ADL Measures Research Articles

Is trunk training effective at improving ability in activities of daily living and function of people who have had a stroke? ACochrane Review summary with commentary.

Effective trunk control is an essential component of sitting and standing balance, and is a key requirement for movement of the head and limbs, and for carrying out functional tasks. A stroke can result in impaired trunk control, affected by stroke-related deficits in balance, muscle function, coordination and position sense. Recovery of trunk control is recognised as a key goal of stroke rehabilitation. To evaluate the effectiveness of trunk training interventions in people with stroke. A summary of the Cochrane Review by Thijs et al. (2023), with comments from a rehabilitation perspective. 68 studies (2585 participants) were included in the Cochrane review. Trunk training was not found to have any benefit on measures of ADL, when compared to other dose-matched therapies, but did improve trunk function and other outcomes. Trunk training was more beneficial than non-dose-matched therapies for measures of ADL, trunk function, and other outcomes. The certainty of these findings is very low. Evidence supports the use of trunk training as part of stroke rehabilitation. However certainty in these findings is very low due to volume, quality and heterogeneity of the evidence.

CT Marker in Emergency Imaging of Acute Basilar Artery Occlusion: Thrombosis vs. Embolism.

Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean/SD/range): 72/13/28–97), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as ‘absolute density loss’ (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p < 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values < 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice.

Measuring self-reported ability to perform activities of daily living: a Rasch analysis

BackgroundSince the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare ADL ability across diagnoses. Accordingly, the ADL-Interview (ADL-I) was developed to be used in rehabilitation research and clinical practice. The aim of this study was to investigate if the ADL-I can be used to provide valid and reliable ADL ability measures across gender and diagnostic groups.MethodsADL-I data were extracted from an existing research database on persons with chronic conditions including medical, rheumatological, oncological, neurological, geriatric and psychiatric diagnoses. Data were analysed based on Rasch Measurement methods to examine: the psychometric properties of the rating scale; ADL item and person fit to the Rasch model; if the difficulty of the ADL tasks differs across gender and diagnostic groups, and if the ADL-I provides precise and reliable measures of ADL ability.ResultsData on n = 2098 persons were included in the final analysis. Initial evaluation of the 0–3 rating scale revealed threshold disordering between categories 1 and 2. After removal of 16 underfitting items, the variance explained by the Rasch dimension increased from 54.3 to 58.0%, thresholds were ordered, but the proportion of persons with misfitting ADL-I measures increased slightly from 8.7 to 9.1%. The person separation index improved slightly from 2.75 to 2.99 (reliability = 0.90). Differential test function analysis, however, supported that the 16 underfitting items did not represent a threat to the measurement system. Similarly, ADL items displaying differential item functioning across gender and diagnoses did not represent a threat to the measurement system. The ADL items and participants were well distributed along the scale, with item and person measures well targeted to each other, indicating a small ceiling effect and no floor effect.ConclusionsThe study results overall suggest that the ADL-I is producing valid and reliable measures across gender and diagnostic groups among persons within a broad range of ADL ability, providing evidence to support generic use of the ADL-I.Trial registrationN/A.

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

BackgroundIt is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities.MethodsParticipants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants’ capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade’s non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated.ResultsForty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70–91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team.ConclusionsThe findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities.Trial registrationClinicalTrials.gov, NCT04436302

A comparison of test–retest reliability and random measurement error of the Barthel Index and modified Barthel Index in patients with chronic stroke

Objective To compare the test–retest reliability and random measurement errors of the Barthel Index (BI) and modified Barthel Index (MBI) in patients with chronic stroke. Method The intraclass correlation coefficient (ICC) and the minimal detectable change (MDC) were applied respectively to examine the test–retest reliability (about 2 weeks apart) and the random measurement errors. The MDC% was used to adjust the cut-off score for determining whether a real change had been achieved, if heteroscedasticity existed. Results A total of 60 patients participated. The BI and MBI both had high ICCs (0.94 and 0.94, respectively) with small MDCs (16.2 and 15.4, respectively) and MDC%s (21.2% and 19.0%, respectively), indicating that both measures have comparable reliability in repeated assessments. However, moderate associations (r = −0.47 for the BI and −0.59 for the MBI) were found between the means of tests and retests and the absolute values of change scores, indicating heteroscedasticity. These findings suggest that a fixed MDC value is not appropriate for determining the real change in both measures because the amount of random measurement error varies with the patients’ ADL function. Conclusion The MBI, which showed excellent test–retest reliability and relatively lower random measurement error than the BI, appears to be a better ADL measure. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error. IMPLICATIONS FOR REHABILITATION The MBI is recommended for clinical and research applications because it has better test–retest reliability and relatively lower random measurement error than those of the original BI. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error when the MBI or the BI is used.

Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China

BackgroundSocial participation (SP) is known to have a favourable impact on health. However, studies on this issue have been conducted mainly in advanced countries, and results in China have been mixed. This study examined the impact of SP on health outcomes of middle-aged and elderly adults in China, adjusted for simultaneity and heterogeneity biases.MethodsIn total, 57,417 observations of 28,935 individuals obtained from the population-based, three-wave panel survey, Chinese Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015 were used. The associations between one- or two-wave-lagged SP and health outcomes (mental health, self-rated health [SRH], activities of daily living [ADL], and diagnosed diseases) were examined by linear regression models. Individual-level heterogeneity was addressed by the random-effects estimation method.ResultsSP was found to have a positive impact on mental health and ADL. Specifically, one-wave-lagged SP improved mental health measure (range: 10–70) by 0.820 (standard error [SE]: 0.199, p < 0.001), the basic ADL measure (range: 6–24) by 0.147 (SE: 0.043, p < 0.001), and the instrumental ADL measure (range: 5–20) by 0.159 (SE: 0.035, p < 0.001). In contrast, SP did not significantly affect SRH or diagnosed diseases. The impact of SP differed by SP type; playing Mah-jong (Chinese traditional game), chess, or cards, or going to the community club had the most favourable effect. The impact of SP on health was also greater for women than men and greater for individuals aged 60–69 years than those aged 45–59 years and aged 70 and older.ConclusionsSP had a positive, albeit selective, impact on health outcomes among middle-aged and elderly adults in China. The results suggest that policy measures to encourage these individuals to engage in SP are needed to enhance their health.

Effects of a New Sensory Re-Education Training Tool on Hand Sensibility, Manual Dexterity and Functional Activities of Daily Living in People with Traumatic Brachial Plexus Injury (Pilot Study)

The protocols of sensory re-education programs have not changed in recent decades even with the advancement in Neuroscience and cognitive science. Based on the current knowledge and developments in neuro physiology to enhance cortical mapping, this study describe and evaluate the effects of a modified clinical-based sensory re-education training tool not only on hand sensibility and manual dexterity but also functional ADL as well. The study was conducted on ten participants (N=10) with Traumatic brachial Plexus injury (TBPI) with upper extremity sensory deficits participate in the study. Participants were divided equally into control group (n=5) and experimental group (n=5). The experimental group were assigned to 8-week of 12-session intervention phase of sensory re-education program. Measurements used were the Semmes Weinstein monofilaments test, nine-hole peg test, turning fork test, Nottingham Extended activities of daily living and the Michigan Hand Outcome questionnaire. Measurements were collected at baseline, following the control phase and at the end of the intervention. Outcome of this study shows that, Compared to control group, experimental group demonstrated significant improvement in both Nottingham extended ADL scale and Michigan Hand Outcomes Questionnaire (MHQ) in functional Activities of Daily Living (fADL) with (p<0.05). However, No significant differences were observed as to the nine hole peg test and the monofilament tests. In conclusion, sensory re-education training not necessarily affects the level of sensory impairment in the hand but may lead to improvement in functional ADL measures.

Generating Rasch-based activity of daily living measures from the Spinal Cord Injury Longitudinal Aging Study.

Retrospective Longitudinal Study. (1) To determine whether the Spinal Cord Injury Activities of Daily Living (SCI_ADL) measure shows adequate item-level and precision psychometrics; (2) to investigate whether the SCI_ADL measure effectively detects ADL changes across time; (3) to describe self-care task(s) participants can and cannot do across time. Two Midwestern hospitals and 1 Southeastern specialty hospital in 1993. All participants were adults with traumatic SCI of at least 1-year duration at enrollment. We used 20-year (1993-2013) retrospective longitudinal data and categorized participants into three injury levels: C1-C4 (cervical; n=50), C5-C8 (n=126) and T1-S5 (thoracic, lumbar and sacral; n=168). We first examined psychometrics of the SCI_ADL with factor and Rasch analyses; then we investigated longitudinal change of SCI_ADL scores at three time points over 20 years (1993, 2003 and 2013) using generalized linear mixed modeling and post hoc analyses. The SCI_ADL measure demonstrated unidimensionality, person strata of 2.9, high Cronbach's α (0.93) and fair person reliability (0.76). T1-S5 had the highest measures, following C5-C8 and C1-C4 at three time points (P<0.05). The C1-C4 and T1-S5 groups showed significant decreases from 2003 to 2013; however, none of the three groups showed significant differences from 1993 to 2003 (P<0.05). The SCI_ADL measure could detect longitudinal ADL changes of the population with SCI across time. The C1-C4 group decreased the most in ADLs, indicating higher need of long-term services and rehabilitation.

Laughter is the best medicine: The Second City® improvisation as an intervention for Parkinson's disease

BackgroundExpressive therapies are increasingly incorporated into the management of Parkinson's disease (PD), although there are little objective data assessing their benefits. ObjectiveDevelop and study a novel community Improvisation Theater (IT) program for PD in order to improve quality of life. MethodsA prospective, rater-blinded, modified cross-over design study of IT for PD. 22 subjects were randomized 1:1 to active-start (AS) or control-start (CS) groups, controlling for age and Hoehn and Yahr stage. Participants were recruited from the Northwestern PD and Movement Disorders Center. 60 min IT sessions were led by The Second City® faculty weekly for 12 weeks. The primary aim was to assess feasibility, determined as 70% of participants attending at least 75% of the classes. Exploratory data were obtained comparing pre- and post-intervention outcomes using Wilcoxon signed rank test for UPDRS parts I-IV, PDQ-39, and 5 neuro-QoL measures (communication, anxiety, stigma, depression, and wellbeing). ResultsAll 22 participants completed the study. 21/22 (95%) participants attended at least 80% of the classes. All participants indicated that they would recommend the class to others with PD. 21/22 participants enjoyed the class and felt it was beneficial for their symptoms. A significant improvement pre-to-post intervention was seen with the UPDRS part II ADL measure (mean −1.5, p = 0.019). ConclusionA novel improvisation program can be well-attended, enjoyable, and improve ADL measures among patients with PD of varying ages and disease severity.

Metabolic Equivalent as an Underlying Component of ADL Measures

Abstract Date Presented 4/8/2016 This study identifies metabolic equivalent (MET) as a common underlying component in two activity of daily living measures. Regression models demonstrated that MET was a significant factor in explaining item difficulties for the FIM™ and the Stroke Impact Scale. Primary Author and Speaker: Matthew Husband Additional Authors and Speakers: Ickpyo Hong, Christine Harris, Emily Schoen, Clare Fitzmaurice, Danielle Kapustka, Craig Velozo, Erica Ingram

The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia

Background: Functional impairments in schizophrenia are substantial, complex, and persistent. Objective measurement of ADL ability, functional capacity and performance is needed for effective intervention planning and outcome evaluation. Objective: To evaluate ADL ability in people with schizophrenia using the Assessment of Motor and Process Skills (AMPS) and to determine the utility of using the AMPS to predict levels of assistance required for successful community living. Method: In a retrospective audit, AMPS ADL measures of a consecutive sample of 64 people with schizophrenia admitted to a mental health facility were compared with normative data and with recommended “cut-off” measures for competency to live independently in the community. Results: Substantial difficulties were measured in both ADL motor (mean z = –1.5) and ADL process ability (mean z = –2.1). AMPS ability measures did not predict problems with independent living for 62.5% of the patients. Conclusion: People with schizophrenia admitted to an inpatient rehabilitation facility experienced significant difficulty performing ADL tasks. AMPS is a useful measure of ADL ability but should be used in conjunction with measures of functional performance in order to plan interventions and supports for people with schizophrenia that reflect the complexity of factors affecting community functioning.

P037: Characteristics of the Abbreviated Mental Test Score (AMTS) and Montreal Cognitive Assessment (MoCA) in consecutive older acute medicine patients

movements, on a touch screen while their eye movements were monitored using an eye tracking system. Based on performance parameters as describing timing and execution of eye and hand movements, patients were divided into a ‘fast’ and a ‘slow’ group. Measures of ADL and IADL interference, assessed using standardized scales, were compared between groups. Results: Dementia patients in the ‘slow’ group reported more frequently IADL interference in the categories reaching destinations beyond walking distance, shopping, meal preparing and work around the house. No differences between groups were found in frequencies of reported ADL interference. Conclusions: The results indicate that impairments found in a planning based eye–hand coordination task may be related to the degree of (I)ADL interference in dementia patients. This might suggest a prognostic role of eye–hand coordination in predicting future disability in dementia patients.

The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity

The assessment of visuospatial abilities is usually performed by drawing tasks. In patients with very low formal education, the use of these tasks might be biased by their cultural background. The Stick Design Test was developed for the assessment of this population. We aim to expand the test psychometric properties by assessing its construct, criterion-related and ecological validity in older adults with low formal education. Healthy older adults (n = 63) and Alzheimer's disease patients (n = 92) performed the Stick Design Test, Mini-Mental State Examination, Digit Span Forward and the Clock Drawing Test. Their caregivers answered Personal Care and Instrumental Activities of Daily Living). Construct validity was assessed by factor analysis, convergent correlations (with the Clock Drawing Test), and divergent correlations (with Digit Span Forward); criterion-related validity by receiver operating characteristic curve analysis and binary logistic regression; and Ecological validity by correlations with ADL. The test factor structure was composed by one component (R 2 = 64%). Significant correlations with the Clock Drawing Test and Digit Span Forward were found, and the relationship was stronger with the first measure. The test was less associated with formal education than the Clock Drawing Test. It classified about 76% of the participants correctly and had and additive effect with the Mini-Mental State Examination (84% of correct classification). The test also correlated significantly with measures of ADL, suggesting ecological validity. The Stick Design Test shows evidence of construct, criterion-related and ecological validity. It is an interesting alternative to drawing tasks for the assessment of visuospatial abilities.

Functional impairment in geriatric hoarding participants

Older adults with clinically significant hoarding (n=28) and non-psychiatric controls (n=25) were formally assessed using measures of mental status, psychiatric comorbidity, hoarding symptom severity, and the activities of daily living-hoarding (ADL-H) scale. Moderate to substantial impairment was found in multiple functional domains for a portion of hoarding participants. Significant differences were detected between ADL-H scores in non-psychiatric controls and geriatric hoarding participants. As expected, hoarding severity measures significantly were associated with ADL impairment. The ADL-H is a clinically useful tool for measuring and assessing important functional domains affected by clutter that may not be assessed by traditional hoarding severity or ADL measures. ADL improvement is an important treatment target for older adults with hoarding.

The home environment and quality of life-related outcomes in advanced old age: findings of the ENABLE-AGE project.

With the present research, we further exploited the potential of the ENABLE-AGE Project, more precisely the Swedish and German data. We hypothesised that the magnitude of accessibility problems (MAP) in the home environment and external housing-related control beliefs (HCB) play a substantial role for a range of outcomes related to quality of life. Our sample at T1 consisted of 847 single-living and community-dwelling individuals aged between 80 and 89years, from urban regions in Sweden and Germany, 636 of whom were re-assessed 1year later. MAP was measured with the Housing Enabler instrument, while external HCB assessment was based on a questionnaire proved useful in earlier research. Outcomes were assessed with established measures of ADL independence/dependence, general well-being, positive and negative affect and depression. Cross-sectional regressions underscored that MAP and external HCB were rather consistently associated with outcomes, with MAP being more strongly associated with ADL independence/dependence and external HCB more strongly with well-being related outcomes. Furthermore, significant and marginally significant interaction terms underscored that being high in external HCB in the situation of large MAP was linked with more negative outcomes, while external HCB did not play a role in the situation of small MAP. In the longitudinal regression analysis, MAP at T1 was predictive for T1-T2 change in ADL independence/dependence and depression, while external HCB did not show substantial relations with any change in outcomes. Our study underlines and qualifies substantial relations between objective and perceived person-physical environment measures and a range of outcomes. Such evidence is required to further improve housing-oriented prevention and intervention strategies in advanced old age.

Characteristic Profiles of Instrumental Activities of Daily Living in Different Subtypes of Mild Cognitive Impairment

Background/Aims: The purposes of this study were to describe restrictions in instrumental activities of daily living (IADL) in mild cognitive impairment (MCI) and to assess different patterns of IADL in each MCI subtype. Methods: A total of 566 participants, those not cognitively impaired (NCI; n = 311) and MCI patients (n = 255), 60–94 years old (71.25 ± 6.00), were examined. Neuropsychological tests were administered to participants, and each MCI patient was classified into one of four subtypes. They completed the Barthel ADL and Seoul-IADL (S-IADL) for ADL measures. Results: There was a significant difference between NCI and MCI in terms of total S-IADL scores. ANOVA and a post hoc Dunnett analysis revealed that MCI patients performed significantly worse on four out of a total 15 items (i.e. telephone, transportation, finances and household appliances). ANCOVA showed a significant difference in S-IADL-MCI (4 of 15 items) between NCI and amnestic MCI-multiple domains after adjusting for age, gender, education and Geriatric Depression Scale (F = 4.257, d.f. = 1,556, p = 0.002). Conclusion: These findings suggest that scorings of specific IADL items are different in MCI subjects, and these items can possibly help in the identification of MCI subtypes, especially amnestic MCI-multiple domains.

Validierung eines Screening-Fragebogens zur Erhebung von Alltagsfertigkeiten (M-ADL) bei behinderten Kindern

The issue to what extent acitivities of daily living are impaired becomes increasingly relevant for social integration and for the indication and evaluation of therapies in children with developmental disorders and handicaps. The study presents the validation of a screening questionnaire for activities in children (M-ADL). The validity of the M-ADL was examined in 2 studies with 3-7-year old children with the full spectrum of severity of cerebral palsy. In study I, the concurrent validity with the Pediatric Evaluation of Disability Inventory (PEDI) has been studied in 33 children. In study II, the predictive validity was evaluated by comparing 63 handicapped children with a stratified sample of 217 normal children of the same age. The scales of the M-ADL covered eating/drinking, self care at home, toileting, manual ability (summarised as "self care") and mobility. In section A, a general estimation from 0 (full support) to 10 (independent) and in section B a rating based on preset graded scales is given. The correlation of the two ratings has been taken to estimate the criterion validity. Further, the subjective bias of the rater has been estimated by comparison of the absolute values in both sections between the groups. The M-ADL domains showed a very good concurrent validity with those of the PEDI (r=.78-r=.92). The sensitivity and specificity were excellent, particularly for ratings in section B. The criterion validity was high (mobility domain r=.76, self care domain r=.82). Comparison of the subjective bias showed that parents of CP children over-estimated the activities level of their children compared with controls showing the same values in both sections (group differences, t-test: 95% CI for mobility 0.47-1.46, p<0.001, self care 0.91-1.48, p<0.001). The M-ADL is a valid standardised instrument of functional independence in handicapped children, which needs little time and requires no special training for the examiner. In addition to other ADL measures, manual ability, e.g. playing, doing handicrafts, using a pen, is rated. Further, a subjective bias of the raters can be estimated. The instrument may serve as a tool for quick information on the level of activities according to the International Classification of Functioning, Disability and Health (ICF).

Neuropsychiatric symptoms, functional impairment and executive ability in Thai patients with Alzheimer's Disease

Instrumental activities of daily living (IADL) depend on executive planning and procedural memory mediated by the frontal lobes. Planning and judgment are involved in clock drawing. Neuropsychiatric symptoms are also mediated by frontal lobes, and a relationship between ADL, clock drawing and neuropsychiatric symptoms was hypothesized. To investigate the relationship between behavioral disturbances, ADL, and executive function. Seventy-three Thai patients with Alzheimer's disease (AD) were evaluated. Neuropsychiatric symptoms and behaviors were assessed with the Nevropsychiatric Inventory (NPI). The Thai version of the Mini-mental State Examination (TMSE) was utilized as a global cognitive assessment. A clock-drawing test (CDT) and both category (animals) and letter (ko, so in Thai) verbal fluency were used as executive measures. Thai ADL scale, Barthel Index (BI), and Functional Assessment Questionnaire (FAQ) were ADL measures used in this study. There were statistically significant correlations between CDT and the frontally-mediated behaviors of agitation (r = -0.367), apathy (r = -0.273) and disinhibition (r = -0.247). Verbal fluency correlated with agitation (r = -0.341). There were significant correlations between Thai ADL scores and agitation (r = 0.350), apathy (r = 0.441), and disinhibition (r = 0.417). FAQ correlated with the same three behaviors. After controlling for TMSE, a significant correlation remained between Thai ADL scores and agitation (r = 0.291) and apathy (r = 0.342). We demonstrated correlations between ADL and behavioral changes in Thai elderly with AD. Our results emphasize the important relationships among behavioral changes and impaired ADL.

The relationship of social support, social networks and negative events with depression in patients with coronary artery disease

This study examined the relationship of social relationships and negative life events with major depression among 335 inpatients with coronary artery disease (CAD) who were free of neurological illnesses. Depression was assessed using the Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression sub-scale, two scales for measuring instrumental and self-maintenance activities of daily living, a measure of negative events and four dimensions of social support. Twenty-seven subjects met DSM-IV criteria for major depression. Examination of the bivariate relationships indicated that being younger, having at least one problem with an ADL and/or one IADL, being non-white, experiencing a greater number of negative events, lack of perceived social support and a lack of social interactions were significantly related to an increased likelihood of being depressed. In multivariate analyses depressed subjects were significantly more likely to report a greater number of negative events than non-depressed individuals after adjusting for sociodemographic and ADL measures. A lack of perceived social support and increased number of negative events increased the likelihood of reporting major depressive symptoms among CAD patients. Understanding the causes of depression in CAD patients may have clinical utility in that reduction in depression may lead to a decreased risk of future CAD events.

Self-care practices used by older men and women to manage urinary incontinence: results from the national follow-up survey on self-care and aging.

To estimate the extent to which self-care practices are employed by older adults with urinary incontinence (UI); to determine how demographic and functional status measures are associated with self-care practice use; and to explore the relationship between contacting a doctor and disposable pad use. A cross-sectional analysis of a national probability sample using multiple logistic regression. Responses of subjects with UI (n = 787) from the 1993-1994 National Follow-up Survey on Self-Care and Aging, a follow-up survey of older Medicare beneficiaries living in the community within the contiguous United States drawn in 1990-1991 Subject responses about UI, fecal incontinence, dressing, eating, bathing, Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, proxy response to the survey, and self-reported medical conditions. Self-care practices used by more than 25% of respondents with UI included using disposable pads, limiting trips, and limiting fluids. Among older adults with incontinence, more women used disposable pads (44.5%; 95% CI, 36.9-52.1) and performed exercises (14.2%; 95% CI, 9.7-18.9) than did men (15.1%; 95% CI, 8.1-22.1; and 4.3%; 95% CI, 1.0-7.7, respectively). Bi-variate analysis showed respondents with severe UI or fecal incontinence reported greater use of self-care practices. In multivariate models of the three most commonly used self-care practices, measures of UI severity were not always associated independently with self-care practice use, whereas ADL measures of functional status were. Disposable pad use was positively independently associated (OR 3.36; 95% CI, 2.01-5.63) in multivariate models with contacting a doctor about incontinence, even after controlling for age, gender, demographics, and self-reported medical conditions. Use by older adults of self-care practices to manage urinary incontinence is predicted independently in multivariate models by measures of functional status such as dressing, eating, bathing, IADLs or MADLs, but not by all UI measures. Disposable pad users had increased odds of contacting a doctor, suggesting that self-care practices and formal medical care are not always inversely related.