Level Of Functional Dependence Research Articles

Determining the Need for Palliative Care Patients with Multiple Sclerosis-A Cross-Sectional Study.

Multiple sclerosis is characterised by the manifestation of heterogeneous symptoms that affect daily functioning. Patients face physical impairment, psychological problems and socioeconomic changes. Depending on the form of the disease, they may have different needs, which are often unsatisfied and could be overcome by including palliative care in the treatment. Despite the above, not enough is known about this population's needs for palliative care. This cross-sectional study aimed to identify the need for palliative care and assess the functional dependence level in daily living activities in patients with multiple sclerosis. The sample consisted of 120 patients from the Neurology Clinic of the University Clinical Center of Vojvodina, Serbia. The following research instruments were used: a General questionnaire, Sheffield Profile for Assessment and Referral for Care, Multiple Sclerosis Impact Scale and Barthel Index. The need for palliative care was expressed by 36.7% of patients, who expressed the most concern for the physical symptoms, independence and activity domains. Also, it was determined that the disease prevents patients from doing demanding physical tasks and that they are worried about multiple sclerosis. Almost a quarter of patients have had complete/severe dependence on other persons in performing daily activities. The most frequently reported physical symptoms by patients with MS were weakness, bladder problems, fatigue and different levels of dependence, while concerns related to sexual health, low mood and anxiety emerged as key challenges in the psychological domain. These findings underscore the importance of conducting needs assessments to guide the development of an appropriate palliative care model for MS patients.

Comparison of assistance preferences of older adults with different functional dependence levels on domestic tasks performed by robots

BackgroundRobots have the potential to assist older adults in their home-based daily living tasks. Previous studies indicated that older adults generally accept robot assistance. However, the preferences of older adults with different functional dependence levels are lacking. These older adults encounter varying levels of difficulty in daily living and may have distinct preferences for robot assistance. This study aimed to describe and compare the preferences for robot assistance on domestic tasks in older adults with different functional dependence levels.MethodsThis cross-sectional descriptive study recruited a convenience sample of 385 older adults in Hong Kong. They were categorized as independent, partially dependent, and dependent using the Katz Index of Independence in Activities of Daily Living. Their preferences for robot assistance on a list of 48 domestic tasks under six categories were assessed through the Assistance Preference Checklist. Differences in preferences between the three groups were compared using one-way ANOVA test.ResultsFindings revealed the differences and similarities in preferences between participants with different dependence levels. In most domestic tasks under the personal care category, dependent and partially dependent older adults reported a significantly lower preferences for human assistance or a higher preferences for robot assistance (p < 0.001), compared with the independent ones. The effect size varied from medium to large (eta squared = 0.07 to 0.52). However, participants, regardless of functional dependence levels, preferred human to assist in some domestic tasks under the health and leisure activities category and preferred robot to assist in most of the domestic tasks under the chores, information management, and manipulating objects category.ConclusionsOlder adults with different levels of functional dependence exhibit different preferences for robotic assistance. To effectively use robots and assist older adults as they age, the specific preferences of older adults must be considered before designing and introducing robots in domestic care.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Association between chronic conditions, multimorbidity, and dependence levels in Chinese community-dwelling older adults with functional dependence: a cross-sectional study in south-central China.

The rising prevalence of multimorbidity and functional dependence in community-dwelling older adults contribute to the demand for home care services. Evidence on how chronic conditions, especially multimorbidity, affect dependence levels among older adults with functional dependence in a socio-cultural context is much needed to inform policy, workforce, aged care service development to meet the care needs of this population. This study aimed to determine the association between chronic conditions, multimorbidity and dependence levels among Chinese community-dwelling older adults with functional dependence. A cross-sectional study was conducted with 1,235 community-dwelling older adults with functional dependence in Hunan province, China, from June to October 2018. Data on socio-demographic factors, cognitive function, vision and hearing conditions, activities of daily living (ADLs), and health conditions were collected, and binary logistic regression analyses were used to determine the association between chronic conditions, multimorbidity and dependence levels, with adjustments for relevant covariates. Among the participants, 62.9% had multimorbidity. Parkinson's disease, stroke, COPD, hypertension, mood and psychotic disorders (Anx/Sch/Dep) were significantly associated with high levels of functional dependence. After adjusting for demographic variables, cognitive function, vision, and hearing conditions, we observed a significant relationship between multimorbidity and higher functional dependence, but this association became insignificant when including certain chronic diseases closely associated with high-level dependence. Study revealed that Parkinson's disease and stroke notably increase dependency risk across seven ADL domains, demonstrating their extensive impact on daily functioning. The prevalence of multimorbidity among Chinese community-dwelling older adults with functional dependence is very high. The association of multimorbidity with functional dependence is mediated by specific chronic conditions. These findings highlight the necessity of adopting an integrated care model that combines medical and social care, with a particular emphasis on managing multimorbidity and critical chronic conditions that lead to severe functional dependence to preventing and diminish the onset of disabilities.

Prediction of functional dependence with digital clock drawing, word recall, and assessment of lifestyle and health factors

AbstractBackgroundDistinguishing mild cognitive impairment (MCI) and Alzheimer’s disease‐related dementia (ADRD) requires assessing the clinical impact of cognitive deficits on a patient’s activities of daily living. To accurately monitor cognitive decline, it is thus critical to combine early screening of cognitive deficits with the assessment of functional impairment. The Digital Clock and Recall (DCR™), consisting of DCTclock™ and a 3‐word delayed recall, employs AI‐enabled performance analyses to evaluate memory, executive function, visuospatial abilities, and motor functions. The Life and Health Questionnaire (LHQ) is a brief digital survey that captures key lifestyle and health factors for cognitive decline/dementia. We evaluated whether the combination of the DCR and LHQ can predict functional status, measured by the Functional Abilities Questionnaire (FAQ) reported by an informant, in older individuals with statuses ranging from cognitively unimpaired to MCI and ADRD.Method849 participants from a multisite study (age mean±SD = 72.1±6.7; 56.8% female; years of education mean±SD = 15.4±2.7), classified as cognitively unimpaired (n = 369), MCI (n = 262), or ADRD (n = 215). Mild (mFD) and moderate (modFD) levels of functional dependence were defined as FAQ score ≥ 6 and ≥ 9, respectively. We conducted 10‐fold cross‐validated regularized logistic regressions using LHQ responses and DCR metrics to predict mFD or modFD, controlling for age, sex, and education.ResultLHQ significantly predicted mFD and modFD (p’s&lt;0.001, R2 = 0.13, and R2 = 0.12). Adding DCR metrics to the model improved both models (p’s&lt;0.001, R2’s = 0.18 and 0.13, respectively). Surviving LHQ questions for predicting mFD related to unintended weight loss, social engagement/volunteering, cognitively stimulating tasks, sleep, and life satisfaction/purpose. Surviving LHQ questions for predicting modFD related to unintended weight loss, social engagement/volunteering, cognitively stimulating tasks, and sleep.ConclusionA brief assessment that can be completed in primary care settings in &lt;10 min consisting of an objective digital cognitive assessment and a survey of self‐reported lifestyle and health factors can not only identify early cognitive impairment but also reliably predict level of functional dependence in instrumental activities of daily living ‐ without need for an informant.

Worsening preoperative functional status increases morbidity and mortality in patients undergoing coronary artery bypass grafting: A propensity matched study of the ACS-NSQIP database

IntroductionDependent functional status is correlated with increased mortality in patient undergoing coronary artery bypass grafting (CABG). However, patients who are partially dependent and totally dependent may have different peri‑operative outcome profiles. This study aims to retrospectively examine the effect of different levels of functional dependency on post-CABG morbidity and mortality. MethodsPatients who underwent a CABG from 2005 to 2021 were identified in the ACS-NSQIP database. Subjects were stratified into independent (IFS), partially dependent (PDFS), and totally dependent functional status (TDFS). A 5:1 propensity matching between IFS and each functional dependent group was performed, respectively. The 30-day peri‑operative outcomes of PDFS and TDFS were compared to that of IFS. Peri-operative outcomes between PDFS and TDFS were compared using multivariable logistic regression, adjusted for demographics and co-morbidities. ResultsThere were 968 PDFS with 4779 matched IFS and 247 TDFS with 1202 matched IFS. Compared to IFS, PDFS and TDFS had higher mortality, sepsis, bleeding, and length of stay>7 days. TDFS have higher MACE, cardiac/pulmonary/renal complications, and OR return than IFS. Compared to PDFS, TDFS had higher mortality (aOR 1.68, p = 0.03), higher risk of MACE (aOR 1.88, p<0.01), cardiac events (aOR 2.74, p<0.01), perioperative sepsis (aOR 1.73, p = 0.03), pulmonary complications (aOR 2.16, p<0.01), and returning to OR (aOR 1.68, p = 0.02). ConclusionOur study shows that dependent functional status is associated with increased morbidity and mortality after CABG. Additional post-CABG complication monitoring and care may be required for TDFS.

30-Day Readmission Following Outpatient Transmetatarsal Amputation in the Geriatric Population: An ACS NSQIP Analysis

Whether secondary to deformity, traumatic injury, infection, neoplasm, or ischemic disease, the transmetatarsal amputation provides a functional means of limb preservation prior to major proximal amputation. With similar readmission rates following inpatient and outpatient surgery, prevention of an unnecessary admission among vulnerable patients, specifically geriatrics, proves beneficial. This investigation examines differences among geriatric patients admitted and not requiring readmission following outpatient transmetatarsal amputation. An ACS NSQIP database analysis following filtering for CPT 28805, specific for transmetatarsal amputations, was performed among geriatric patients. Patient demographic, medical history, operative characteristics, and social/functional determinants were compared between the no admission and readmission cohorts. The threshold for statistical significance was set at p ≤ .05. Overall, a 19% readmission rate was reported among geriatric patients who underwent an outpatient transmetatarsal amputation. No statistically significant difference among patient demographics, past medical history, or surgical presentation was found between cohorts. Geriatric patients that maintained some level of functional dependence were 3.41 times more likely to be readmitted than the nonreadmission cohort (p=.006). Among geriatric patients undergoing outpatient transmetatarsal amputation, function status should be taken into account prior to surgery. Greater consideration should also be given to patients who do not maintain independence during their activities of daily living. As the population continues to age, recognizing social circumstances associated with the geriatric population proves important in preventing readmission.

Functional dependence as a contributing factor for patient hand contamination by multidrug-resistant organisms in acute care

Background and objectives: Patients with functional disabilities are at higher risk of adverse outcomes, including infections. Although healthcare worker hand contamination has long been recognized as an important source of pathogen acquisition, the role of patient hands has been less clearly defined. We sought to determine whether the presence of functional disabilities is correlated with patient hand contamination by multidrug-resistant organisms (MDROs) and thus a potential target for patient hand hygiene (PHH) interventions. Methods: Case–control study of hand contamination with methicillin-resistant S. aureus, vancomycin-resistant enterococci, and gram-negative bacilli resistant to cephalosporins, fluoroquinolones, and/or carbapenems in 2 acute-care hospitals in southeastern Michigan. Cases (n = 40) and controls (n = 359) were defined as patients with or without hand contamination by MDROs, respectively. We assigned 3 exposure categories based on Katz activities of daily living scores: no functional disabilities (independent, reference group), 1–3 functional disabilities (partially dependent), and 4+ functional disabilities (dependent). We used stepwise logistic regression to identify confounding variables. Logistic regression was then used to establish the relationship between a patient’s functional dependence level and their hand contamination by MDROs. Results: The distribution of hand contamination of each target MDRO by level of patient dependence is shown in the Table. Overall, methicillin-resistant Staphylococcus aureus (MRSA) was the most represented, followed by resistant gram-negatives and vancomycin-resistant enterococci (VRE). Hospital site, sex, and history of MDROs were included in the model based on stepwise regression. The odds ratio (OR) of MRSA hand contamination in the dependent category was 3.19 (95% CI, 1.18–5.54) compared to the independent category, and for any MDRO the OR was 2.77 (95% CI, 1.22–6.32) (Fig. 1). The OR of MRSA hand contamination in the partially dependent category was 1.38 (95% CI, 0.27–7.07) compared to the independent group, and for any MDRO the OR was 0.86 (95% CI, 0.24–3.10) (Fig. 1). Feeding dependence had the highest single association with hand contamination (OR, 3.79, 95% CI, 1.26–11.43), with dressing dependence having the second highest association with hand contamination (OR, 2.82; 95% CI, 1.31–6.05) (Fig. 2). Conclusions: Patients with more functional dependencies were more likely to have MDRO hand contamination. This finding suggests a need for targeted PHH interventions in patients with functional disabilities to help prevent the spread of MDROs in the acute-care setting.Disclosures: None

Individuals with stroke three months after hospital discharge reported worse quality of life during the COVID-19 pandemic

PurposeTo compare quality of life (QOL) of individuals with stroke three months after hospital discharge, using generic and specific QOL measures, before and during the COVID-19 pandemic. MethodsIndividuals, who were admitted to a public hospital, were recruited and evaluated before (G1) and during (G2) the COVID-19 pandemic. The groups were matched for age, sex, socio-economic status, and levels of stroke severity (National Institutes of Health Stroke Scale) and functional dependence (Modified Barthel Index). After three months of hospital discharge, they were evaluated and compared using generic (Short-form Health Survey 36: SF-36) and specific (Stroke Specific Quality of Life: SSQOL) QOL measures. ResultsSeventy individuals were included (35 in each group). Statistically significant between-group differences were found for both total SF-36 (p=0.008) and SSQOL (p=0.001) scores, indicating that individuals reported worse QOL during the COVID-19 pandemic. Furthermore, G2 also reported worse generic QOL related to the SF-36 domains of physical functioning, bodily pain, general health perception, and emotional role limitations (p < 0.01) and worse specific QOL related to following SSQOL domains: Family roles, mobility, mood, personality, and social roles (p < 0.05). Finally, G2 reported better QOL related to energy and thinking (p < 0.05) SSQOL domains. ConclusionIn general, individuals with stroke, who were evaluated during the COVID-19 pandemic three months after hospital discharge, reported worse perceptions of QOL in several domains of both generic and specific QOL measures.

Recognizing the Needs of High-Need High-Risk Veterans.

Understanding the needs of higher-risk older adult patients can support the delivery of high quality and patient-centered healthcare. We sought to characterize the physical, functional, social and psychological needs of High-Need High-Risk (HNHR) Veterans. We hypothesized that the concept of frailty could be useful in identifying the highest-risk HNHR patients and characterizing their needs. We conducted a cross-sectional study of Veterans in the Miami Veterans Affairs Healthcare System who were identified as High-Need High-Risk by the Department of Veterans Affairs (VA) using data analytic techniques. We analyzed data of 634 Veterans who completed questionnaires by mail, telephone or in person. We assessed the Veterans' frailty status and needs in the physical, functional, psychological and social domains. Beyond descriptive statistics, we used Chi-square (χ 2) test, one-way ANOVA and Kruskal-Wallis to analyze whether there were differences in Veterans' needs in relation to frailty status. The HNHR Veterans who participated in the questionnaire had complex needs that spanned the physical, functional, psychological, and social domains. We observed a potential mismatch between functional needs and social support; over two-thirds of respondents endorsed having dependence in at least one ADL but only about a third of respondents reported having a caregiver. Patients with frailty had higher levels of functional dependence and were more likely than the other HNHR respondents to report recent falls, recent hospitalizations, depression, and transportation issues. High-Need High-Risk Veterans have complex needs related to the physical, functional, psychological and social domains. Within the HNHR population, HNHR Veterans with frailty appear to have particularly high levels of risk and multidomain needs. Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support development of appropriate strategies and care-models to support HNHR Veterans.

Health profile of the elderly person accompanied by the family health strategy in a countryside of Ceará - Brazil

Objective: To evaluate the correlation between functional dependence and emotional state, cognitive function, and ambulation of the elderly people accompanied by a family health team. Methods: A cross-sectional, quantitative, and prospective study was conducted in the city of Quixeré/CE between August 2020 and April 2021. Participated in 229 elderly people registered in the Family Health Strategy teams evaluated using the Lawton scale, MMSE, GDS-15, and Tinneti test. The association of variables was verified using the chi-square or Fisher's exact tests. Odds Ratio (95%CI) were calculated, followed by logistic regression using the Hosmer and Lemeshow test. Results: The sample was primarily composed of women with low education, average age of 70 years, and a high demand for primary health services. Women were more vulnerable to depression, with no difference in falls related to sex. Age was a risk factor for all aspects evaluated. There was a correlation between functional dependence and all aspects analyzed. There was a relationship between the level of functional dependence and education (OR: 2.0; 95%CI: 0.05 - 78.32), living in the rural area (OR: 2.83; 95%CI: 1.6 - 5.1), depression (OR: 5.18; 95%CI: 1.2 – 22.8) and risk of falls (OR: 1.67 CI: 0.8 – 3.5), with the last two factors remaining significant in the logistic regression. Conclusion: Functional dependence to more complex daily activities among the elderly was significant, with an essential relationship with emotional and cognitive aspects and risk of falls.

1047 VALIDATION OF THE CHINESE VERSION OF THE KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING

Abstract Introduction Among the instruments that measure an elder’s functional dependence level, the Katz Index of Independence in Activities of Daily Living has the advantages of being neutral, easy to use, valid, and reliable. It is a six-item instrument rating an elder’s functional dependence level in performing activities of daily living, including bathing, dressing, toileting, transferring, continence, and feeding. Each item can be rated nominally as 1 (does not require assistance to finish the activity) or 0 (requires assistance to finish the activity). By summing the score of the six items, the functional dependence level of an elder can be classified as independent (6 points), partially dependent (3–5 points), or dependent (&amp;lt; 2 points). The instrument has been translated from English to Chinese through forward and backward translation. This study aims to validate the Chinese version of the Katz Index of Independence in Activities of Daily Living (Katz ADL-Chinese). Method This was a validation study. The Katz ADL-Chinese was examined by an expert panel (one academic specialized on instrument validation, four academic specialized on translation, fifteen nurses specialized on geriatrics) for its semantic and content equivalence with the original English version. It was evaluated by another expert panel (one academic specialized on instrument validation and two nurses specialized on geriatrics) for its content validity. Moreover, it was tested and re-tested at 1-week interval on 30 Chinese-speaking elders in Hong Kong. Results Good result was achieved on the testing for semantic and content equivalence. All experts confirmed that the Katz ADL-Chinese was appropriately translated. Good content validity was observed. The context validity index at item-level and scale-level was 1.00, respectively. Good stability was observed as well. The test–retest reliability coefficient was 0.85.

Natural History Study of STXBP1-Developmental and Epileptic Encephalopathy Into Adulthood.

Background and ObjectivesPathogenic STXBP1 variants cause a severe early-onset developmental and epileptic encephalopathy (STXBP1-DEE). We aimed to investigate the natural history of STXBP1-DEE in adults focusing on seizure evolution, the presence of movement disorders, and the level of functional (in)dependence.MethodsIn this observational study, patients with a minimum age of 18 years carrying a (likely) pathogenic STXBP1 variant were recruited through medical genetics departments and epilepsy centers. Treating clinicians completed clinical questionnaires and performed semistructured video examinations while performing tasks from the (modified) Unified Parkinson Disease Rating Scale when possible.ResultsThirty adult patients were included for summary statistics, with video recordings available for 19 patients. The median age at last follow-up was 24 years (range 18–58 years). All patients had epilepsy, with a median onset age of 3.5 months. At last follow-up, 80% of adults had treatment-resistant seizures despite long periods of seizure freedom in 37%. Tonic-clonic, focal, and tonic seizures were most frequent in adults. Epileptic spasms, an unusual feature beyond infancy, were present in 3 adults. All individuals had developmental impairment. Periods of regression were present in 59% and did not always correlate with flare-ups in seizure activity. Eighty-seven percent had severe or profound intellectual disability, 42% had autistic features, and 65% had significant behavioral problems. Video examinations showed gait disorders in all 12 patients able to walk, including postural abnormalities with external rotation of the feet, broad-based gait, and asymmetric posture/dystonia. Tremor, present in 56%, was predominantly of the intention/action type. Stereotypies were seen in 63%. Functional outcome concerning mobility was variable ranging from independent walking (50%) to wheelchair dependence (39%). Seventy-one percent of adults were nonverbal, and all were dependent on caregivers for most activities of daily living.DiscussionSTXBP1-DEE warrants continuous monitoring for seizures in adult life. Periods of regression are more frequent than previously established and can occur into adulthood. Movement disorders are often present and involve multiple systems. Although functional mobility is variable in adulthood, STXBP1-DEE frequently leads to severe cognitive impairments and a high level of functional dependence. Understanding the natural history of STXBP1-DEE is important for prognostication and will inform future therapeutic trials.

Образование и революции (Почему революционные выступления принимают вооруженную или невооруженную форму?)

Despite the existence of numerous hypotheses about what factors influence protesters’ choice of armed vs. unarmed struggle tactics, today there is a dearth of global, quantitative cross-national studies aimed at identifying the reasons why revolutions take a violent vs. a non-violent form. The article attempts to fill one of the gaps existing here by conducting a crossnational analysis of the relationship between education and the type of revolutionary action. Based on the existing literature, the authors document several mechanisms that nudge educated people to choose unarmed forms of protest. In particular, education makes people more receptive to liberal-democratic valu es (including recognition and respect for the rights of others), promotes the development of tolerance and a culture of peaceful discussion, as well as increases human capital, which, on the one hand, makes it possible to successfully use non-violent instruments to defend one’s interests, and, on the other hand, increases the relative costs of participating in armed uprisings. Hence, the authors put forward a hypothesis, according to which in countries with a higher percentage of the population with formal education, the likelihood of armed revolutionary uprisings will decrease. The analysis of 387 revolutionary events that took place in the world from 1950 to 2019 conducted via cross-tabulation, correlation and regression methods, fully confirms the hypothesis: high level of education is indeed a strong and significant predictor of the unarmed nature of revolutionary upheavals. The correlation is especially high between the proportion of revolutionary events and the average number of years of schooling (in the logged form), which approaches the level of functional depen dence. Therefore, the factor of education has the maximum influence on the nature of revolutionary uprisings precisely in the early stages of modernization.

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents

BackgroundCovid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality.Methods We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death.ResultsA total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001).ConclusionsOur results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

THE VASCULAR COGNITIVE IMPAIRMENT AND FUNCTIONAL DEPENDENCE AMONG POST-STROKE PATIENTS AT HOSPITAL UNIVERSITI SAINS MALAYSIA

Effectiveness of stroke care and treatment recently was associated with increase stroke survivors however, half of them are left with significant vascular cognitive impairment and functional dependent. The aims of this study is to determine the association between Vascular Cognitive Impairment (VCI) with clinical characteristics and functional dependence among 42 post-stroke patients admitted at Hospital Universiti Sains Malaysia (Hosp.USM), Kelantan, Malaysia. Personal information, level of cognitive impairment using Mini-Mental State Examination (MMSE) and functional dependence and independent level using a Barthel index data was collected. The result showed that 23.8% of stroke patients had severe vascular cognitive impairment, 40.5% had mild vascular cognitive impairment, while the other 35.7% had no vascular cognitive impairment. Besides, the functional level indicated that 19.0% of participants were dependent and 81.0% were independent. There was no statistically significant association between vascular cognitive impairment with gender, stroke location, and underlying medical disease. However, a significant and positive correlation was found between the level of vascular cognitive impairment and functional dependence level (r = 0.553, p &lt; 0.001). An early assessment of the degree of cognitive impairment and functional independence will help enhance the treatment of stroke patients and reduce potential problems such as secondary strokes or other cardiovascular events.

Impact of Diabetes on the Patients Undergoing Coronary Artery Bypass Grafting

: This study was designed to evaluate the impact of diabetes on functional capacity, level of physical activity, quality of life, dependency level and mortality risk in patients undergoing primary coronary artery bypass grafting. A total of 30 patients undergoing CABG procedure were assessed pre and postoperatively for their functional capacity by New York Heart Association classification and six-minute walk test, physical activity by Duke activity status index, dependency level by functional independency measurement, mortality risk by Society of thoracic surgeons, EuroSCORE II and CASUS and, quality of life preoperatively by Nottingham Health Profile questionnaire. Patients with a history of ≥10 years of diabetes were compared to the non-diabetics group. On analysis it was observed, that the diabetic group are older (68.67+7.52 years), hypertensive (87%), less obese, and have lesser ejection fraction than the non-diabetics. There was no significant difference between the group’s functional capacity, quality of life and mortality risk, but the diabetic group showed a significantly higher postoperative risk to stroke (p=0.042) and longer hospital stay (p=0.006). Dependency level, functional capacity and total ICU stay was reported to be more affected in the diabetics. Both the groups showed an improved dyspnea and angina after the surgery. The dependency level in diabetics (p=0.00) and non-diabetics (p=0.003) was also observed to decrease significantly with the surgery. The study concluded that diabetes has an impact on the functional capacity, physical activity, angina, dependency level, and total hospital stay in the individuals following bypass surgery.

Frailty phenotypes in patients with heart failure in the early post-discharge period: insights from the iCOR randomised controlled trial and a machine learning-based clustering analysis

Abstract Background/Introduction Several variables such as clinical, socioeconomic, functional or cognitive, among others can have an impact on the prognosis of heart failure (HF) patients despite the optimisation of follow-up strategies (e.g. telemedicine [TM] solutions). The clustering of HF patients may to identify different patient frailty phenotypes. Purpose The aim of this study was to perform a machine learning-based clustering analysis to identify different patient frailty phenotypes in a cohort of HF patients recruited in a randomized clinical trial (The Insuficiència Cardíaca Optimitzaciό Remota [iCOR] study). Methods We performed the clustering analysis on the basis of 8 frailty-related dimensions. To define the number of clusters, dissimilarity matrix was calculated with Gower's distance. Then, hierarchical divisive clustering was performed. Using then Elbow and Silhouette to analyse how the within sum of squares changes for the different number of clusters, the final number of clusters were chosen. The incidence proportion of the each of the study endpoints (non-fatal HF events as primary endpoint and all-cause hospitalization, all-cause death and the composite endpoint combining of all-cause death or non-fatal HF events as secondary endpoints) was calculated for cluster. Results 5 different frailty phenotypes were identified. Cluster 1 (29 patients, 16%) comprised patients with the best reported self-perceived health status (QoL), fair emotional-affective status, but low levels of self-care. Cluster 2 (41 patients, 23%) included the youngest patients with the highest level of education and a better level of cognition. Cluster 3 (68, 38%) encompassed the patients who had the best level of self-care behaviour (18.9±9.8), greater physical and instrumental functioning for activities of daily living (ADL) and a lower rate of comorbidities. Patients in the Cluster 4 (30 patients, 17%) tended to be elderly females with poor health-related QoL, and a higher level of functional dependence. Finally, Cluster 5 was the smallest group (10 patients, 6%), encompassing the oldest patients with low level of education, a worse affective-emotional state, a significant cognitive decline and a higher proportion of comorbidities compared to the other clusters. Cluster 4 had the highest incidence rate of the primary endpoint (57 per 100 patient-years at risk, 95% CI [37.4–74–5]) and a higher incidence of all-cause hospitalization and of the combined variable of all-cause of death or non-fatal HF events. Conclusion(s) Using the cluster analysis, we were able to stratify HF patients according to the stage of their impairment and vulnerability in each of the different frailty domains. This will allow clinicians to incorporate holistic multi-domain assessments in HF programmes to identify patients' needs and provide each patient with personalised and structured follow-up programme according to patient's needs (personalised and precision medicine). Funding Acknowledgement Type of funding sources: None. Radar chart to compare frailty clustersClinical endpoints according clusters

P7. Early parietofrontal network upregulation relate to subsequent limited recovery after a severe motor stroke

Recent brain imaging has evidenced that parietofrontal networks show alterations after stroke which also relate to the motor recovery processes. There is converging evidence for an upregulation of parietofrontal coupling between parietal brain regions and frontal motor cortices. The majority of studies base these findings on moderately to mildly affected patients particularly in the subacute or chronic stage. Whether these network alterations will also be present in severely affected patients and early after stroke and whether such information can be used to improve correlative models to infer motor recovery remains unclear. Nineteen severely affected first-ever stroke patients (mean age 74 years, 12 females) underwent resting-state functional MRI and clinical testing during the initial week after the event. Clinical evaluation was repeated after three and six months. Nineteen healthy participants of similar age and gender were also recruited. MRI data were used to calculate functional connectivity values between the ipsilesional primary motor cortex, the ventral premotor cortex, the supplementary motor area and the anterior and caudal intraparietal sulcus of the ipsilesional hemisphere. Linear regression models were estimated to compare parietofrontal functional connectivity between stroke patients and healthy controls and to relate them to motor recovery. The main finding was a significant increase in ipsilesional parietofrontal coupling between anterior intraparietal sulcus and the primary motor cortex in severely affected stroke patients ( P < 0.003). This upregulation significantly contributed to correlative models explaining variability in subsequent motor recovery: Patients with increased parietofrontal coupling in the acute stage showed higher levels of disability and residual motor impairment in the late subacute stage of recovery ( P < 0.05). This study provides novel insights that parietofrontal networks of the ipsilesional hemisphere undergo neuroplastic alteration already very early after severe motor stroke. The association between early parietofrontal upregulation and future levels of persistent functional deficits and dependence from help in daily living might be useful in models to enhance clinical neurorehabilitative decision making.

Early parietofrontal network upregulation relates to future persistent deficits after severe stroke-a prospective cohort study.

Recent brain imaging has evidenced that parietofrontal networks show alterations after stroke which also relate to motor recovery processes. There is converging evidence for an upregulation of parietofrontal coupling between parietal brain regions and frontal motor cortices. The majority of studies though have included only moderately to mildly affected patients, particularly in the subacute or chronic stage. Whether these network alterations will also be present in severely affected patients and early after stroke and whether such information can improve correlative models to infer motor recovery remains unclear. In this prospective cohort study, 19 severely affected first-ever stroke patients (mean age 74 years, 12 females) were analysed which underwent resting-state functional MRI and clinical testing during the initial week after the event. Clinical evaluation of neurological and motor impairment as well as global disability was repeated after three and six months. Nineteen healthy participants of similar age and gender were also recruited. MRI data were used to calculate functional connectivity values between the ipsilesional primary motor cortex, the ventral premotor cortex, the supplementary motor area and the anterior and caudal intraparietal sulcus of the ipsilesional hemisphere. Linear regression models were estimated to compare parietofrontal functional connectivity between stroke patients and healthy controls and to relate them to motor recovery. The main finding was a significant increase in ipsilesional parietofrontal coupling between anterior intraparietal sulcus and the primary motor cortex in severely affected stroke patients (P < 0.003). This upregulation significantly contributed to correlative models explaining variability in subsequent neurological and global disability as quantified by National Institute of Health Stroke Scale and modified Rankin Scale, respectively. Patients with increased parietofrontal coupling in the acute stage showed higher levels of persistent deficits in the late subacute stage of recovery (P < 0.05). This study provides novel insights that parietofrontal networks of the ipsilesional hemisphere undergo neuroplastic alteration already very early after severe motor stroke. The association between early parietofrontal upregulation and future levels of persistent functional deficits and dependence from help in daily living might be useful in models to enhance clinical neurorehabilitative decision making.