Performance Of Instrumental Activities Research Articles

Factors Associated With Intended Utilization of Home-Based Long-Term Care Among Older Adults in China: The Moderating Effect of Community Support.

Guided by Andersen's behavioral model, the objectives of this study were to (a) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (b) explore the influence of community support, if any, on these associations. Using a multistage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process. Two predisposing (i.e., being old and unmarried), 4 enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and 6 need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -0.20, p < .001), peer support (B = -0.20, p < .001), self-image of aging (B = -0.39, p < .001), depression (B = -0.34, p < .001), and loneliness (B = -0.48, p < .001) on the intended utilization of home-based LTC services. Policy-makers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.

Integrating Biomarkers From Virtual Reality and Magnetic Resonance Imaging for the Early Detection of Mild Cognitive Impairment Using a Multimodal Learning Approach: Validation Study.

Early detection of mild cognitive impairment (MCI), a transitional stage between normal aging and Alzheimer disease, is crucial for preventing the progression of dementia. Virtual reality (VR) biomarkers have proven to be effective in capturing behaviors associated with subtle deficits in instrumental activities of daily living, such as challenges in using a food-ordering kiosk, for early detection of MCI. On the other hand, magnetic resonance imaging (MRI) biomarkers have demonstrated their efficacy in quantifying observable structural brain changes that can aid in early MCI detection. Nevertheless, the relationship between VR-derived and MRI biomarkers remains an open question. In this context, we explored the integration of VR-derived and MRI biomarkers to enhance early MCI detection through a multimodal learning approach. We aimed to evaluate and compare the efficacy of VR-derived and MRI biomarkers in the classification of MCI while also examining the strengths and weaknesses of each approach. Furthermore, we focused on improving early MCI detection by leveraging multimodal learning to integrate VR-derived and MRI biomarkers. The study encompassed a total of 54 participants, comprising 22 (41%) healthy controls and 32 (59%) patients with MCI. Participants completed a virtual kiosk test to collect 4 VR-derived biomarkers (hand movement speed, scanpath length, time to completion, and the number of errors), and T1-weighted MRI scans were performed to collect 22 MRI biomarkers from both hemispheres. Analyses of covariance were used to compare these biomarkers between healthy controls and patients with MCI, with age considered as a covariate. Subsequently, the biomarkers that exhibited significant differences between the 2 groups were used to train and validate a multimodal learning model aimed at early screening for patients with MCI among healthy controls. The support vector machine (SVM) using only VR-derived biomarkers achieved a sensitivity of 87.5% and specificity of 90%, whereas the MRI biomarkers showed a sensitivity of 90.9% and specificity of 71.4%. Moreover, a correlation analysis revealed a significant association between MRI-observed brain atrophy and impaired performance in instrumental activities of daily living in the VR environment. Notably, the integration of both VR-derived and MRI biomarkers into a multimodal SVM model yielded superior results compared to unimodal SVM models, achieving higher accuracy (94.4%), sensitivity (100%), specificity (90.9%), precision (87.5%), and F1-score (93.3%). The results indicate that VR-derived biomarkers, characterized by their high specificity, can be valuable as a robust, early screening tool for MCI in a broader older adult population. On the other hand, MRI biomarkers, known for their high sensitivity, excel at confirming the presence of MCI. Moreover, the multimodal learning approach introduced in our study provides valuable insights into the improvement of early MCI detection by integrating a diverse set of biomarkers.

Translation and Psychometric Properties of the Portuguese Version of the Timed Instrumental Activities of Daily Living (TIADL).

(1) Background: to examine the psychometric properties of the Portuguese version of the Timed Instrumental Activities of Daily Living (TIADL) in nursing home residents. (2) Methods: Fifty-two participants (85.8 ± 4.2 years) were assessed on two occasions, 10-14 days apart. The same rater administered all assessments. Internal consistency was analysed through Cronbach's α. The reliability was estimated using the intraclass correlation coefficients (ICCs), and the standard error of the mean (SEM) was used to estimate the minimal detectable change (MDC). Construct validity was determined by Spearman's correlation coefficients. (3) Results: For internal consistency, Cronbach's α (0.81) revealed high internal reliability. All of the subtests demonstrated good or excellent reliability and also presented acceptable measurement precision, considering the criterion SEM < SD/2. According to Spearman's rho, correlations with the Portuguese version of the TIADL, the Useful Field of View test, and semantic and phonemic fluency tests were significant, with moderate positive and negative correlations (0.4 < rs < 0.69). (4) Conclusions: The Portuguese version of the TIADL had good to excellent test-retest reliability (ICC > 0.90) and acceptable measurement precision. This test could be a valuable clinical tool for assessing actual performance in instrumental activities of daily living in nursing home residents.

Effect of the cognitive strategy training protocol on task mastery and cognitive performance during the instrumental activity of daily living in stroke patients

Background: Stroke leads to decrease in physical, emotional, social function, and activities in daily living. Cognitive functions, either basic or higher-level, are fundamental factors in performing tasks and functional activities in daily life. Therefore, cognitive training to enhance functions in stroke patients is necessary. This study developed a cognitive strategy training protocol using the Perceive, Recall, Plan &amp; Perform (PRPP) System of Intervention and the Multicontext Approach to improve cognitive function during performance in instrumental activities of daily living (IADL) tasks. Objectives: This study aimed to examine the task mastery of stroke patients during the performance of IADL tasks and to examine the effects of the cognitive strategy training protocol on cognitive performance in stroke patients. Materials and methods: The study was a quasi-experimental, one-group, pretestposttest research design. Eight stroke patients with cognitive impairment aged between 18-70 years old participated in the study. The intervention called “cognitive strategy training protocol” included 12 sessions, 3 times a week across 4 consecutive weeks. Each session took approximately 60 minutes. An outcome measure was the PRPP System of Task Analysis-Thai version. Descriptive data obtained from Stage One of the PRPP System-Thai version were analyzed to determine for task mastery, and pre-and post-scores of Stage Two of the PRPP System-Thai version were computed using the Wilcoxon signed-rank test. Results: After the cognitive strategy training protocol, all participants had higher percentage scores obtained from Stage One of the PRPP System-Thai version for at least 1 activity. Five out of eight participants showed higher percentage scores in both activities. Comparing the pre- and post-test scores from Stage Two of the PRPP System-Thai version using the Wilcoxon signed-rank test revealed no significant difference in all activities (p&gt;0.05). However, the descriptive results of the posttest percentage scores of Stage Two of the PRPP System-Thai version showed that 4 out of 8 participants had higher scores for at least 1 activity and 2 participants showed higher scores in both activities. Conclusion: The cognitive strategy training protocol was likely to be possible to improve task mastery and cognitive performance during the IADLs tasks in the participants despite no statistically significant difference.

Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania.

This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania. We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors. The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (β=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (β=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (β=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (β=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance. Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.

Trajectories of mobility difficulty and falls in community-dwelling adults aged 50 + in Taiwan from 2003 to 2015

BackgroundA decline in mobility leads to fall occurrence and poorer performance in instrumental activities of daily living, which are widely proved to be associated with older adults' health-related quality of life. To inform potential predicaments faced by older adults at different age levels, predictors of this mobility change and falls along with the ageing process need to be further evaluated. Therefore, this study examined the risk factors associated with the longitudinal course of mobility difficulty and falls among community-dwelling middle-aged and older adults in the Taiwanese community.MethodsWe evaluated data for the period between 2003 and 2015 from the Taiwan Longitudinal Study on Aging; the data cover 5267 community-based middle-aged and older adults with approximately 12 years of follow-up. In terms of mobility, the participants self-reported difficulties in mobility tasks (eg, ambulation) and whether they used a walking device. We employed linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with mobility difficulty and falls.ResultsMobility difficulty significantly increased over time for the participants aged ≥ 60 years. Perceived difficulties in standing, walking, squatting, and running became apparent from a younger age than limitations with hand function. The probability of repeated falls increased significantly with older age at 70 (p = .002), higher level of mobility difficulty (p < .0001), lower cognitive status (p = .001), living alone (p = .001), higher number of comorbid illnesses (p < .001), walking device use (p = .003), longer time in physical activities (p < .011), and elevated depressive symptoms (p = .006). Although walking aid use increased the probability of falls, individuals with mobility difficulty had a reduced probability of repeated falls when using a walking device (p = .02).ConclusionCommunity-dwelling Taiwanese adults face an earlier mobility difficulty starting in 60 years old. Individuals with more leisure and physical activities in daily life were more likely to maintain mobility and walking safety. Long-term, regular, social, and physical activity could be a referral option for falls prevention program. The use of a walking device and safety precautions are warranted, particularly for individuals with walking difficulties.

Mortality rate of high cardiovascular risk patients with mild cognitive impairment

People with mild cognitive impairment (MCI) may be at higher risk of death than normal aging ones. On the other hand, patients with cardiovascular risk factors are also with higher risk of death. It may be logical to question then if the combination of MCI and cardio-vascular risk factors (in most cases arterial hypertension) can lead to higher mortality rate than expected both for high cardio-vascular risk patients and for the general population. This hypothesis is important in the light of effective early screening and prophylaxis. The general death rate of patients with very high-cardio-vascular-risk was compared in the subgroups of normal cognition and MCI. We used MMSE and MoCA (reassessment 6 months apart), Geriatric Depression scale and 4-point version of the scale for evaluating the performance in instrumental activities of daily living (4-IADL) in 249 patients. The patients also had laboratory testing, ambulatory blood pressure monitoring, ECG and echocardiography. The general mortality rate of this very high cardio-vascular risk group was assessed 8–10 years afterwards and also compared to the general national death rate published for the corresponding period from the National Social Security Institute of Bulgaria. We registered significantly higher general death rate in patients with MCI and very high cardio-vascular risk as compared to the group without MCI. The logistic regression analysis attributed approximately 14.6% of the mortality rate in this high-risk group to MCI. The major cardio-vascular risk factor was arterial hypertension—with 63.85% of the patients with home blood pressure values not in the target range at the initial cognitive screening. During the neuropsychological reevaluation 56.43% were with poor control despite the multidrug antihypertensive regimen. It is known that MCI is correlated with cardiovascular risk factors with the leading role of arterial hypertension. We found that the combination of MCI and arterial hypertension can lead to higher mortality rate than in the general aging population. This has important clinical implications for the everyday practice.

Do neurocognitive impairments explain the differences between brain tumor patients and their proxies when assessing the patient's IADL?

BackgroundNeurocognitive impairments are common among brain tumor patients, and may impact patients’ awareness of performance in instrumental activities in daily life (IADL). We examined differences between patient- and proxy-reported assessments of the patient’s IADL, and whether the level of (dis)agreement is associated with neurocognitive impairments.MethodsBrain tumor patients and their proxies completed the phase 3 version of the EORTC IADL-BN32 questionnaire measuring IADL, and patients completed six neurocognitive measures. Patient-proxy difference scores in IADL were compared between patients who were defined as neurocognitively impaired (≥2 neurocognitive measures ≥2.0 standard deviations below healthy controls) and non-neurocognitively impaired. With multinomial logistic regression analyses we examined if neurocognitive variables were independently associated with patient-proxy disagreement in IADL ratings.ResultsPatients (n = 81) did not systematically (P < .01) rate IADL outcomes different than their proxies. Proxies did report more problems on 19/32 individual items and all five scales. This effect was more apparent in dyads with a neurocognitively impaired patient (n = 37), compared to dyads with non-neurocognitively impaired patients (n = 44). Multinomial logistic regression analyses showed that several neurocognitive variables (e.g., cognitive flexibility and verbal fluency) were independently associated with disagreement between patients and proxies on different scales.ConclusionNeurocognitive deficits seem to play a role in the discrepancies between brain tumor patients and their proxies assessment of patient’s level of IADL. Although replication of our results is needed, our findings suggests that caution is warranted in interpreting self-reported IADL by patients with neurocognitive impairment, and that such self-reports should be supplemented with proxy ratings.

Intrinsic Capacity: Validation of a New WHO Concept for Healthy Aging in a Longitudinal Chinese Study.

The World Health Organization has proposed a model of healthy aging built around the concept of functional ability, comprising an individual's intrinsic capacity, the physical and social environment they occupy, and interactions between the two. However, these constructs have been poorly defined. We examined the structure of intrinsic capacity in a representative sample of the Chinese population aged 60 years and older and assessed its value in predicting declining performance in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) using similar methods to a construct validation previously undertaken in an English cohort. Deidentified data were accessed on 7 643 participants of the China Health and Retirement Longitudinal Study 2011 and 2013 waves. Incrementally related structural equation modeling was applied, including exploratory and confirmatory factor analysis, and path analysis. Multiple linear regression tested construct validity, and simple and serial mediation models assessed predictive validity. Factor loadings for the models showed a clear structure for intrinsic capacity: 1 general factor with 5 subfactors-locomotor, cognitive, psychological and sensory capacities, and vitality (reflecting underlying physiologic changes). Intrinsic capacity predicted declining performance in both IADLs (standardized coefficient (SE) -0.324 (0.02), p < .001) and ADLs (-0.227 (0.03), p < .001), after accounting for age, sex, education, wealth, and number of chronic diseases. Each characteristic was associated with intrinsic capacity, providing strong construct validity. Assessment of intrinsic capacity provides valuable information on an individual's subsequent functioning beyond that afforded by age, other personal factors, and multimorbidity.

Critical Differences in Instrumental Activities of Daily Living Among Older Adults With Chronic Conditions

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The aim of this research was to determine whether there are differences in ability and performance of instrumental activities of daily living (IADLs) among groups of older adults with no multiple chronic conditions (MCC), low MCC, or multisystem morbidity (MM). We found that older adults with MM had more IADL impairment in both ability and performance than those with low or no MCC. Our findings also suggest that older adults with MM are able to do more than they actually do. Primary Author and Speaker: Tara C. Klinedinst Additional Authors and Speakers: Juleen Rodakowski Contributing Authors: Lauren Terhorst

The relationship between cognitive function and performance in instrumental activities of daily living in older adults

Introduction Deficits in cognition have been found to be associated with problems in performing daily activities; however, it is unknown what specific domains of cognition are related to each daily activity. Method Thirty-six occupational therapists identified the 20 most important instrumental activities of daily living for older adults and the cognitive demands required. Thirty-two older adults rated the perceived mental effort when performing these activities. They were assessed on their cognitive functions. Descriptive statistics were used to report the results. The Pearson correlation coefficient was used to identify relationships between cognitive functions and perceived mental effort. Results Activities relating to ‘communication’, ‘financial management’, ‘health management’ and ‘safety and emergency management’ require more cognitive demands. Results from the older adults showed the highest significant correlations in immediate memory and ‘paying bills’ ( r = 0.54), delayed memory and ‘following emergency procedures’ and ‘paying bills’ ( rs = 0.52), and executive functioning and ‘making and keeping medical appointments’ ( r = −0.49). Conclusion Findings contribute to the emerging understanding of specific cognitive domains related to the instrumental activities of daily living. The results can be used to reframe and improve intervention strategies for individuals with cognitive decline to maintain or improve performance in daily activities.

MORTALITY RATE OF PATIENTS WITH ARTERIAL HYPERTENSION AND MILD COGNITIVE IMPAIRMENT

Objective: People with mild cognitive impairment (MCI) are with elevated risk of death. On the other hand, patients with cardiovascular risk factors are at a higher risk of death in comparison with the general population. Thus, the combination of mild cognitive impairment and hypertension/high cardio-vascular risk, may lead to even higher mortality rate than expected. However, this has not been proven. The question is important in the light of effective early screening and prophylaxis, because the real patients in our everyday practice are not with a single isolated disease or risk factor. Design and method: This is a retrospective analysis. We compared the general death rate of hypertensive high-cardio-vascular-risk patients with and without MCI. Two hundred-forty-nine patients underwent neuropsychological screening twice at least 6 months apart with MMSE and MoCA, Geriatric Depression scale and 4-point version of the scale for evaluating the performance in instrumental activities of daily living (4-IADL). The patients also had laboratory testing, ambulatory blood pressure monitoring, ECG echocardiography. Their death rate was examined 8 to 10 years afterwards. Results: The patients with arterial hypertension and clinically diagnosed mild cognitive impairment (MoCA and MMSE) had significantly higher general death rate compared to those without MCI. Logistic regression analysis showed that about 14.6% of the mortality rate in this high-risk group could be attributed to MCI. The home blood pressure values were not in the target range for 63.85% at the initial neuropsychological test and for 56.43% on the reevaluation 8–10 years ago, despite the multi-drug antihypertensive regimen. The yearly all-cause mortality rate for the recent years for Bulgaria was about 14.1–15.4/1000. The relative all-cause mortality rate of this studied population was about 25.7/1000 patient on yearly basis – 1.67 times higher. Conclusions: It is known that MCI is correlated with cardiovascular risk factors and mainly - arterial hypertension. We found that the combination of MCI and arterial hypertension may lead to high mortality rate. This has important clinical implications. We will study further this issue to define in detail the factors responsible for the higher death rate in this group.

I'd Rather Be . . . : Activities Older Adults Reported Leading to Decreased Engagement With Cognitive Training

One modifiable risk factor of dementia is cognitive inactivity. Given cognitive ability is closely tied to continual performance of instrumental activities of daily living, cognitive training programs continue to be explored as a way to boost cognition and allow older adults to remain independent longer. While the efficacy of cognitive training is controversial, identifying activities older adults are willing to limit in exchange for cognitive training provides valuable information in relation to designing cognitive training programs that appeal to older adults. Using a qualitative approach, this study highlights activities older adults (ages 64+) noted as contributing to decreased gameplay of a cognitive training program on a tablet device. We found that respondents (61%) noted playing less as a result of entertainment activities (i.e., reading and playing games), social activities (31%) and travel (27%). Findings have implications for device form factor in administering cognitive training and other programs.

Ability and Performance of Daily Activity for Older Adults With Multiple Chronic Conditions

Older adults with multiple chronic conditions (MCC), and especially with added depression, have lower levels of daily activity than those without MCC. Engagement in daily activities can be measured by ability (what individuals can do) and performance (what individuals actually do). Understanding this difference is critical to developing interventions that align with the daily activity needs of older adults with MCC. The aim of this study was to understand the relationships between ability and performance of instrumental activities of daily living (IADL) among older adults with varied MCC and depression status. We conducted a cross-sectional study using data from the National Health and Aging Trends Study. We used MANOVA to detect differences in ability and performance of IADL by MCC status and t-tests to test the difference between ability and performance for our sample. There was an effect of MCC status on ability and performance for older adults in this sample, F (10,13386) = 67.12, p < .001, ηp2 = .05; performance and ability were lowest for MM-D, and highest for no MCC. Post-hoc t-tests revealed a difference between the mean scores for ability (M = .79, SD = .29) and performance (M = .92, SD = .23) across all groups of MCC status, t (6693) = -50.174, p < .001. Older adults with MCC, particularly with depression, displayed diminished performance of IADL, although they have the ability. Our results suggest interventions should not only address what individuals can do, but also what they actually do in their context.

Cognitive predictors of a performance-based measure of instrumental activities of daily living following stroke

ABSTRACT Background To inform cognitive interventions that target functional capacity for individuals who have survived stroke, an evaluation of predictors of daily functioning is necessary. The current literature is limited regarding identifying the associations between objective cognitive functioning and objective performance of Instrumental Activities of Daily Living (IADLs). Objectives To investigate the relationship between objectively measured cognitive domains/executive functions and performance on an objective measure of IADLs following a stroke. Methods Cross-sectional examination of 52 participants who have survived strokes and completed assessments of immediate memory, visuospatial/constructional skills, language, attention, delayed memory, executive functions (i.e., inhibition and flexibility, concept-formation and problem-solving, abstract thinking, deductive thinking, and verbal abstraction), and a performance-based measure of IADLs (UCSD Performance-based Skills Assessment; UPSA). Results Results indicated significant correlations between the UPSA and immediate memory, visuospatial/constructional skills, language, delayed memory, and executive functions (i.e., concept formation and problem-solving, flexibility of thinking, and verbal abstraction). A hierarchical multiple regression, controlling for age, severity of stroke, side of stroke, and depressive symptoms and including the cognitive measures individually significantly associated with the UPSA, explained approximately 62% of the variance in overall UPSA performance. This regression demonstrated that only language significantly predicted UPSA total score, in the context of multiple variables. Conclusions Cognitive functioning is significantly associated with IADL functioning post-stroke, and considering multiple domains of cognitive functioning together largely explains the performance of IADLs.

Living With Neglect: A Qualitative Analysis of Stroke Survivor Perspectives

Abstract Date Presented 03/26/20 Neglect is a common impairment following stroke. Currently, there is a lack of evidence regarding the impact of neglect on performance of instrumental activities of daily living, participation, safety, perceived quality of life, and caregiver burden. This study examined the experience of living with poststroke neglect. These findings can help clinicians better understand the long-term needs of stroke survivors with neglect and the daily challenges they face. Primary Author and Speaker: Emily Grattan Additional Authors and Speakers: Emerson Hart Contributing Authors: Nicholas Dean, Brianna Eberl, Hannah Hooks, Lindsay Manning, Katie Schafer, Stacie McLamb

Cognitive strategy use in adults with acquired brain injury

ABSTRACTObjective: Difficulty applying cognitive strategies during task performance is a hallmark feature of brain injury. This study aimed to develop a cognitive strategy profile of people living in a transitional living unit for people with brain injury.Research design: Prospective, longitudinal study (n = 16)Method: Cognitive strategy application was assessed using the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis. Functional measures were also administered. Data were examined using Rasch analysis (FACETS 3.71.4) and relationships between variables were analyzed.Results: Rasch analysis of PRPP data generated a hierarchy of cognitive strategies: from the most complex executive processing strategies to the simplest perceptual and recall strategies. The functional profile revealed a more impaired group of clients than has been previously reported in similar residential programs. Cognitive strategy use (PRPP Total score) was correlated with functional independence (r = .61), the performance of instrumental activities of daily living (r = .45), and community participation (r = −.63).Conclusions: The PRPP System enabled assessment of cognitive strategy difficulties and generation of individual profiles that allowed for individualized intervention planning. More efficient and effective application of cognitive strategies was related to the improved functional performance of everyday tasks and activities, greater independence and community participation.

Self-perceived health in a group of older adults covered by a health insurance plan

INTRODUCTION: Self-perceived health reported by older adults is a tool of great importance for the health care system as it provides an indicator representing physical, cognitive, and emotional aspects of health. OBJECTIVE: To report how a group of older adults covered by a health insurance plan evaluate their self-perceived health and which variables influence their perception. METHOD: This quantitative cross-sectional study included 148 older adults living in the city of São Paulo, Brazil, in 2017. The study variables were sex, age, marital status, performance in basic activities of daily living and instrumental activities of daily living, sleep quality, leisure activity, number of diseases, and use of continuous medication. Statistical analysis was performed using Student’s t-test, χ2 test, or Fisher’s exact test, and logistic regression was used. RESULTS: Significant relationships were observed between poor self-perceived health and the following variables: being female, polypharmacy, number of diseases, sleep quality, and performance in instrumental activities of daily living. Dependence on the instrumental activities of daily living made these older adults 5.33 times more likely to have poor self-perceived health. Each comorbidity added to the health status of this group increased the chance of poor self-perceived health by 1.39 times. CONCLUSION: Self-perceived health in this group of older adults is influenced by several variables; however, degree of dependence and number of diseases were those with the greatest impact.

The efficacy of cognitive interventions on the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia: protocol for a systematic review and meta-analysis

BackgroundCognitive changes associated with mild cognitive impairment or mild dementia can lead to difficulties in completing instrumental activities of daily living. The ability to live independently at home and in the community is often compromised due to the inability to complete these activities. Cognitive interventions have been reported as beneficial in maintaining or improving cognitive functions among this group of adults. However, the effectiveness of different types of cognitive interventions on the performance of instrumental activities of daily living in older adults with mild cognitive impairment and mild dementia is not well established. The aim of this paper is to develop a protocol for a systematic review and meta-analysis to investigate the effectiveness of cognitive interventions in maintaining or improving the performance of instrumental activities of daily living in individuals with mild cognitive impairment or mild dementia.MethodsRandomised control studies which investigate the effectiveness of cognitive interventions on the performance in instrumental activities of daily living for older adults with mild cognitive impairment and mild dementia will be sought. A systematic search will be conducted in five databases: CINAHL, MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. The search strategy was developed with assistance from a health science librarian. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using the Physiotherapy Evidence Database (PEDro) scale. A narrative synthesis of the findings will be used to report outcomes of all included studies. If appropriate, a meta-analysis will combine the results of individual studies.DiscussionThis systematic review and meta-analysis will determine the effectiveness of cognitive interventions in maintaining or improving the performance of IADL in individuals with MCI or mild dementia. It is anticipated that the results will inform rehabilitation professionals of the most effective cognitive interventions to be implemented into clinical practice. It will potentially provide substantial benefit to both the persons with MCI or dementia and the health care system by keeping more people out of full-time care and allowing those in full-time care to require less intensive support.Systematic review registrationPROSPERO CRD42016042364

Occupational therapy for knee osteoarthritis: A case study

Osteoarthritis (OA) is a prevalent condition in India. It can cause functional limitations and affect the quality of life (QoL). This case study describes the occupational therapy (OT) services implemented for a female patient diagnosed with bilateral knee OA. The patient described in this case study experienced pain and fatigue. Further, the suboptimal performance in instrumental activities of daily living tasks affected her subjective well-being. The patient was consulted for seven sessions in total, including the follow-up. The treatment techniques used were patient education, home modification, activity modification, and assistive device prescription and training. The patient verbalized improvement during the follow-up visit after 6 months. The improvement was also evident through improved fatigue and QoL scores. The implications of the case for OT practice in India were highlighted.