Lawton Instrumental Activities Of Daily Living Scale Research Articles

Healthy Aging: Interaction of Cognition, Lifestyle, and Instrumental Activities of Daily Living.

Background: The increasing elderly population highlights the importance of comprehending healthy aging by examining the interactions among cognition, daily activities, and lifestyle. This study aims to address this by investigating these relationships within the World Health Organization's Healthy Aging Model. Methodology: A cross-sectional study was conducted with 178 older adults from southern Iran, representing various cognitive levels. Participants underwent assessments to measure cognitive functions, lifestyle preferences, and independence in instrumental activities of daily living (IADL) using the Mini-Mental State Examination, the Lifestyle Assessment Questionnaire for the Iranian Elderly, and the Lawton IADL Scale. Findings: The relationships between the studied variables were identified. Lower cognitive function was found to be associated with decreased engagement in IADL and less-favorable lifestyle choices. Conclusion: Integrating cognition, IADL, and lifestyle into assessments and interventions align with both the domain and process of occupational therapy, thereby enhancing well-being and promoting healthy aging in older adults.

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.

The Role of Functional Deficits, Depression, and Cognitive Symptoms in the Perceived Loneliness of Older Adults in Mexico City.

The world is aging and experiencing loneliness. Functional impairment in instrumental activities of daily living (IADL) in older people (OP) with mild neurocognitive disorder (MNCD) predicts loneliness. After the pandemic, there was an increase in perceived loneliness. We explored the association between loneliness, depression, deficits in IADL, and cognitive symptoms among OP. From February to December 2023, using a cross-sectional design, we interviewed probable cases with mild cognitive impairment and caregivers in two public facilities. We administered the UCLA Loneliness Scale v3, Lawton IADL Scale, Mini-Mental State Examination (MMSE), and Yesavage's Geriatric Depression Scale. Samples were matched: 85 per group, 82.4% were women, married (52.95%), and mean age of 69.17 (±6.93) years. In our study, 30% displayed moderate to high levels of perceived loneliness. Multivariate analysis showed loneliness was associated with depression, low levels of IADL, and older age, but not with cognitive symptoms, which explained 22% of the total variance (F 165) = 16.99, (p < 0.001). Targeting symptoms and behaviors that could be modified (i.e., depression and functionality) can improve feelings of perceived loneliness and have an impact on morbidity and mortality with which it is associated.

Prediction and mediation analysis for treatment responses to combined cognitive and physical training for older adults

Diminished cognitive and physical functions negatively affect the daily functions of individuals. Although combined cognitive and physical training prevents instrumental activities of daily living (IADL) disability in older adults, no predictive model or mediation analysis of IADL after combined training exists. This study aims to employ prediction and mediation analysis to identify the predictors of IADL performance and to elucidate the mediators of the association between baseline global cognition and subsequent IADL performance following combined cognitive and physical training. This study involved 177 participants aged 60 years and older who underwent combined training. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Color Trails Test, Word List, and a dual task; physical function with the Timed Up and Go (TUG) test; daily function with the Lawton IADL Scale. We conducted regression analyses to identify the predictors of IADL performance, and mediation analysis to examine whether DSST and TUG mediate the relationship between MoCA and IADL. The pre-intervention DSST and TUG were significant independent predictors of post-intervention IADL. The association between the pre-intervention MoCA and post-intervention IADL was mediated by pre-intervention DSST and TUG. This study highlighted the importance of measuring and improving processing speed and functional mobility before and during interventions to enhance IADL outcomes.Trial registration: NCT03619577, 23/07/2018; NCT04689776, 29/12/2020.

Frailty efficacy as a predictor of clinical and cognitive complications in patients undergoing coronary artery bypass grafting: a prospective cohort study

BackgroundFrailty is proposed as a predictor of outcomes in patients undergoing major surgeries, although data on the association of frailty and coronary artery bypass grafting (CABG) are lacking. We assessed the association between frailty and cognitive and clinical complications following CABG.MethodsThis prospective study included patients aged over 60 years undergoing elective CABG at Tehran Heart Center from 2020 to 2022. Baseline and three-month follow-up data on frailty using the Frail scale and clinical Frail scale, functional status using the Lawton Instrumental Activities of Daily Living Scale (IADL), cognitive function by Montreal Cognitive Assessment (MoCA), and depression by the Geriatric Depression Scale (GDS) were obtained. The incidence of adverse outcomes was investigated at the three-month follow-up. Outcomes between frail and non-frail groups were compared utilizing T-tests and Mann-Whitney U tests, as appropriate.ResultsWe included 170 patients with a median age of 66 ± 4 years (75.3% male). Of these, 58 cases were classified as frail, and 112 individuals were non-frail, preoperatively. Frail patients demonstrated significantly worse baseline MOCA scores (21.08 vs. 22.41, P = 0.045), GDS (2.00 vs. 1.00, P = 0.009), and Lawton IADL (8.00 vs. 6.00, P < 0.001) compared to non-frail. According to 3-month follow-up data, postoperative MOCA and GDS scores were comparable between the two groups, while Lawton IADL (8.00 vs. 6.00, P < 0.001) was significantly lower in frail cases. A significantly higher rate of readmission (1.8% vs. 12.1%), sepsis (7.1% vs. 19.0%), as well as a higher Euroscore (1.5 vs. 1.9), was observed in the frail group. A mildly significantly more extended ICU stay (6.00 vs. 5.00, p = 0.051) was shown in the frail patient.ConclusionFrailty showed a significant association with a worse preoperative independence level, cognitive function, and depression status, as well as increased postoperative complications.

Depressive symptoms and daily living dependence in older adults with type 2 diabetes mellitus: the mediating role of positive and negative perceived stress

BackgroundHigher stress is associated with higher levels of depression and instrumental-activities-of-daily-living (IADL) dependence, and depression is strongly associated with specific IADL disabilities. Accordingly, the aim of this study was to investigate the mediating effect of perceived stress on the association between depression and IADL dependence among older adults with diabetes mellitus (DM).MethodsWe examined baseline data collected from a longitudinal study that recruited 110 patients with DM aged ≥ 65 years from the endocrinology outpatient clinic of a district hospital. The instruments used for our measurement processes comprised a demographic data sheet and Chinese versions of the Perceived Stress Scale (PSS), the short form of the Geriatric Depression Scale (GDS-S), and the Lawton IADL Scale. We assessed the mediating effects of positive perceived stress (PPS) and negative perceived stress (NPS) after controlling for five covariates by using a regression-based model run through the SPSS macro PROCESS.ResultsWe observed negative correlations between GDS-S scores and PPS and between PPS and IADL dependence; we noted positive correlations between GDS-S scores and NPS and between NPS and IADL dependence (all P < 0.01). The indirect effect is coefficient = 0.12, [95% confidence interval = (0.0, 0.33)], suggesting that PPS achieves a mediating effect between depressive symptoms and IADL dependence. However, the NPS does not achieve a mediating effect in the relationship between depressive symptoms and IADL dependence (coefficient = 0.06, 95% CI = − 0.03, 0.15).ConclusionsPersonal PPS mediates the association between depression and IADL dependence in older adults with DM. This finding suggests that providing patients with psychological education to promote their PPS may help prevent their functional decline.

66 Association of Executive Functions and Instrumental Activities of Daily Living in Parkinson’s Disease

Objective:Executive function (EF) abilities tend to decline with age, and disproportionately so for people with neurodegenerative disorders such as Parkinson’s Disease (PD), where EF deficits are commonly seen in the early stages of the disease. Due to their nature, EF are essential for performing tasks of daily life, particularly for the more complex instrumental activities of daily living (IADL), and deficits can impair the ability to execute IADL in PD participants. The aim of this study was to examine how EF impairments relate to IADL deficits in both healthy elderly controls and PD participants.Participants and Methods:Seventy-four participants with idiopathic PD and 66 elderly controls were recruited. All participants were non-demented. A comprehensive neuropsychological assessment was administered including the following measures of EF: Hayling Sentence Completion, Brixton Spatial Anticipation, Trail Making Test A and B, Stroop Color-Word Test, Symbol Span (Wechsler Memory Scale-III), Digit Span (Wechsler Adult Intelligence Scale-III), F-A-S test, and Semantic Fluency (Animals and Actions). Z scores were calculated from respective test manuals. Independence was measured using the 8-item Lawton IADL Scale where items are coded from 0 (dependent) to 1 (independent) and the total score ranges from 0 to 8. Motor impairments were assessed using Part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Regression models were run with each cognitive measure as the dependent variable, with group (control vs. PD), age, sex, education, and motor severity as predictors, to examine the effect of group on each cognitive variable. Correlations were then run between the total IADL score, demographic variables, and cognitive variables for each participant group separately to identify the relationship between IADL and EF measures.Results:PD participants were predominantly males (n=51, 68.9%), with an average age of 70.64±6.03 and 15.22±2.78 education years. Controls were predominantly female (n=34, 51.5%) and had an average age of 71.19±7.75 and 15.85±2.82 education years. Regarding IADL function, all participants were relatively independent in their IADLs (PD: 7.72±0.69, range 4-8, Controls: 7.98±0.13, range 7-8). The most difficult IADL items for PD participants were shopping (8.2% dependent) and food preparation (12.2% dependent). When correcting for age, education, sex, and motor severity, only the Stroop Interference z-score was significant for participant group (b=0.44, t=2.14, p=0.034), where controls had slightly lower scores (-0.33±0.77) than PD participants (-0.31±0.91). Correlations in controls were significant between IADL total score and Hayling trials 1 (r=0.35, p=0.005) and 2 (r=0.33, p=0.008), and semantic fluency actions trial (r=0.34, p=0.006). In PD participants, IADL total score was only correlated with semantic fluency (animals trial, r=0.26, p=0.028).Conclusions:There were only weak associations between EF abilities and IADL in both healthy controls and PD participants, suggesting that impairments in EF do not necessarily translate into worse ability to execute IADL in PD. More correlations were found in the control group, which may be confounded by the inclusion (in both groups) of participants who already had cognitive impairment. This highlights a further need to examine whether EF impairments in people with PD influence IADL functioning above and beyond normal aging and whether specific deficits have more real-life consequences not attainable through IADL questionnaires.

Functional assessment and depression among geriatric population of rural Patancheru: A community-based cross-sectional study

Abstract Background: Indian aged population is currently the second largest globally. The proportion of 60 years and above population in India is 8%. It is growing faster than any other age group. However, it also challenges society to adapt, in order to maximize the health and functional capacity of older people as well as their social participation and security. Objective: The objective was to study functional assessment and depression among rural geriatric population. Materials and Methods: This was a community-based cross-sectional study among 1020 persons aged &gt;60 from eight villages of three subcenters. Functional assessment was done using the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living Scale (IADL). Depression was measured using the Geriatric Depression Scale (GDS). Results: 81.6% belonged to 60–75 years. Females were almost double compared to males. Majority (65.4%) were having normal body mass index. Majority 759 (74.41%) have no disturbance in sleep pattern. Majority 867 (85%) were functionally independent according to Katz ADL. Majority 745 (73.04%) were partially dependent according to the Lawton IADL. Majority of the respondents 954 (93.53%) were with no depression according to GDS. Sleep disturbance was seen highest in the age group of 60–75 years, and it reduced significantly as the age increased by a decade to 16.09%–7.3% in those aged 85 years and more (P &lt; 0.05). Among study participants with disturbed sleep, majority 176 (67.43%) were alcoholics (P &lt; 0.05). There is an association between ADL and depression (P &lt; 0.05). Conclusion: Majority were functionally independent. Majority were partially dependent, Lawton IADL. Majority were with no depression according to GDS.

Determinant of functional disability in instrumental activities of daily living among elderly living in a rural area in Bali: a crosssectional study

Introduction: Little do we understand about factors associated with functional disability in instrumental activities of daily living among the elderly living at home. This study aimed to explore the prevalence and determinant factors of functional disability in instrumental activities of daily living (IADL) among the elderly living in a rural area in Bali.&#x0D; Method: Using a cross-sectional design, 1,053 elderly aged 60 years and above living in a rural area in Bali were recruited. A structured interview by trained data collectors was conducted. Questionnaires used were the Lawton IADL Scale, the 5-item of Geriatric Depression Scale, and the adoption of questionnaires for vision, hearing, and communication problems from the Washington Group Short Set of Questions on Disability. A logistic regression model was applied to explore determinant factors.&#x0D; Results: Findings indicated that 26.1% of participants aged 75+ and 52.3% were female. Eight percent (8%) experienced functional disability in IADL, 1.9% lived alone, 11.8% indicated depression, 5.1%, 4.7%, and 1.6% of them had vision loss, hearing impairment, and communication problems, respectively. The strongest determinant factor for functional disability in IADL was depression (OR 7.869; 95% CI 4.657-13.296), followed by age (OR 4.602; 95% CI 2.764-7.663), and hearing impairment (OR 2.903; 95% CI 1.190-7.083).&#x0D; Conclusions: Depression is the strongest determinant factor for functional disability in IADL. Health professionals in rural areas should actively screen for depression to increase the ability of the elderly to fulfill their IADLs.&#x0D; Keywords: aged, depression, epidemiology, Indonesia

Comparison of caregiver burden between dementia with Lewy bodies and Alzheimer's disease.

Caring for patients with dementia with Lewy bodies (DLB) would be more stressful for their caregivers than those with Alzheimer's disease (AD). In this study, we compared levels of caregiver burden and the possible influential factors on the caregiver burden between DLB and AD. Ninety-three DLB patients and 500 AD patients were selected from the Kumamoto University Dementia Registry. Caregiver burden, neuropsychiatric symptoms, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were assessed by the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), the Neuropsychiatric Inventory (NPI), the Physical Self-Maintenance Scale (PSMS), and the Lawton IADL scale, respectively. Despite the comparable Mini-Mental State Examination score, the J-ZBI score was significantly higher in the DLB group than the AD group (P = 0.012). A stepwise multiple regression analysis revealed that IADL score (β = -0.23, P = 0.049), PSMS score (β = -0.31, P = 0.010), disinhibition (β = 0.22, P = 0.008), and anxiety (β = 0.19, P = 0.027) were significantly associated with J-ZBI score in DLB. In AD, caregiver's relationship with patient (child) (β = 0.104, P = 0.005), caregiver's gender (female) (β = 0.106, P = 0.004), IADL score (β = -0.237, P < 0.001), irritability (β = 0.183, P < 0.001), apathy (β = 0.132, P = 0.001), agitation (β = 0.118, P = 0.007), and aberrant motor behaviour (β = 0.107, P = 0.010) were associated with caregiver burden. Caring for DLB patients caused a higher degree of caregiver burden than AD patients in the same level of cognitive decline. The factors responsible for the caregiver's burden were different between DLB and AD. The caregiver burden for DLB patients was associated with the disability of basic ADL, IADL impairment, anxiety and disinhibition.

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.

Effects of computer-based cognitive training combined with physical training for older adults with cognitive impairment: A four-arm randomized controlled trial.

Combined physical (PHY) and cognitive (COG) training in sequential (SEQ) and simultaneous (SIMUL) sessions may delay the progression of cognitive impairment. To date, no study has directly compared in older adults with cognitive impairment the effects of COG training, PHY training, SEQ motor-cognitive training and SIMUL motor-cognitve training on specific indices of cognitive performance and activities of daily living (ADL). The purpose of this study was to determine whether SEQ and SIMUL motor-cognitive training can improve treatment outcomes compared with PHY or COG training alone. We also aimed to compare the effects of SEQ versus SIMUL motor-cognitive training on cognitive functions and instrumental ADL (IADL) in older adults with cognitive impairment. A cluster randomized controlled trial was conducted. Eighty older adults with cognitive impairment were randomly assigned to COG, PHY, SEQ or SIMUL training groups. The intervention consisted of 90-min training sessions, totaling 36 sessions. Outcome measures were the Montreal Cognitive Assessment, three subtests of the Wechsler Memory Scale (WMS) and the Lawton IADL scale. Significant interaction effects between group and time were found in WMS-spatial span (p = 0.04) and WMS-word lists (p = 0.041). For WMS-spatial span, the SIMUL group showed outperformed the COG (p = 0.039), PHY (p = 0.010) and SEQ groups (p = 0.017). For WMS-word lists, the SEQ group improve more than COG (p = 0.013), PHY (p = 0.030) and SIMUL (p = 0.019) groups. No significant differences were found in IADL performance among four groups (p = 0.645). Our study showed SEQ and SIMUL motor-cognitive training led to more pronounced improvements in visuospatial working memory or verbal memory compared with isolated COG or PHY training for community-based older adults with cognitive impairment. For enhancing effects on IADL, we suggest the use of sensitive measurement tools and context-enriched cognitive training involving real-life task demands.

Possible association between cerebral white matter atrophy and impaired performance of activities of daily living in patients with Parkinson's disease.

The contribution of brain abnormalities in patients with Parkinson's disease (PD) to impaired functional status remains uncertain. Our study assessed whether global and regional brain structural abnormalities are associated with impaired performance of activities of daily living (ADL) in PD patients. A retrospective analysis was conducted of 46 patients with PD, recruited prospectively from a movement disorder clinic. Motor impairment and disability were assessed using the Hoehn and Yahr (H-Y) scale and Unified Parkinson's Disease Rating Scale Part III (UPDRS-III). Cognitive status was evaluated with Montreal Cognitive Assessment (MoCA). The performance of ADL was indexed by the sum score of the Physical Self-Maintenance Scale (PSMS) and Lawton Instrumental ADL scale. Brain magnetic resonance imaging (MRI) was performed to assess white matter hyperintensities and medial temporal lobe atrophy (MTLA). Global brain atrophy, indexed by the relative grey matter volume (RGM), relative white matter volume (RWM) and average cortical thickness of the whole brain, was quantified by voxel-based morphometry (VBM). The ADL score (where higher scores indicate poorer performance) negatively correlated with RWM (where greater volume indicates less severe atrophy; r = -0.41, p = 0.004) and RGM (where greater volume indicates less severe atrophy; r = -0.43, p = 0.003) but not with the average cortical thickness ( r = -0.16, p = 0.29). With ADL score as the dependent variable in a linear regression model, H-Y stage and RWM significantly correlated with the ADL score after adjusting for age and MoCA score, and together accounted for 51% of the variance therein. RGM was not significantly correlated with the ADL score after adjusting for age and MoCA score. Cerebral white matter atrophy may be associated with the performance of ADL in patients with PD, indicating an important role of white matter impairment in their functional status.

“Effects of Different Measurements of Foot Angle on Vital Activities of Hemodialysis Patients”

Abstract Background Individuals who receive hemodialysis treatment due to chronic renal failure have limitations in their daily life and a decrease in physical activity and walking speed. In this study, we have investigated the effectiveness of various measurements of ankle angles of hemodialysis performed on patients on balance, falling risk, and daily life activities. Materials and Methods 114 volunteer hemodialysis patients with a mean age of 30-94 have measured at the position of plantar flexion, inversion, and eversion by a 1-degree sensitivity manual goniometer. The Time Up and Go test (TUG), Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and Barthel Index (BI) were applied to the patients. Statistical analyzes were made with the SPSS25 program. Results 55 male and 59 female participants were accompanied in the study. The average age was 62,8 ± 15,29, and the average hemodialysis performed duration was 5,59 ± 3,92, the average body mass indexes were 25,08 ± 5,17, the average number of falls was 5,59 ± 3,92. A low positive significant correlation was observed between plantar flexion and inversion foot angle measurements with The Lawton and Brody IADL scale (p&lt;0,05). A low-level significant positive correlation was observed between the BI score and the plantar flexion angle measurements (p&lt;0.05). A highly significant positive correlation was observed between plantar flexion angle measurement and inversion angle measurement. In contrast, a moderately significant positive correlation was observed between plantar flexion angle measurement and eversion angle measurement (p&lt;0.05). Conclusion We observed a decrease in daily life activities and a walking speed increase in falling risk in the diagnosis of chronic renal failure hemodialysis patients.

Exploring Patient Outcomes After Participation in an Inpatient Occupation-Based Group: A Longitudinal Observational Cohort Study.

Occupation-based interventions are used during inpatient rehabilitation, and group models may enhance intervention delivery. However, little is known about the impact of occupation-based groups on patient outcomes. To examine the effect of an occupation-based group on patient outcome measures of instrumental activities of daily living (IADL) skills over time and explore demographic differences among patients. Longitudinal observational cohort study with four time points: preintervention, postintervention, 30-day follow-up, and 90-day follow-up. Tertiary hospital general rehabilitation ward. Inpatient adults age 18 or older recruited using consecutive sampling from those referred to the group. The LifeSkills group, which focused on repetitive practice of meaningful occupation-based activities. Demographic data were obtained, and the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling, Lawton IADL scale, and a self-efficacy scale were administered at each data point. Thirty people (21 women, 9 men; ages 35-91 yr) participated, with 5 lost to follow-up. A statistically significant increase in scores postintervention occurred on all measures and was also seen at 90-day follow-up for COPM occupational performance, satisfaction, and self-efficacy scores. Lawton IADL scale scores at follow-up were lower than those at preintervention and statistically significant. No significant differences were found for age and diagnosis. Positive patient outcomes of goal achievement, occupational performance, satisfaction, and self-efficacy were seen at discharge, with evidence of sustainability over time. This could be a resource alternative for addressing skill retraining because people with different diagnoses and in different age groups benefited equally. What This Article Adds: Occupation-based group programs have encouraging application in general inpatient rehabilitation for addressing patient outcomes.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country.

ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Awareness of Instrumental Activities of Daily Living Disability: Pilot Study for Elderly Requiring Care and Caregivers

Aim: We aimed to investigate differences in the awareness of instrumental activities of daily living (IADL) disability between elderly patients with and without dementia requiring care. Methods: We assessed 25 elderly individuals requiring care and their primary caregivers using the Lawton IADL scale, with score differences between the patients and their caregivers representing the level of impaired awareness of IADL disability. Results: Among the participants, 80% exhibited impaired awareness of IADL disability. In terms of total score on the Lawton scale, there was no between-group difference in the occurrence of impaired awareness of IADL disability (p = 0.274, φ = 0.31). Contrastingly, regarding the subitems of the Lawton scale, the dementia group had a significantly higher number of participants with impaired awareness of responsibility for their own medications than the nondementia group (p = 0.030, φ = 0.47). Further, there were no significant between-group differences in the ability to use telephone, shopping, mode of transportation, or ability to handle finances. Conclusions: It is important for caregivers to notice the emergence of impaired awareness among the elderly as soon as possible to ensure early diagnosis and treatment. The results of this study suggest the need for caregivers to take care of the elderly patients with the perspective that they may develop impaired awareness of responsibility for their own medications.

FACTORS INFLUENCING INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) DISABILITY AMONG ELDERLY ATTENDING HEALTH CLINICS IN KELANTAN

Instrumental activities of daily living (IADL) is a construct that describes the functional ability to perform complex activities, requiring physical and mental capability that allows an elderly to live independently. Studies on IADL in Malaysia are still lacking. Thus, this study aimed to determine the factors influencing IADL disability among the elderly attending health clinics in Kelantan. A cross-sectional study was conducted using a guided questionnaire consisting of sociodemographic characteristics, health-related conditions, Lawton IADL scale, Elderly Cognitive Assessment Questionnaire (ECAQ), Geriatric Depression Scale (GDS), and Duke Social Support Index (DSSI). Multiple logistic regression (MLR) was performed to assess factors influencing IADL disability. Disabled IADL status was defined as having difficulty performing at least one out of eight activities on the Lawton IADL scale. A sample of 248 elderly from 12 health clinics in Kelantan was included, 36.3% of them had disabled IADL status. In the final MLR model, factors influencing IADL disability were, age group 70 years old and above (Adj. OR 3.52; 95% CI: 1.85, 6.69, p-value&lt;0.001), being unmarried/single (Adj. OR 2.37; 95% CI:1.25, 4.49, p-value=0.008), no formal education (Adj. OR 4.03; 95% CI: 1.64, 9.88, p-value=0.002), low level of income (Adj. OR 2.37; 95% CI: 1.11, 5.07, p-value=0.026) and those who reported fair or poor self-rated health status (Adj. OR 2.53; 95% CI: 1.31, 4.89, p-value=0.006). Therefore, recognition of these factors is critical to promote a better health policy and to provide appropriate care for the elderly in the country.

Psychometric Properties of the Persian Version of Penn Parkinson Daily Activities Questionnaire-15.

Appropriate information about the ability of patients with Parkinson disease (PD) to perform cognitive instrumental activities of daily living (IADL) is necessary. The present study aimed to assess the psychometric properties of the Persian version of the Penn Parkinson daily activities questionnaire-15 (PDAQ-15). A total of 165 knowledgeable informants of PD patients completed the PDAQ-15. The clinical dementia rating scale, Hoehn and Yahr staging, hospital anxiety and depression scale (HADS), and Lawton IADL scale were used in the study. Internal consistency and test-retest reliability were evaluated by the Cronbach α coefficient and intraclass correlation coefficient (ICC), respectively. To examine the dimensionality of the questionnaire, exploratory factor analysis was used. The construct validity was assessed using the Spearman rank correlation test. To assess the discriminative validity, PDAQ-15 scores were compared across cognitive stages. The PDAQ-15 showed strong internal consistency (the Cronbach α=0.99) and test-retest reliability (ICC= 0.99). Only one dimension was identified for the PDAQ-15 in the factor analysis. There was a strong correlation between PDAQ-15 with the depression domain of the HADS scale and the Lawton IADL scale (rs=|0.71-0.95|). The correlation of PDAQ-15 with the anxiety domain of the HADS scale was moderate (rs=0.66). Discriminative validity analysis showed that the PDAQ-15 has significant power to discriminate between PD patients across cognitive stages. These results suggest that the PDAQ-15 is a valid and reliable PD-specific instrument and can be useful in clinical and research settings.

Patterns of instrumental activities of daily living between community-dwelling older adults.

ABSTRACTThe ability to perform instrumental activities of daily living (IADLs) is an important marker within the aging process, as it reflects the level of independence to perform in the real world. However, there is a scarcity of studies that investigate the different performance profiles among older adults.Objective:To investigate the heterogeneity present in the community of elderly people, grouping them based on characteristics and patterns observed through an objective performance-based assessment.Methods:Participants were selected according to the following inclusion criteria: fluency in Portuguese, 360 years, regular participation in a social program offered by the government of Rio de Janeiro, and absence of a caregiver. The evaluation of IADLs was determined by the total and brief version of the University of California, San Diego Performance-Based Skills Assessment (UPSA) and the Lawton and Brody IADL scale. The Brief Cognitive Screening Battery and the Mini-Mental State Examination were used to characterize the sample, in addition to the Geriatric Depression Scale. A total of 61 elderly people with an average age of 72.5 years, predominantly females (85.2%), and average education of 11.2 were evaluated and grouped according to their performance at UPSA through clustering analysis.Results:The analysis revealed three grouping patterns, subdividing the sample into subgroups that differed significantly in terms of age, education, global cognition, and all instrumental activities assessed by UPSA — planning, finance, communication, transportation, and household chores.Conclusions:This study was able to identify the heterogeneity present between the elderly people in the different factors that compose the IADLs through a performance-based assessment.