Older Americans Resources And Services Research Articles

Molecular Biomarkers of Aging to Predict Clinical Frailty in Newly Diagnosed Hematologic Malignancy

Introduction: Older adults with hematologic malignancy (HM) are a growing demographic with wide-ranging therapeutic options. With aging, patient health and treatment decision-making are heterogenous. Treatment decisions are impacted by chronological age, performance status, and comorbidities. An approach to treating older adults based on objective measures of health may better personalize therapy by focusing on physiologic parameters. Here we examined the relationship of a blood-based aging biomarker, p16 INK4a (p16), with clinical frailty. Methods: Newly diagnosed patients with HM were enrolled in a prospective study capturing fitness measures and peripheral blood T lymphocyte (PBTL) p16 levels pre-treatment. Clinical phenotypes of fitness included 11 measures: ECOG performance status, Patient-Reported Outcome Measurement Information System (PROMIS) Global Health Scale Short Form v1, Older Americans Resources and Services (OARS) instrumental activities of daily living (IADL), Medical Outcomes Study (MOS) physical function, patient-reported Karnofsky Performance Status (KPS), social activity and social support (MOS) scores, Mental Health Index (MHI), and cognition (Blessed Orientation-Memory-Concentration). Physical function was measured using the Short Physical Performance Battery (SPPB). PBTL p16 was measured using the OSU_Senescence Nanostring CodeSet, which includes 74 additional T cell markers and five controls. PBTL were also examined for DNA methylation. PBTL were extracted, bisulfite converted, and methylation was quantified using the Illumina 850K EPIC methylation array at the TruDiagnostic core laboratory. Raw data was processed using the minfi pipeline, followed by normalization, batch correction, and KNN-based imputation using the GMQN and impute R packages. Principal-component (PC) PhenoAge measures were calculated using the processed methylation values. Results: Patients newly diagnosed with HM (n=33) (acute leukemia n=13, 39.5%, plasma cell dyscrasia n=13, 39.5%, lymphoma n=4, 12.1%, chronic lymphocytic leukemia=3, 9.1%) and complete p16 analysis with geriatric deficits were included. The mean p16 score was 32.6 (range 1.7-259.7). We quantified a composite deficit index defined as a frailty score higher than the third quartile using the aggregate score of the above fitness measures (range 0 to 11). Using a threshold for p16 ≥31.9, the model had 80% sensitivity and 79% specificity to identify frailty. The positive predictive value was 0.40, the negative predictive value was 0.96, and the accuracy was 0.76. The area under the ROC curve (AUC) for frailty versus p16 was 0.725. PBTL p16 was also explored in relation to other biomarkers of interest including epigenetic age (n=50). PBTL p16 correlated with PhenoAge r=0.38, p=0.0067. Conclusion: Aging biomarkers provide a novel means to quantify physiologic age in newly diagnosed HM. PBTL p16 levels showed a significant relationship with a composite metric of clinical fitness and accelerated aging in patients with different HM. PBTL p16 was both a sensitive and specific blood-based biomarker to identify clinical frailty in this preliminary analysis.

Loneliness in Older Adults with Major Depression Across the COVID-19 Pandemic

IntroductionLoneliness has emerged as a distinct clinical construct with detrimental physical and mental health effects. During the COVID-19 outbreak and aftermath, studies examining loneliness in older adults reported mixed results with increased, decreased, and static levels of loneliness. These inconsistent findings likely relate to pandemic-related phenomena of amplified social isolation (e.g., quarantines, social distancing, remote work) for some, and an increased sense of social connectedness (e.g., shared interests, challenges and experiences, greater media engagement) for others. To our knowledge, only one study has examined the effect of the COVID-19 pandemic on older adults with pre-existing major depression. Most were resilient, with no overall change in depression, anxiety, and suicidality scores, however loneliness was not explicitly considered. As such, since loneliness and depression are interrelated in older adults, we sought to examine whether loneliness in non-remitted older depressed patients was impacted during the COVID-19 pandemic.MethodsA brief survey instrument was developed that included relevant socio-demographic information, a modified Older Americans Resources and Services (OARS) scale for assessing perceived health status, a question on communication during the pandemic adapted from the Questionnaire for Assessing the Impact of the COVID-19 Pandemic in Older Adults (QAICPOA), a question on consumption of COVID-19 related news coverage, and the UCLA 3-item Loneliness Scale for three different time points: prior to the pandemic (retrospective self-rating), during the height of the pandemic (defined as between the declaration of a formal pandemic in March 2020 until vaccinations began in December 2020) (retrospective self-rating), and currently at the time of survey administration in Fall 2021 (contemporaneous rating).To ensure a homogeneous patient population, eligibility criteria included a primary diagnosis of a major depressive disorder without psychosis, cognitive impairment, secondary psychiatric disorders, or a remitted state. All patients were active registrants in the Zucker Hillside Hospital (ZHH) Geriatric Psychiatry Outpatient Clinic.A list of eligible patient names and contacts were generated through the IT department by abstracting information from the electronic health record. As per Northwell's IRB review, this survey project met the criteria outlined in 45 CFR 46.101 for IRB exemption.Eligible patients were called and asked to complete the survey over the phone. Data for the current pilot sample were analyzed using a two-tailed paired t-test with a threshold of significance of p ≤0.05.Results106 patients met eligibility criteria. To date, 30 patients completed telephone surveys. The mean age of these respondents was 73.5 (SD ± 6.39) years. 73.3% (n = 22) were female and 26.1% (n = 8) were male. 63.3% of patients were white, 16.6% were Black, 13.3% were Hispanic, and 6.6% were Asian. 50% of patients were married, 26.6% were divorced, and 23.3% were widowed. 10% of patients were still working, while the remaining 90% were retired. 33.3% of patients had an associate, bachelor's, or graduate/advanced degree, 63.3% of patients completed high school, and 3.3% had not. 73% lived with at least one other person and 27% lived alone. 86.7% had one or more children and 13.3% were childless. The mean OARS score was 3.16 (SD ± 1.88) (range 0-6, worse to best perceived health). Compared to prior to the pandemic, 46.6 % of patients reported less communication with friends and family, 46.6 % reported they communicated the same, and 6.7% said they communicated more. Mean COVID-related news consumption rating (range 1-5, 5 = most) was 3.8 (SD ± 1.3). Mean UCLA 3-item loneliness scale (range 3-9) scores were 4.97 (SD ± 1.85) prior to the pandemic, 6.47 (SD ± 1.89) during the height of the pandemic, and 5.37 (SD ± 2.11) in the Fall 2021 vaccination period. A significant difference existed between loneliness scores prior to the pandemic and worsening loneliness during the height of the pandemic (p<0.0001). A significant difference also was found between loneliness scores during the height of the pandemic and improving loneliness during the less acute pandemic vaccination period (p < 0.005). There was no significant difference between loneliness prior to and after the height of the pandemic.ConclusionsIn a representative pilot sample (expansion ongoing) of older depressed adults, loneliness increased significantly during the COVID-19 pandemic. In the context of prior findings of largely stable mental health parameters and resilience during the COVID-19 outbreak in a similar population, this suggests that loneliness is a unique human experience not necessarily alleviated by effective coping strategies. That loneliness significantly improved with a likely sense of incipient normalization reenforces that it is a dynamic psychological state subject to intervention.This research was funded byNone.

Sex‐related differences in cognition with statin usage in a geriatric memory clinic cohort

AbstractBackgroundRecently, there has been debate for the suitability of statins for geriatric populations and patients with dementia as there is evidence suggesting improved quality of life following discontinuation of therapy in these groups, as well as conflicting evidence surrounding its potential to both prevent and potentiate downstream cognitive deficits. Despite large scale studies being conducted in the past regarding statins and cognition, there is a paucity of literature investigating its interaction with sex, as well as possible associations with other variables such as subjective complaints, neuropsychiatric symptoms, and function.MethodsAnalysis was done on patients assessed at a Memory Disorders Clinic at St. Michael’s Hospital between 2012 and 2017, comprising a population of 348 patients divided into groups taking daily atorvastatin (N = 45), rosuvastatin (N = 40), and controls (N = 263) (Table 1). Data form the Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Behavioural Neurology Assessment‐Revised (BNA‐R), Neuropsychological Impairment Scale (NIS), The Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) Scale and Neuropsychiatric Inventory Questionnaire (NPI‐Q) were analyzed.ResultsTwo‐way ANOVA demonstrated a significant interaction between sex, cognitive performance, and statin use in which female statin users scored significantly lower on multiple subdomains of the BNA‐R (p &lt; 0.05) (Table 2). Patients taking atorvastatin additionally scored lower on CERAD delayed recall, delayed recognition, and in the cumulative recognition domain than other groups (p &lt; 0.05). Atorvastatin and rosuvastatin were additionally associated with higher frequency of dysphoria and disinhibition, respectively (p &lt; 0.05). No significant results were found in other measures investigated.ConclusionsIn addition to minor associations between atorvastatin usage and lower memory performance, findings from this investigation suggest a possible interaction between sex, cognition and statin use that has not been well documented in literature. Though these findings were not reflected in other measures such as subjective complaint or function, further research may be warranted to provide insight into the relationship between sex, statin usage and neurological effects.

Associations of quality of social support and beliefs in curability among older adults with advanced cancer.

12049 Background: Prior studies suggest that social support plays a role in disease understanding of older patients with advanced cancer. In this study, we examined the association of quantity and quality of social support with belief in curability among older patients with advanced incurable cancer. Methods: We performed a secondary analysis of a cluster-randomized geriatric assessment trial (URCC 13070: PI Mohile) that recruited older adults (≥70) with advanced incurable cancer and caregivers. At enrollment, patients completed the Older Americans Resources and Services (OARS) Medical Social Support form to measure both quantity (number of close friends and relatives) and quality of social support. Quality of social support was measured using twelve questions, each ranged from 1 (none of the time) to 5 (all of the time). Higher cumulative scores indicated greater quality of support. For beliefs in curability, patients were asked, “What do you believe are the chances that your cancer will go away and never come back with treatment?” Responses were 0%, &lt;50%, 50/50, &gt;50%, and 100%. Ordinal logistic regression was used to investigate the association of social support with beliefs in curability, adjusting for adjusting for age, gender, education, race, number of Geriatric Assessment (GA) impairments, cancer type, and locality (rural versus urban). Results: We included 347 patients; mean age was 76.4 years, 91% were white, 52% were male, 46% had household income &lt;$50,000, and 55% had high school degree or higher. For every unit increase in OARS Medical Social Support score, the odds of believing in curability decreases by 36.4% [Adjusted Odds Ratio (AOR) 0.733, 95% Confidence Interval (CI): (0.555, 0.969)], after controlling for covariates. Quantity of social support was not associated with belief in curability [AOR 1.033 95% CI: (0.921, 1.156)]. Conclusions: Our study revealed that older patients with advanced cancer who felt more supported by their social network were more likely to report that their cancer was not curable. Interventions that improve quality of social support may also affect disease understanding. Funding: Patient-Centered Outcomes Research Institute (PCORI) 4634 and NIH K24 AG056589 to SGM, NCI UG1CA189961, T32CA102618, NCI K99CA237744 to Loh.

The role of social support in the association between dependency and important risk factors among the elderly.

This study aimed to assess the association between social resources and dependency, and explored the effect of social support in modifying important risk factors for dependency among the elderly. This was a population-based cross-sectional study. A total of 950 participants aged ≥60 years were selected using a complex multistage sampling design from 22 locations in China. All data were collected using questionnaires by face-to-face interviews. Dependency was assessed using the Minnesota Multiphasic Personality Inventory-II, and social resource status with the Chinese version of the Older American Resources and Services (OARS) questionnaire. Logistic regression analysis was used to evaluate the association between dependency and social resources. Analysis of covariance was performed to evaluate the effect of social support on modifications of important risk factors for dependency. A total of 913 participants were included in the analysis, and 10.3% of the males and 14.4% of the females were identified as in dependency. The results of logistic regression analysis showed a significant negative association between the levels of social resources and dependency. The odds ratio was 0.78 (95% confidence interval, 0.73-0.84) after adjusting for important confounding factors. The results of analysis of covariance showed differences in the mean dependency scores between different groups defined by chronic disease status and social support level. Levels of social resources were negatively associated with dependency. Our results suggest that social support has both a direct effect on dependency and an indirect effect through modifying chronic disease status and individual income.

Moderators of Treatment Outcomes from Family Caregiver Skills Training: Secondary Analysis of a Randomized Controlled Trial

Background: Moderator analyses may be helpful for evaluating intervention effects. The objective of this study was to evaluate whether the effect of a caregiver skills training intervention – Helping Invested Families Improve Veterans' Experience Study (HI-FIVES) – on care recipient outcome and caregiver outcome is moderated by the veteran’s risk for hospitalization or level of functional impairment. Methods: Secondary data analysis of HI-FIVES. Outcomes included community days (cumulative days in the community at 12 months alive and not in the emergency department, hospital, or post-acute facility) and caregiver burden (Zarit Burden Interview at baseline, 3, 6, and 12 months). Moderators, risk for hospitalization and functional impairment, was assessed using their Care Assessment Need (CAN) score the Older Americans Resources and Services (OARS) Questionnaire, respectively. Negative binomial and linear mixed models were used to assess intervention effects on community days and caregiver burden, respectively. Results: Of 241 dyads, veteran (caregiver) mean age was 73 (61) years, 53% (54%) were Black, and 4% (89%) were female. Medium hospitalization-risk (91-98 CAN score) participants who received HI-FIVES had 3.75 times more community days vs. medium risk participants in the control group. By contrast, the high hospitalization-risk (99+ CAN score) participants who received HI-FIVES had 4.39 times fewer community days vs. high-risk participants in the control group. The CAN score did not have a significant moderating effect on caregiver burden. OARS did not have a significant moderating effect on community days or caregiver burden. Conclusions: Targeting the HI-FIVES based on hospitalization risk may be an effective strategy for keeping veterans in the community longer.

Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study.

The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research. We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. The mean age of the 846 participants was 77years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered 'patients who decline' at 3 or 6months' follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06). ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.

Mediating and regulating effect of sleep between anxiety and activity of daily living among elderly patients with chronic disease

Objective To explore the mechanism of sleep between anxiety and activity of daily living (ADL) among elderly patients with chronic disease. Methods A total of 478 elderly patients with chronic disease were investigated with the Pittsburgh Sleep Quality Index (PSQI) , Self-Rating Anxiety Scale (SAS) and Older American Resources and Services (OARS) Multidimensional Function Evaluation Scale. Pearson correlation analysis and multiple hierarchical regression analysis were used to analyze the investigation results. Results Sleep was positively correlated with ADL, and anxiety was negatively correlated with ADL (P<0.01) . Sleep had a partially mediating effect between ADL and anxiety with 0.131 for the mediating effect, and accounting for 37.25% of the total effect. Sleep had a regulating effect between ADL and anxiety among elderly patients with chronic disease (△R2=0.337, P<0.05) . Conclusions Anxiety has a direct effect and indirect effect by sleep in ADL. Sleep can improve the negative effect of anxiety on ADL. Sleep is a protective factor of the ADL among elderly patients with chronic disease. Key words: Aged; Anxiety; Activity of daily living; Chronic disease; Sleep quality

National survey of family physicians to define functional decline in elderly patients with minor trauma.

BackgroundFailing to assess elderly patients for functional decline at the time around a minor injury may result in adverse health outcomes. This study was conducted to define what constitutes clinically significant functional decline and the sensitivity required for a clinical decision instrument to identify such functional decline after an injury in previously independent elderly patients.MethodsAfter a thorough development process, a survey questionnaire was administered to a random sample of 178 family physicians. The surveys were distributed using a modified Dillman technique.ResultsFrom 143 eligible surveys, we received 67 completed surveys (response rate, 46.9 %). Respondents indicated that a drop of at least 3 points on the 28-point Older Americans Resources and Services (OARS) ADL Scale was considered clinically significant by 90 % of physicians. Ninety percent (90 %) of physicians would be satisfied with a sensitivity of 90 % or more for a clinical decision instrument to detect patients at risk of functional decline at 6 months following an injury. The majority of family physicians do not routinely assess the majority of the tasks on the OARS scale for injured elderly patients.ConclusionsA high proportion of physicians (90 %) would consider a drop of 3 points on the OARS ADL Scale as significant to define functional decline and would be satisfied with a sensitivity of 90 % for a clinical decision instrument to detect such a decline. Any instrument to identify patients at elevated risk for subsequent decline should consider these outcome measures to be clinically useful.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0520-1) contains supplementary material, which is available to authorized users.

Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study.

BackgroundDepressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography.MethodsThis was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003–February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0–14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits.ResultsEstimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (−1.32 [95 % CI −1.78 to −0.86] and −0.63 [−0.97 to −0.30], respectively) and from 12 to 30 months (−0.79 [−1.27 to −0.31] and −1.00 [−1.35 to −0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months.ConclusionsPatients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0986-3) contains supplementary material, which is available to authorized users.

LO034: Does head injury matter? Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study

Introduction: The older adult population is growing. The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a MT-HI on the functional and cognitive outcomes six months post injury of older adults who sustained a minor trauma. Methods: This multicenter prospective cohort study in eight sites included patients who were: aged 65 years or older, presenting to the emergency department (ED) within two weeks of injury with a chief complaint of a minor trauma, discharged within 48 hours, and independent for their basic activities of daily living prior to the ED visit. Participants underwent a baseline evaluation and a follow-up evaluation at six months post-injury. The main outcome was the functional decline measured with the Older Americans’ Resources and Services (OARS) scale six months after the trauma. Results: All 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 without head injury. After six months, the functional decline was similar in both groups, 10.8% and 11.9% respectively (RR=0.79 [95% CI: 0.55-1.14]). The proportion of participants with mild cognitive disabilities was also similar, 21.7% and 22.8% respectively (RR=0.91 [95% CI: 0.71-1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR= 1.35 [95% CI: 0.71-2.59]), or with or without the presence of a mTBI as defined by the WHO criteria (RR= 0.90 [95% CI: 0.59-1.13]). Conclusion: This study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population six months after injury.

Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study.

To estimate past-year prevalence and identify risk and protective factors of elder emotional abuse, physical abuse, and neglect. Cross-sectional, population-based study using random-digit-dial sampling and direct telephone interviews. New York State households. Representative (race, ethnicity, sex) sample (N = 4,156) of English- or Spanish-speaking, community-dwelling, cognitively intact individuals aged 60 and older. The Conflict Tactics Scale was adapted to assess elder emotional and physical abuse. Elder neglect was evaluated according to failure of a responsible caregiver to meet an older adult's needs using the Duke Older Americans Resources and Services (OARS) scale. Caseness thresholds were based on mistreatment behavior frequencies and elder perceptions of problem seriousness. Past-year prevalence of elder emotional abuse was 1.9%, of physical abuse was 1.8%, and of neglect was 1.8%, with an aggregate prevalence of 4.6%. Emotional and physical abuse were associated with being separated or divorced, living in a lower-income household, functional impairment, and younger age. Neglect was associated with poor health, being separated or divorced, living below the poverty line, and younger age. Neglect was less likely in older adults of Hispanic ethnicity. Elder abuse and neglect are common problems, with divergent risk and protective factor profiles. These findings have direct implications for public screening and education and awareness efforts designed to prevent elder mistreatment.

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma.

There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

Kingston Caregiver Stress Scale (KCSS) Greek Validation on Dementia Caregiver Sample

In this study, we focus on the Greek validation of the Kingston Caregiver Stress Scale (KCSS) and its 3 categories: “Caregiving issues”, “Family issues” and “Financial issues”. Our sample consists of 100 caregivers (Ν = 100) who support a relative that suffers from a type of dementia. The participants are looking after the patients, systematically, for at least an hour per week. The questionnaires were distributed by day care centres for patients with dementia, which were located in Athens. Also, we correlated KCSS with the following questionnaires: Zarit Burden Interview (ZBI), Perceived Stress Scale (PSS), Older Americans Resources and Services (OARS), Multidimensional Functional Assessment Questionnaire (MFAQ)-Activities of Daily Living Section (ADL). The results for the reliability and the validity of the scale were satisfactory and the tool had high reliability a = 0.85. We also concluded that KCSS had criterion validity as it showed a positive correlation with both ZBI and PSS, while it had a negative correlation with OARS-MFAQ-ADL.

Disability Associated With Obesity, Dynapenia and Dynapenic-Obesity in Chinese Older Adults

Whether the combination of obesity and low muscle strength (dynapenic-obesity) would cause greater impairment of the activities of daily living (ADL)/instrumental activities of daily living (IADL) than obesity alone and low muscle strength alone (dynapenia) remains unclear. The aim of this study was to reveal the possible independent and additive effects of dynapenia and obesity on ADL/IADL disability in an older Chinese population. A cross-sectional study, including 616 community-dwelling older adults, was conducted in China from 2010 to 2012. Based on the World Health Organization Asian Criteria of Obesity and handgrip strength tertiles, 4 independent groups were identified as follows: nondynapenia/nonobesity, dynapenia alone, obesity alone, and dynapenic-obesity. The Katz Index of Independence in ADL was used to assess ADL disability, whereas 6 IADL items of the Older Americans Resources and Services (OARS) multidimensional functional assessment questionnaire were used to assess IADL disability. The prevalence of ADL and IADL disability was 21.1% and 28.9% in the dynapenic-obesity group, 15.5% and 22.6% in the dynapenia alone group, 13.1% and 19.6% in the obesity alone group, and 11.9% and 12.9% in the nondynapenia/nonobesity group, respectively. After adjusting for the covariates, in comparison with the dynapenic-obesity group, the adjusted odds ratios (95% confidence interval) for ADL disability were 0.36 (0.13-0.73) in the nondynapenia/nonobesity group, 0.51 (0.20-0.78) in the dynapenia-alone group, and 0.40 (0.11-0.61) in the obesity-alone group. The corresponding data for IADL disability were 0.55 (0.20-0.93), 0.82 (0.39-0.98), and 0.61 (0.30-0.91), respectively. Dynapenia, obesity, and dynapenic-obesity were associated with an increased risk of ADL/IADL disability. Dynapenic-obesity was associated with a greater risk of ADL/IADL disability in comparison with dynapenia or obesity alone.

Impact of venous thromboembolism, venous stasis syndrome, venous outflow obstruction and venous valvular incompetence on quality of life and activities of daily living: a nested case-control study.

The role of venous stasis syndrome (VSS) mechanisms (i.e. venous outflow obstruction [VOO] and venous valvular incompetence [VVI]) on quality of life (QoL) and activities of daily living (ADL) is unknown. The objective of this study was to test the hypotheses that venous thromboembolism (VTE),VSS,VOO and VVI are associated with reduced QoL and ADL. This study is a follow-up of an incident VTE case-control study nested within a population-based inception cohort of residents from Olmsted County, MN, USA, between 1966 and 1990. The study comprised 232 Olmsted County residents with a first lifetime VTE and 133 residents without VTE. Methods included a questionnaire and physical examination for VSS; vascular laboratory testing for VOO and VVI; assessment of QoL by SF36 and of ADL by pertinent sections from the Older Americans Resources and Services (OARS) and Arthritis Impact Measurement Scales (AIMS2) questionnaires. Of the 365 study participants, 232 (64%), 161 (44%), 43 (12%) and 136 (37%) had VTE, VSS, VOO and VVI, respectively. Prior VTE was associated with reduced ADL and increased pain, VSS with reduced physical QoL and increased pain, and VOO with reduced physical QoL and ADL.VVI was not associated with QoL or ADL. In conclusion,VSS and VOO are associated with worse physical QoL and increased pain. VOO and VTE are associated with impaired ADL. We hypothesize that rapid clearance of venous outflow obstruction in individuals with acute VTE will improve their QoL and ADL.

Test-Retest Reliability of Functional Anthropometry and OARS Survey among Older Mexican American Adults

The aim of this study is to assess test-retest reliability of functional anthropometry measures and the Older American Resources and Services (OARS) survey among older Mexican American adults. A healthy sample of 30 Older Mexican American adults was selected from senior recreation centers. For functional anthropometry 20 variables were measured in the participants, and the participants were also asked to fill the OARS survey. All the participants responded to both the test again after two weeks and helped to assess the test-retest reliability of functional anthropometry measures and the OARS Survey. Pearson correlation analysis of the results indicates that the results of the anthropometric test and the OARS survey for the first administration and second administration were significantly positively correlated.

Short‐term Functional Decline and Service Use in Older Emergency Department Patients With Blunt Injuries

Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were > or = 65 years old, with blunt injuries <48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.

Enfermedades crónicas y deterioro funcional para las actividades de la vida diaria en población mayor no institucionalizada

Objective To analyze the influence of chronic medical conditions on functional performance of activities of daily living, both basic (BADL) and instrumental (IADL), among the socially-active older population. Methods We performed a cross-sectional study of 380 individuals aged over 64 years old who regularly attended community centers in the city of Zaragoza. The Older Americans Resources and Services (OARS) questionnaire was completed in a personal interview. A multivariate logistic regression model was used to analyze functional capacities for BADL and IADL as dependent variables, and socio-demographic variables and chronic medical conditions as predictive variables. Results The risk of showing dependence for BADL significantly increased in the presence of mild and severe mental illness (OR=4.02; 95% CI=1.81–8.95; and OR=10.61; 95% CI=4.68–24.05, respectively), heart disease (OR=2.79; 95%CI=1.32–5.91), rheumatism/osteoarthritis (OR=2.75; 95% CI=1.42–5.33) and age 75 years or older (OR=2.70; 95% CI=1.42–5.13). For IADL, these risks increased with mild and severe mental illness (OR=2.11; 95% CI=1.10–4.04; and OR=4.50; 95% CI=2.27–8.90, respectively), age 75 years or older (OR=3.06; 95% CI=1.78–5.25) and heart disease (OR=2.64; 95% CI=1.35–5.16). Conclusion There was greater level of independence for BADL than for IADL. The factor creating most dependence was mental illness, followed by heart disease and rheumatism/osteoarthritis. A declining ability to perform IADL should prompt early assessment of dependence, as it is the first sign to appear. Prevention is fundamental for independent functioning in older people.

Validação da versão em português europeu de questionário de avaliação funcional multidimensional de idosos

To validate the European Portuguese version of the Older Americans Resources and Services (OARS) instrument, used for the multidimensional evaluation of the quality of life of the elderly. The study was authorized by the authors of the original English version. First, the questionnaire was translated into European Portuguese and culturally adapted. The resulting version was then validated by experts and administered to 302 elderly persons (147 living in nursing homes and 155 at day care centers) in the central region of Portugal (districts of Aveiro, Castelo Branco, Coimbra, Leiria, Guarda, and Viseu). Subsequently, a global psychometric study was conducted on the instrument, evaluating internal coherence, validity of construction, criterion validity, and reproducibility. The sample was randomly selected and stratified by age, sex, and type of institutional support. The internal coherence (Cronbach's alpha) was between 0.64 and 0.91 for each of the five functional assessment scales included in the instrument. For criterion validity, the relatively low Pearson correlation values obtained (<0.700) through the Medical Outcomes Study 36-Item Short-Form General Health Survey reflect the challenges associated with establishing a criterion by which new health evaluation instruments might be compared. Pearson's correlation for reproducibility was between 0.859 and 1.0 for all the scales. The European-Portuguese version of the OARS (Questionário de Avaliação Funcional Multidimensional de Idosos) is useful for collecting valid information that can help focus community interventions and promote strategies that specifically target this population group.