Lawton-Brody Scale Research Articles

Delphi consensus of an expert committee in oncogeriatrics regarding comprehensive geriatric assessment in seniors with cancer in Spain.

The aim of this work was to reach a national consensus in Spain regarding the Comprehensive Geriatric Assessment (CGA) domains in older oncological patients and the CGA scales to be used as a foundation for widespread use. The Delphi method was implemented to attain consensus. Representatives of the panel were chosen from among the members of the Oncogeriatric Working Group of the Spanish Society of Medical Oncology (SEOM). Consensus was defined as ≥66.7% coincidence in responses and by the stability of said coincidence (changes ≤15% between rounds). The study was conducted between July and December 2016. Of the 17 people invited to participate, 16 agreed. The panel concluded by consensus that the following domains should be included in the CGA:(and the scales to evaluate them): functional (Barthel Index, Lawton-Brody scale, gait speed), cognitive (Pfeiffer questionnaire), nutritional (Mini Nutritional Assessment - MNA), psychological/mood (Yesavage scale), social-familial (Gijon scale), comorbidity (Charlson index), medications, and geriatric syndromes (urinary and/or fecal incontinence, low auditory and/or visual acuity, presence of falls, pressure sores, insomnia, and abuse). Also by consensus, the CGA should be administered to older patients with cancer for whom there is a subsequent therapeutic intent and who scored positive on a previous frailty-screening questionnaire. After 3 rounds, consensus was reached regarding CGA domains to be used in older patients with cancer, the scales to be administered for each of these domains, as well as the timeline to be followed during consultation.

Factors associated with home hazards: Findings from the Malaysian Elders Longitudinal Research study.

Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation. Geriatr Gerontol Int 2018; 18: 387-395.

METABOLIC SYNDROME AND DISABILITY IN CHINESE NONAGENARIANS AND CENTENARIANS

AbstractMetabolic syndrome (MetS) increases with aging. Little is known about the relationship between MetS and disability in the elderly population, especially in the oldest old. We therefore conducted this study to investigate the possible association between MetS and disability in a population of Chinese nonagenarians and centenarians. Data were obtained from a face-to-face survey conducted in 870 Chinese adults aged 90 years or older. MetS was diagnosed according to the International Diabetes Federation criteria. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities were evaluated using the physical self-maintenance scale and the Lawton-Brody IADL scale, respectively. The subjects included in the current analyses were 500 women and 225 men (mean age: 93.8 ± 3.1 years). MetS was present 13.0% in women and 9.8% in men. In women, the prevalence of ADL and IADL disabilities was significantly higher in the MetS group compared with the non-MetS group (ADL:43.1% vs. 30.6%, p=0.044; IADL: 73.8% vs. 59.8%, p=0.030). After adjusting for relevant confounders, the MetS group showed significantly increased odds ratios (ORs) for either ADL (1.8, 95% confidence interval [CI] 1.2–3.4) or IADL disability (2.1, 95% CI 1.3–4.7) compared with the non-MetS group. In men, similar results were found with respect to the prevalence of ADL or IADL disability and adjusted ORs between MetS and non-MetS groups, but these results were not statistically significant. In conclusion, in our study population, MetS appeared to be associated with an increased risk of either ADL or IADL disability, especially in women.

Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome

The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome.

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents.

Objectives:To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test.Methods:This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed.Results:A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass.Conclusions:The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents.

Relationship between hospitalization and functional and cognitive impairment in hospitalized older adults patients

ABSTRACTObjectives: To study changes in the cognitive status and dependency of patients aged over 65 years during hospitalization for bone fracture and how these changes relate to the total number of days of admission and absolute rest during hospitalization. Along with cognitive decline, musculoskeletal disorders are considered key factors in this patient population. As well as requiring hospital admission and/or surgical treatment, fractures increase the risk factors that contribute to disability and dependency in older adults.Method: A longitudinal case-series study with repeated follow-up assessments was conducted. The sample consisted of 259 older adults. The following tests were administered: Barthel index, Lawton-Brody's scale, Phototest, and informant questionnaire on cognitive decline in the elderly.Results: The main variable which fosters functional dependency, cognitive decline, and functional loss and diminishes functional gain (both in the hospital and at home) is the number of days of bed rest during hospitalization.Conclusions: The present study reveals that the greater impact on levels of functional dependency and cognitive decline comes from the patient's days of bed rest in hospital, rather than the total days of hospitalization. These findings could be taken into consideration when discussing post-discharge functional recovery.

Is it better to be happy or not depressed? Depression mediates the effect of psychological well-being on adverse health outcomes in older adults.

To examine the relationship between psychological well-being and depression in older adults and the relative contribution these psychological factors have on risk of functional disability, frailty, and mortality. This is a secondary analysis of 1668 community-dwelling older adults without dementia who participated in the second wave of the Canadian Study of Health and Aging. Baseline assessments of psychological well-being (Ryff scale) and depression (Geriatric Depression Scale; GDS) were collected. At 5-year follow-up, mortality data were collected; frailty and disability in activities of daily living were evaluated using the frailty index (FI) and the Lawton-Brody scale, respectively. Area under the receiver-operating characteristic curve indicated that GDS and Ryff scores were able to independently discriminate whether individuals were considered frail (C = 0.66; C = 0.59, respectively), had limitations in basic (C = 0.64; C = 0.57, respectively) or instrumental (C = 0.70; C = 0.57, respectively) activities of daily living, or had died (C = 0.63; C = 0.57) at follow-up (all P < 0.01). Regression models in which the Ryff and GDS were included in the same model demonstrated that the GDS significantly predicted frailty, disability, and mortality, whereas the Ryff effect was not significant. Mediation analysis determined that the effect of psychological well-being on adverse outcomes was fully mediated by depression. Our results suggest that although both depression and psychological well-being appear to modulate risk for adverse physical health outcomes, depression mediates this relationship. Detecting and treating depressive symptoms should be of high priority in older patients to mitigate risk of future physical health adversities including mortality. Copyright © 2016 John Wiley & Sons, Ltd.

Influence of peripheral arterial disease on daily living activities in elderly women

Aging has been associated with decreases in physical and cognitive functions. Peripheral artery disease (PAD) has been associated with further impairments in these functions, especially in women. However, no detailed information is available indicating whether PAD leads to further impairment in these functions in elderly women. Thus, the aims of this study were 1) to compare the capacity to perform daily living activities between elderly women with and without PAD and 2) to identify the factors related with the performance in daily activities. Twenty-seven elderly women with PAD and 22 elderly non-PAD women were surveyed in a geriatric hospital. Women aged ≥65years and with no signal of dementia were included. PAD was identified by the ankle-brachial index ≤0.90, whereas elderly non-PAD women presented ankle-brachial index >1.0. Patients were interviewed to obtain information regarding basic (Katz questionnaire) and instrumental daily living activities (Lawton-Brody scale) and performed the mini-mental state examination, handgrip strength test, and timed up and go tests. PAD and non-PAD women had similar age, clinical characteristics, handgrip strength test, and cognitive function (P>0.05). The capacity to perform basic and instrumental daily living activities was similar between PAD and non-PAD women (P>0.05). In PAD and non-PAD, the instrumental daily living activities were significantly correlated with cognitive function (r=0.44, P<0.05 and r=0.74 and P<0.05, respectively). PAD elderly women present similar capacity to perform basic and instrumental daily activities than non-PAD women. In addition, in both groups, the capacity to perform instrumental daily activities was related with cognitive function.

Decline in Fast Gait Speed as a Predictor of Disability in Older Adults.

To determine whether fast gait speed at study baseline and change in gait speed had independent associations with disability onset. Cohort study with 11-year follow-up (1999-2010). Three-City Study center, Dijon, France. Community-dwelling individuals aged 65 to 85 (N=3,814, 61% female). Fast gait speed (over 6m) was assessed up to five times and disability (mobility (Rosow-Breslau scale), instrumental activities of daily living (IADLs; Lawton-Brody scale), basic activities of daily living (ADLs; Katz scale)) six times. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and IADLs or with mobility, IADLs, and ADLs. The association between baseline fast gait speed and its slope of change and disability incidence was examined using joint models for longitudinal and time-to-event data. Over follow-up, 628 participants (68% women) developed disability. Mean fast gait speed at baseline was 1.54m/s, and annual decline was 0.017m/s. The hazard ratio of disability per standard deviation (SD)(-0.22m/s) slower baseline fast gait speed was 1.77 (95% confidence interval (CI)=1.60-1.94) and for one-SD (-0.013m/s) faster annual decline was 1.38 (95% CI=1.10-1.73) when both parameters were included in a sex- and age-adjusted model. All associations remained statistically significant in multivariable models, except for slope of change when chronic conditions were added to the model; of chronic conditions, dyspnea was the main contributor. Accelerated decline in fast gait speed was associated with disability independent of baseline fast gait speed. These results confirm the importance of measuring gait speed repeatedly in elderly adults to identify those at higher risk of disability and the need to identify determinants of decline, because they are likely to be targets for prevention and treatment to reduce disability risk.

Assessment of nutritional status and health-related quality of life before and after liver transplantation.

BackgroundPatients with chronic liver disease frequently suffer from malnutrition, together with a decline in their health-related quality of life.This study was carried out with the aim of evaluating the nutritional status, complications of medical and surgical care, anxiety, health-related quality of life and dependence level on basic and instrumental activities of daily living in pre- and post-liver transplant patients.Methods/DesignA prospective observational study with follow-up of patients on the waiting list for liver transplants who subsequently received a transplant at the University Hospital Complex in A Coruña during the period 2012–2014 (n = 110).All the patients will be followed-up for a maximum of 6 months. For survivors, assessments will be re-evaluated at one, three and six months post- transplant.Informed consent of the patient and ethical review board approval was obtained (Code: 2010/081 and 2010/082).The following variables will be studied: socio-demographic data, reason for the transplant, comorbidity (Charlson Score), analytical parameters, time on transplant waiting list and post-transplant complications. A trained nurse will evaluate the following for each patient: nutritional indices, anthropometric variables and handgrip strength. Validated questionnaires will be used to determine the patients’ nutritional status (Subjective Global Assessment), anxiety (STAI questionnaire), Health-Related Quality of Life (LDQoL 1.0 questionnaire), dependence (Barthel Index and Lawton-Brody Scale), nursing diagnoses (NANDA) and post-transplant quality indicators.Multiple linear/logistic regression models will be used to identify variables associated with the events of interest. Changes in nutritional status, quality of life and dependence over time will be analysed with linear mixed-effects regression models.Actuarial survival analysis using Kaplan-Meier curves, Cox regression and competitive risk will be performedConcordance between the different scores that assess nutritional status and interobserver agreement regarding nursing diagnoses will be studied using the statistical Kappa index and Bland Altman method.DiscussionThe risk of malnutrition can be considered as a possible prognostic factor in transplant outcomes, associated with anxiety, health-related quality of life and dependence.For this reason we consider interesting to perform a prospective follow-up study of patients who require a transplant to survive, studying their nutritional status and health-related quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0232-3) contains supplementary material, which is available to authorized users.

A cross-sectional study examining the functional independence of elderly individuals with a functioning kidney transplant.

Cross-sectional studies of patients dependent on dialysis show that they have a high need for help with routine daily activities. In many cases, individuals who undergo kidney transplantation have previously been treated with dialysis for a significant period of time, thus many of the characteristics may be similar. The purpose of this study was to estimate the rate of functional disability in a cross-sectional population of older patients with a functioning kidney transplant. Kidney transplant patients, aged 65 years or more, were approached to participate. Patients were interviewed to ascertain current living situation, employment status, and 1-year fall history. Functional assessments included the Barthel Index, the Lawton-Brody Scale, the Timed Up and Go (TUG) test, and dynamometer handgrip strength. Eighty-two patients (71%) agreed to participate. Over half (54%) reported being disabled or requiring assistance for at least one daily-living activity, with housekeeping, grocery shopping, and laundry being the activities most commonly affected. Most patients had markedly impaired TUG and handgrip tests, and 21% recalled having fallen more than once in the past year. We used a single-center, cross-sectional study design. These results demonstrate a high prevalence of functional dependence, unintentional falls, and significant morbidity associated with decreased muscle strength in the older kidney transplant population.

Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome

Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome. A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up. Seventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% CI 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% CI 1.09-1.24, P = .0001). A Green score ≥ 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score. Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.

Reduced cognitive function predicts functional decline in patients with heart failure over 12 months

Occurrences of impaired activities of daily living (ADL) are common in heart failure (HF) patients and contribute to the elevated mortality and hospitalization rates in this population. Cognitive impairment is also prevalent in HF, though its ability to predict functional decline over time is unknown. This study examined the longitudinal pattern of activities of daily living (ADL) in HF persons and whether reduced baseline cognitive status predicts functional decline in this population. Altogether 110 persons with HF completed the Lawton-Brody Instrumental Activities of Daily Living (IADL) scale and were administered the Modified Mini-Mental Status Examination (3MS) at baseline and a 12-month follow-up. Three composite scores were derived from the Lawton-Brody scale, including total, instrumental, and basic ADL. HF patients reported high rates of baseline impairments in instrumental ADL, including shopping, food preparation, housekeeping duties, laundry, among others. Repeated measures analyses showed significant declines in total and instrumental ADL from baseline to the 12-month follow-up in HF (p<0.05). Hierarchical regression analyses showed that poorer baseline performance on the 3MS predicted worse total ADL performance at 12-months (β=0.15, p=0.049), including greater dependence in shopping, driving, feeding, and physical ambulation (p<0.05 for all). The current results show that HF patients report significant functional decline over a 12-month period and brief cognitive tests can identify those patients at highest risk for decline. If replicated, such findings encourage the use of cognitive screening measures to identify HF patients most likely to require assistance with ADL tasks.

Barber test as a screening tool in multidimensional geriatric evaluation in elderly women with early breast cancer

e20645 Background: The Comprehensive Geriatric Assessment (CGA) is a key component of the treatment approach for older cancer patients, but it is time consuming. In this study, we have evaluated the validity of a brief frailty screening tool, the Barber test (BT), for identifying disability in older patients with early breast cancer (BC) in the University General Hospital in Elche. Methods: Between January 2007 and December 2007, a total of 41 patients older than 65 years who were actively receiving chemotherapy for early BC, were enrolled in our study. Eligible patients were screened with the Barber test and completed a standardized CGA (Activities of Daily Living measured by Barthel Scale, Instrumental Activities of Daily Living measured by Lawton-Brody Scale, cognitive evaluation measured by Pfeiffer Test, comorbidity (Charlson´s index), risk of malnutrition (Nutritive Initiative Screening), and ECOG). The validity of the BT in this population was assessed by comparing the BT results with results from a simultaneous CGA. A receiver operating characteristic (ROC) analysis was employed. The ROC evaluated the BT as a screening measure for impairment compared with the CGA (using the definition of impairment on the CGA as deficits on ≥2 individual tests within the battery, and on the BT as a score &gt;0). The area under the ROC curve (AUC) was calculated to reflect the predictive value of the BT for identifying impairment. Results: Forty-one women were recruited. Median age was 72.88 years (range 65.03 to 85.46). 30 patients (73.2%) were older than 70 years. 36.6% were dependent in Barthel Scale, and 46,3% were dependent in Lawton-Brody Scale. 19,5% had cognitive impairment. The Barber test was moderate predictive for identifying impairment compared with the CGA, with an AUC of 0.730 (standard error, 0.081; 95% confidence interval for detecting asymptomatic normals, 0.571–0.889); p=0.012). Conclusions: Functional impairments are prevalent among older patients with early BC who receive adjuvant chemotherapy treatment. The current results indicate that the brief Barber test performed nearly as well as a conventional CGA in detecting geriatric impairment in this population. No significant financial relationships to disclose.

Multidimensional geriatric evaluation in elderly cancer patients and its relationship with age

19651 Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value &lt;0,05 was considered significative. Results: Sixty-four oncologic patients age &gt; or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients. No significant financial relationships to disclose.

Capacidad funcional y problemas socioasistenciales de los ancianos del área de salud de Cáceres

To describe the social environment and to identify the health problems and the functional and mental ability of the elderly in the community. Cross-sectional, observational study by means of a questionnaire. 228 people over 71 and not living in an institution. Cáceres Health Area. Questionnaire on social and demographic details, main pathologies, social assessment (Gijón scale), functional assessment (Barthel and Lawton-Brody scales), mental assessment (Pfeiffer test), geriatric problems and visits from health professionals. 67% of the 228 people in the sample were women, with an average age of 79. Comorbidity, present in over 70% of the elderly, was significantly related to multi-medication, falls, hospital admission, depression and insomnia. The most common social and family situation was of a person living with his/her partner (38.3%; CI, 6.31) or children, in a dwelling with architectural barriers (43.0%; CI, 6.43), with a good relationship to his/her social surroundings (61.0%; CI, 6.33). The Barthel test showed a significant relationship with all the geriatric problems declared. The Pfeiffer test showed a relationship with falls (t=3.10; P=.00214), with hearing problems (t=1.98; P=.048), with incontinence (t=3.59; P=.0040) and constipation (t=2.64; P=.0086). The Lawton-Brody test was related, in women, with falls (t=4.27; P=.00034), admissions (t=2.02; P=.044), constipation and sight and hearing problems; and in men, with depression and incontinence. Elderly people in the Cáceres Health Area showed good functional ability in their basic daily tasks, less ability in instrumental activities and high comorbidity.

Dependencia evitable para las actividades de la vida diaria: una perspectiva de género

IntroductionThe aim of this study was to describe gender-related differences in dependence in instrumental activities of daily living (IADL) in people older than 75 years, and to assess the variables associated with dependence in these activities in Spanish men and women. Patients and methodWe performed a cross-sectional study of people older than 75 years living at home in the basic health area of Santa Lucía in the city of Zaragoza (Spain) in 1998 (n = 351). Data were obtained through personal interview. The Lawton-Brody scale for IADL, the Short Portable Mental Status Questionnaire for cognitive deficit, the Geriatric Depression Scale for depressive symptomatology, and the Katz index for self-care activities were also used. Dependence in IADL inside and outside the home were compared in men and women. To assess the relationship between sociodemographic variables and health indicators with dependence in IADL, two multivariate multiple logistic regression models were applied separately for men and women. ResultsThe level of dependence in IADL in our population was very high. In men, dependence in IADL inside and outside the home was not associated with sociodemographic characteristics or health indicators. In women, old age, impaired cognitive function, and dependence in self-care activities were associated with a higher prevalence of dependence in IADL inside the home; old age and depressive symptoms were associated with greater dependence in IADL performed outside the home. ConclusionsThe prevalence of dependence is higher in men than in women. Dependence is associated with health status in women but not in men. The development of gender equality policies aiming to promote the distribution of household tasks could reduce dependence in environmental activities, especially in men.