOC variables were included as main effects. We included interaction terms with time to allow for different longitudinal trends in ADL difficulties within each exposure group of interest. <h3>Main Outcome Measures</h3> History of TBI with LOC was based on participant self-report during the baseline visit. History of military employment was ascertained based on items addressing the longest and second longest occupations for each participant. ADL functioning was assessed at baseline and biennial follow-up via participant self-reported function on the 6-item Katz ADL index. For analyses, we summed the number of ADLs with which a person reported at least some difficulty (range 0-6). <h3>Results</h3> TBI with LOC before age 40 was associated with greater ADL difficulty at baseline for females (RR=1.44, 95% CI: 1.08-1.93, p=0.01). For males, TBI with LOC at any age was associated with greater ADL difficulty at baseline (age < 40: RR=1.58, 95% CI: 1.20 - 2.08, p = 0.001; age 40+: RR=2.14, 95% CI: 1.24 - 3.68, p = 0.006). TBI with LOC was not associated with the rate of accumulation of ADL difficulties over time in males or females. There was no evidence of an association between military employment and either outcome, nor of an interaction between military employment and TBI with LOC. Findings were consistent across a variety of sensitivity analyses. <h3>Conclusions</h3> Future study of the implications of TBI and military employment on late-life physical functioning as measured by performance-based tools in more diverse cohorts is warranted. <h3>Author(s) Disclosures</h3> No conflicts of interest reported.

Baseline measure of activities of daily living (ADL) using Katz index of ADL on participants those who were recruited to a RCT form a tertiary care hospital in Sri Lanka

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Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. DesignPlanned analysis of a randomized controlled trial with 3- and 12-month follow-ups. SettingGeriatric ward, ordinary housing, and residential care facilities. ParticipantsOf 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. InterventionIndividually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome MeasuresIndependence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes. ResultsThere were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207). ConclusionsIn older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.

Disability and quality of life in individuals with muscular dystrophy

In the county of Orebro, Sweden, 32 individuals with myotonic disorders and 25 with other types of muscular dystrophy were examined. Disability was assessed with functional tests and standardized observations of muscle function (mainly based on those proposed by Dr. Brooke), a new self-administered questionnaire regarding the Activities of Daily Living (ADL) and the ADL staircase (based on Katz ADL index). The results of the different tests of disability were highly correlated. The Sickness Impact Profile and the Kaasa test were used for assessing the quality of life, and no significant differences were found between the groups of muscular dystrophy. In an explanatory factor analysis three main factors of disability were found. The factors walk and move" and "finger function" were fair to good associated with the quality of life. This study offers an approach for research on the consequences of muscular dystrophy using established as well as new methods."

Satisfaction with Care in Late Stage Parkinson's Disease.

In late stage Parkinson's disease (PD) (i.e., Hoehn and Yahr (HY) stages IV-V), both motor and nonmotor symptoms (NMS) are pronounced, and the patients become increasingly dependent on help in their daily life. Consequently, there is an increasing demand on health-care and social care resources for these patients and support for their informal caregivers. The aim of this study was to assess satisfaction with care in late stage PD patients and to identify factors associated with satisfaction with care. Moreover, to assess their informal caregivers' satisfaction with support and to identify factors associated with caregivers' satisfaction with support. Factors potentially associated with satisfaction with care/support were assessed in 107 late stage PD patients and their informal caregivers (n=76) and entered into multivariable logistic regression analyses. Fifty-eight (59%) of the patients and 45 (59%) of the informal caregivers reported satisfaction with their overall care/support. Patients satisfied with their care reported higher independence in activities of daily living (ADL) (Katz ADL index; P=0.044), less depressive symptoms (Geriatric Depression Scale, GDS-30; P=0.005), and higher individual quality of life (QoL) (Schedule for the Evaluation of Individual Quality of Life Questionnaire, SEIQoL-Q; P=0.036). Multivariable logistic regression analyses identified depressive symptoms (P=0.015) and independence in ADL (P=0.025) as independently associated with satisfaction with care. For informal caregivers, the analyses identified patients' HY stage (P=0.005) and caregivers' QoL (Alzheimer's Carers Quality of Life Inventory, ACQLI; P=0.012) as independently associated with satisfaction with caregiver support. The results indicate that an effective both pharmacological and nonpharmacological PD therapy is important, to adequately treat motor and NMS (e.g., depressive symptoms) in order to improve depressive symptoms and patient independence in ADL. This may benefit not only the patients, but also their informal caregivers.

The relationship between healthy life expectancy and smoking, hypertension and body mass index in a Japanese population: A multistate life table method using Nippon Data90

Introduction Healthy life expectancy (HLE) is an important measure for describing population health. Human factors such as smoking, hypertension, and obesity can reduce overall HLE in a population. Little is known about the relationship between HLE and cardiovascular risk factors in Asian populations. Our study aimed to estimate HLE in various combinations of cardiovascular risk factors in a Japanese population using a multistate life table approach. Methods Data were obtained from NIPPON DATA90, which is a nationwide cohort study of nine thousand Japanese people that was established in 1990. From among the NIPPON DATA90 participants, our analysis focused on people who were aged 60 years or older at the baseline survey and had received activities of daily living (ADL) assessment. Participants underwent a two-wave interview survey process using the Katz ADL index in 1995 and 2000. The participants were queried on five items of the Katz ADL index, and any participant who answered that they were “not independent” for at least one item was designated “disabled” in the multistate life table. Smoking status was categorized into non-smokers (never-/ex-smokers) and current smokers. Blood pressure (BP) was categorized into four groups (optimal, normal, stage 1 hypertension, and stage 2 hypertension). Obesity was defined using body mass index (BMI), which was categorized into three groups (thin: 18.5; normal: 18.5–24.9; and overweight/obese: ≥ 25). All HLE calculations were performed using iMaCh version 0.98r7 (A Maximum Likelihood Computer Program using Interpolation of Markov Chains). Results The study sample comprised 6676 participants (2840 men and 3836 women). Among all the BMI and BP groups, HLE at age 60 in current smokers was shorter than that of non-smokers. Among obese men with optimal BP, HLE in current smokers was 20.0 years, whereas that of non-smokers was 17.7 years. Among obese current smokers, HLE at age 60 decreased linearly as BP increased in men (optimal BP: 19.8 years, normal BP: 19.3 years, stage 1 hypertension: 18.1 years, stage 2 hypertension: 17.7 years) and women (optimal BP: 23.1 years, normal BP: 22.6 years, stage 1 hypertension: 21.4 years, stage 2 hypertension: 21.0 years). Among thin current smokers, HLE at age 60 also decreased linearly as BP increased in men (optimal BP: 18.3 years, normal BP: 17.8 years, stage 1 hypertension: 16.6 years, stage 2 hypertension: 16.3 years) and women (optimal BP: 21.8 years, normal BP: 21.2 years, stage 1 hypertension: 19.9 years, stage 2 hypertension: 19.6 years). The distribution of HLE at age 60 showed a slight inverted U-shape as BMI increased in both sexes. Conclusions We examined the relationship between HLE at age 60 and combinations of BMI, BP, and smoking status using a nationwide cohort study of the Japanese population. HLE at age 60 was clearly shorter in smokers and individuals with higher BP. Furthermore, both thin and obesity has a slight impact on HLE at age 60.

Comparison of methods for calculating healthy life expectancy in a Japanese population: An analysis of Nippon Data90

Introduction There are several methodological approaches to calculating healthy life expectancy (HLE). Sullivan's method (prevalence-based life tables), which uses age-specific disability prevalence, is conventionally employed to estimate HLE. The multistate life table method presents an alternative approach that permits transitions from one health state to another using Markov models. Although these two approaches are frequently applied to calculate regional and national HLE, little is known about the differences in their estimates. To examine these differences, we applied both approaches for estimating HLE in a nationwide cohort study of the Japanese population and compared the resulting estimates. Methods The National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged (NIPPON DATA90) is a nationwide cohort study involving nine thousand Japanese participants. Data from this project were used in our analysis. We identified participants who were aged 60 years or older at the baseline survey and had provided activities of daily living (ADL) information based on the Katz index. Two-wave interview surveys of ADL were conducted in 1995 and 2000. Participants who answered “not independent” to any of five stipulated items in the Katz ADL index were designated “disabled” in the analysis. Both Sullivan's method and the multistate life table method were used to estimate HLE in participants aged 60 to 99 years. In both estimations, smoking status was categorized into three groups (never-smokers, ex-smokers, and current smokers). Blood pressure was fixed at an optimal level (systolic blood pressure Results Our analysis was conducted on 6676 individuals (2840 men and 3836 women). The HLE estimates at age 60 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 23.24, 22.55, and 19.33 in men and 25.04, 20.84, and 20.74 in women, respectively. The corresponding HLE estimates from the multistate life table method were quite similar to those of Sullivan's method both in men (23.32, 21.88, and 19.71, respectively) and in women (25.39, 23.37, and 22.22, respectively). The disparity in HLE estimates at age 60 between these two methods was virtually negligible but widened gradually as the index age increased. The HLE estimates at age 70 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 14.95, 14.36, and 11.58 in men and 16.26, 12.68, and 12.41 in women, respectively. The corresponding HLE estimates from the multistate life table method were 14.98, 13.68, and 12.06 in men and 16.66, 14.82, and 14.02 in women, respectively. The HLE estimates at age 90 from Sullivan's method in never-smokers, ex-smokers, and current smokers were 3.45, 3.21, and 1.94 in men and 3.44, 2.16, and 1.55 in women, respectively. The corresponding HLE estimates from the multistate life table method were 4.06, 3.46, and 3.13 in men and 4.57, 3.70, and 3.67 in women, respectively. Conclusions Two different approaches to calculating HLE were compared using a nationwide Japanese cohort study. The HLE estimates at ages 60 and 70 were generally similar between Sullivan's method and the multistate life table method, but the latter produced higher estimates when the index age was 90 years. Analysts should be aware that the choice of method may influence HLE estimates.

Patient- and Caregiver-Related Factors Associated with Caregiver Assessed Global Deterioration Scale Scoring in Demented Patients.

Background Informant-based rating scales are widely used in dementia but patients' and caregivers' features influence the final scoring. We aimed to evaluate the role of patient- and caregiver-related factors in a caregiver rated Global Deterioration Scale (GDS) score in a sample of Greek patients with dementia. Methods We included 194 patients with dementia and 194 caregivers/family relatives; Mini-Mental State Examination (MMSE); Neuropsychiatric Inventory (NPI); Katz Index of Activities of Daily Living (K-IADL) were administered to (a) patients and Center for Epidemiologic Studies-Depression (CES-D) Scale; Zarit Burden Interview (ZBI) to (b) caregivers. Participants' demographics and patients' and caregivers' characteristics were entered into a 3-block regression analysis. Results The final model explained 55% of the total variance of the caregiver assessed GDS score. The following variables significantly contributed to the final model: MMSE (β=-0.524); K-IADL (β=-0.264); ZBI (β=0.145). Conclusion We herein confirm the contribution of patients' cognitive and functional status and caregivers' burden in caregiver rated GDS scoring irrespective of demographic-related characteristics.

Reliability and validity of Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ).

We aimed to investigate reliability and validity of the Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in geriatric outpatients. A cross-sectional study was designed through 2013-2016 years. At first, translation and back translation processes of the SNAQ from English to Turkish languages were done consecutively. Then construct validity was performed. They were recruited among the outpatients aged >=60 years that were consecutively admitted to the geriatric outpatient clinic of the Istanbul University hospital. Demographic data was recorded. SNAQ, Mini Nutritional Assessment (MNA), six-item Katz activities of daily living (ADL) and eight-item Lawton instrumental activities of daily living (IADL) scales were applied. 442 participants consisted of 305 women and 137 men with a mean age of 77.1 ± 6.8 years. The SNAQ identified 21.5% (n=95) of the participants with poor appetite. Reliability analysis showed good inter-rater reliability (r= 0.693, p< 0.05) and test-retest stability (r= 0.654, p< 0.05). Cronbach's alpha coefficient was 0.522. In terms of construct validity of SNAQ, Cohen's kappa analysis showed fair to moderate agreement between SNAQ and MNA (κ=0,355, p<0.001). Female gender, being illiterate, functional dependency in IADL were significantly associated with poor appetite. The SNAQ score was weakly correlated with scores of MNA-SF and MNA-LF (r=0.392 and r=0.380, respectively, p<0.0001 for both). There was statistically significantbut negligible correlation between the SNAQ and Katz ADL index, Lawton IADL index, and age. Turkish version of the SNAQ is a simple measurement with sufficient reliability and validity to screen poor appetite in community-dwelling older adults.

The association of kyphosis assessed in supine and standing positions with future activities of daily living dependence: the Kurabuchi Study.

We have previously found an association between severe kyphosis and future dependence in activities of daily living (ADL) in people who manifest the condition in the supine position (structural curvature). However, because some people show severe kyphosis only in the standing position (postural curvature), we combined our noninvasively obtained kyphosis measurements from participants in the supine position (block method) with those obtained from participants in the standing position (kyphosis index) to determine whether not only structural curvature but also postural curvature is associated with ADL dependence and death. Between 2005 and 2006, we carried out health evaluations of adults aged 65years or older in Kurabuchi Town, Japan: 792 participants (337 males, 455 females) who were independent in ADL at baseline and underwent evaluation of kyphotic posture were followed up until March 2014 (mean follow-up: 7.5years). Participants who experienced one or more admissions to a nursing home, certification of a need for long-term care/support, or a decline in the Katz ADL Index during the follow-up period were defined as being dependent in ADL. A flat back (straight spine in a standing position) and structural curvature were associated with future ADL dependence, but postural curvature was not. The multivariate-adjusted odds ratios (95% confidence interval) compared with physiological curvature (physiological curvature in a standing position) as the reference were 1.72 (1.04-2.86) for a flat back and 2.76 (1.59-4.79) for structural curvature. A weak association with death was observed in those with structural curvature. Our results suggest that the prognoses of people with kyphosis differ according to the type of kyphotic posture.

Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function.

To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function.

English

INTRODUCTION: Health problems are a major concern for the elderly and they are prone to diseases and disabilities more than the younger age groups which can make them physically and economically dependent. The increasing number of elderly in the country means that they are going to make contributions to the economy. Elderly persons, being one of the most vulnerable groups of the society have more chances of chronic disease, infections, as well as disabilities. Disability has been defined as a restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.(1) It reflects how well an individual is able to function in general areas of life. Disability in elderly can be grouped in three large groups. First - who can manage in their daily activities with the help of mechanical devices. Second - who have multiple health problems and severe limitations in mental and/or physical functioning who require very intensive levels of care. Third-in between above two groups, they are functionally disabled in one or two ADLs, or have mild cognitive impairments. (2) OBJECTIVE OF THE STUDY: 1. To assess disability related to Activities of Daily Living(ADL) amongst the elderly in the urban and rural area. 2. To determine the use of physical aids by the elderly in both the urban and rural areas. MATERIAL AND METHODS: This community-based cross-sectional study was conducted among persons aged 60 years and above, in urban and rural areas in the Kamrup district, Assam. In the study, 400 no.s of elderly are under study of which 200 are from the urban area and 200 from the rural areas. The urban area is from the Guwahati city which consists of 60 municipalty blocks. Out of the sixty municipalty blocks, 10 no.s of blocks are randomly selected and 20 elderly are chosen from each block totaling a mark of 200.The kamrup rural area of Rani Community Development block is choosen from where 20 no.s of villages are randomly selected out of the 78 no.s of voillages. From each village, 10 no.s of elderly respondent are taken for the study. The study was conducted in June 2005 to June 2006. During the study, informed consent has been taken from the respondents and household visits are conducted for completing the study. For measuring the activities of daily living, the Katz index of ADL is used. Activities of daily living are tasks of self maintenance, mobility, communication, home management and community living that enables an individual to achieve personal independence.In the study, the main six basic items of ADL viz. bathing, dressing, going to toilet, transferring, continence and feeding. STATISTICAL ANALYSIS: MS excel, Chi-square tests. RESULTS: In the study, it was found that visual disability is the most common disability in both urban and rural area which account for 22.5% and 21.5% respectively. While the hearing disability is more amongst the respondents of the urban area than the rural area. The disability in ADL is increasing with age in both the urban and the rural areas. 22.5% of the elderly are using physical aids compared to 11% in the rural areas. CONCLUSION: The association between the use of physical aids by the respondents in urban and the rural areas is highly significant (p< 0.001).

Functional decline of older patients 1 year after cardiothoracic surgery followed by intensive care admission: a prospective longitudinal cohort study.

there is a growing demand for cardiothoracic surgery in patients' aged ≥65 years. : to explore which variables were independently associated with functional decline 12 months after cardiothoracic surgery followed by intensive care admission. prospective cohort study. cardiothoracic unit of a university teaching hospital. a total of 356 elderly patients undergoing cardiothoracic surgery followed by intensive care unit admission. functioning was assessed at hospital admission and 3 and 12 months after hospital discharge with the modified Katz activities of daily living (ADL) index. Data collection included demographics, surgical procedure, diagnosis, comorbidities, pre-morbid geriatric conditions and intensive care unit length of stay. Functional decline was defined as a one-point loss on the modified Katz ADL index score at 1 year compared with baseline functioning at hospital admission. Logistic regression analysis was performed to study the association between independent variables and functional decline. the 1-year mortality rate was 8.7% of which 4.8% was in-hospital mortality. The youngest group consisted of 295 patients (64% men; 72 ± 4 years), there were 61 octogenarians (56% men; 82 ± 2 years). One year after hospital discharge, younger patients demonstrated less functional decline (45 versus 56%, P < 0.001). Cognitive impairment, higher age, female gender, alcohol use, type of cardiac procedure and serum creatinine were independently associated with functional decline 1 year after discharge. the survival rates after cardiothoracic surgery were good, the rates of functional decline were substantial. These results suggest that studies on geriatric rehabilitation before and after surgery might be needed to overcome the decline in functioning.

Occupational Gaps in Everyday Life One Year After Stroke and the Association With Life Satisfaction and Impact of Stroke

Purpose: To examine the presence, frequency, and distribution of occupational gaps and to explore whether there are associations between occupational gaps and life satisfaction, self-rated recovery, and functioning and participation in activities of daily living (ADLs) 1 year after stroke. Method: Data were collected at onset and at 12 months after stroke from 161 patients admitted to a stroke unit in central Sweden by using Occupational Gaps Questionnaire, LiSat-11, Stroke Impact Scale, Katz ADL Index, and Barthel Index. Spearman rank correlation and Mann Whitney U test were used in the analyses. Results: Occupational gaps were reported by 87% of the participants. The number of occupational gaps was moderately associated with participation and self-rated recovery. There was a significant difference in the number of occupational gaps between the participants who were independent in ADLs and those who were not, both at baseline and at 12 months after stroke. There was, however, no significant association between occupational gaps and life satisfaction. Conclusions: Occupational gaps 1 year after stroke are very common, particularly among individuals experiencing difficulties in ADLs. Increased efforts are vital to enable individuals to do the activities that are important to them, irrespective of whether these are instrumental ADLs or leisure or social activities. Occupational gaps could be reduced by developing rehabilitation interventions that enable desired activities in different contexts that are crucial for individual patients.