Instrumental Activities Of Daily Living Performance Research Articles

Characterization of symptoms and determinants of disease burden in dementia with Lewy bodies: DEvELOP design and baseline results

BackgroundThe DEmEntia with LEwy bOdies Project (DEvELOP) aims to phenotype patients with dementia with Lewy bodies (DLB) and study the symptoms and biomarkers over time. Here, we describe the design and baseline results of DEvELOP. We investigated the associations between core and suggestive DLB symptoms and different aspects of disease burden, i.e., instrumental activities of daily living (IADL) functioning, quality of life (QoL), and caregiver burden.MethodsWe included 100 DLB patients (69 ± 6 years, 10%F, MMSE 25 ± 3) in the prospective DEvELOP cohort. Patients underwent extensive assessment including MRI, EEG/MEG, 123FP-CIT SPECT, and CSF and blood collection, with annual follow-up. Core (hallucinations, parkinsonism, fluctuations, RBD) and suggestive (autonomous dysfunction, neuropsychiatric symptoms) symptoms were assessed using standardized questionnaires. We used multivariate regression analyses, adjusted for age, sex, and MMSE, to evaluate how symptoms related to the Functional Activities Questionnaire, QoL-AD questionnaire, and Zarit Caregiver Burden Interview.ResultsIn our cohort, RBD was the most frequently reported core feature (75%), while visual hallucinations were least frequently reported (39%) and caused minimal distress. Suggestive clinical features were commonly present, of which orthostatic hypotension was most frequently reported (64%). Ninety-five percent of patients showed EEG/MEG abnormalities, 88% of 123FP-CIT SPECT scans were abnormal, and 53% had a CSF Alzheimer’s disease profile. Presence of fluctuations, lower MMSE, parkinsonism, and apathy were associated with higher IADL dependency. Depression, constipation, and lower IADL were associated with lower QoL-AD. Apathy and higher IADL dependency predisposed for higher caregiver burden.ConclusionBaseline data of our prospective DLB cohort show clinically relevant associations between symptomatology and disease burden. Cognitive and motor symptoms are related to IADL functioning, while negative neuropsychiatric symptoms and functional dependency are important determinants of QoL and caregiver burden. Follow-up is currently ongoing to address specific gaps in DLB research.

Impact of treatment and frailty on elder-relevant physical function outcomes in older adults with metastatic castration-resistant prostate cancer (mCRPC).

76 Background: Maintenance of physical function is a key consideration in treatment decision-making for older adults with metastatic cancer, many of whom are frail. However, physical function outcomes with treatment, and effects of frailty, have not been adequately explored in the mCRPC setting. We evaluated the effects of frailty status and treatment with docetaxel (CHEMO), abiraterone (ABI), enzalutamide (ENZA), and radium 223 (RAD) on elder-relevant physical function outcomes in older men with mCRPC. Methods: Men aged 65+ were enrolled in this multicenter prospective observational cohort study. Daily function was evaluated with the OARS instrumental activities of daily living (IADL). Objective physical function was assessed by grip strength and the Short Physical Performance Battery (SPPB). Falls were documented during interviews. We also collected FACT-G physical well-being (PWB) and functional well-being (FWB) subscales. Assessments were performed at baseline, 3 months, and 6 months. We identified frailty status with a validated frailty index. Mixed effects regression models were used to examine the difference in primary outcomes over time by treatment group or frailty status adjusted for baseline characteristics. Factors associated with falls within 6 months of treatment initiation were determined with logistic regression. Results: A total of 70, 38, 67, and 23 men starting CHEMO, ABI, ENZA, and RAD were included. Mean age, education, race, number of medications, and BMI were similar at baseline between treatment groups. In treatment-stratified analyses without considering frailty, no significant changes over time were reported for any physical function outcome. Frailty was significantly associated with lower IADL function (p < 0.0001), worse grip strength (p < 0.0001), worse SPPB score (p < 0.0001), worse PWB (p < 0.0001), and worse FWB (p < 0.0001) at baseline. In frailty-stratified analyses, grip strength (p = 0.0345) worsened, but SPPB (p = 0.0147) improved significantly over time. Also, changes in SPPB (p = 0.0394) and PWB scores (p = 0.0269) over time differed by frailty status, where frail cohorts had greater improvement over time in both scores. Frailty and treatment type were not predictors of falls whereas prior falls history (OR: 3.52, 95% CI: 1.40-8.86) and age (OR: 1.07, 95% CI: 1.01-1.14) were significant predictors. Conclusions: Frail older men receiving treatment for mCRPC have worse IADL function, grip strength, SPPB scores, PWB, and FWB at baseline. Although grip strength worsened over time, they had greater improvement in SPPB scores and PWB over time than fit patients. Contrary to our hypothesis, most older adults do not experience significant worsening in elder-relevant physical function outcomes over time regardless of treatment. The impact of frailty requires further study.

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 Processing Speed Is Strongly Related to Driving Skills, Financial Abilities, and Other Instrumental Activities of Daily Living in Persons With Mild Cognitive Impairment and Mild Dementia.

Cognitive processing speed is important for performing everyday activities in persons with mild cognitive impairment (MCI). However, its role in daily function has not been examined while simultaneously accounting for contributions of Alzheimer's disease (AD) risk biomarkers. We examine the relationships of processing speed and genetic and neuroimaging biomarkers to composites of daily function, mobility, and driving. We used baseline data from 103 participants on the MCI/mild dementia spectrum from the Applying Programs to Preserve Skills trial. Linear regression models examined relationships of processing speed, structural magnetic resonance imaging (MRI), and genetic risk alleles for AD to composites of performance-based instrumental activities of daily living (IADLs), community mobility, and on-road driving evaluations. In multivariable models, processing speed and the brain MRI neurodegeneration biomarker Spatial Pattern of Abnormality for Recognition of Early Alzheimer's disease (SPARE-AD) were significantly associated with functional and mobility composite performance. Better processing speed and younger age were associated with on-road driving ratings. Genetic risk markers, left hippocampal atrophy, and white matter lesion volumes were not significant correlates of these abilities. Processing speed had a strong positive association with IADL function (p < .001), mobility (p < .001), and driving (p = .002). Cognitive processing speed is strongly and consistently associated with critical daily functions in persons with MCI in models including genetic and neuroimaging biomarkers of AD risk. SPARE-AD scores also significantly correlate with IADL performance and mobility. Results highlight the central role of processing speed in everyday task performance among persons with MCI/mild dementia.

Cognitive and physical functioning as predictors of everyday functioning

AbstractBackgroundAlzheimer’s disease and associated cognitive impairments are major contributors to functional declines and difficulties with instrumental activities of daily living (IADL); however, it is postulated that functional decline is likely a product of multiple factors. Higher prevalence of cardiovascular conditions has been associated with greater vascular brain injury that can result in greater physical impairments (slower gait speed and reduced grip strength). Thus, physical functioning can also contribute to IADL disability. The current study examined how cognitive and physical functioning contribute to IADL functioning among a diverse ethnoracial sample.MethodThe Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) cohort is comprised of Kaiser Permanente Northern California members who are age ≥65, without a diagnosis of cognitive impairment or dementia, and who participated in Multiphasic Health Checkups between 1964‐1977. At enrollment, participants completed a self‐report measure of IADLs, neuropsychological testing measuring memory and executive functioning, and physical functioning assessment (grip strength and walk speed). Analyses include 1,260 participants (401 Caucasian (32%), 339 African American (27%), 292 Asian (23%), and 228 Latino (18%)).ResultThe sample was comprised of 59.05% females and average baseline age was 75.5 ± 6.8 years. When examined individually, executive functioning (p=0.0466), grip strength (p=0.0005), and walking speed (p&lt;.0001) were significant predictors of IADL functioning after controlling for demographics (age, education, gender, self‐rated health). Memory (p=0.4468) was not a significant predictor. When considering all 4 of these predictors in a combined model, walk speed remained the only significant predictor of IADL performance (p&lt;.000) with slower walking speed being associated with poorer IADL performance. This relationship also differed by race (p=0.0011), with slower walk speed having the greatest negative impact in Asians.ConclusionThere are limited studies examining how both cognitive and physical functioning predicts everyday functioning, particularly among a diverse ethnoracial sample. Our results indicate that among a cohort of older adults without a formal diagnosis of cognitive impairment or dementia, physical functioning, specifically walking speed, plays an important role in IADL difficulties. Importantly, when considering walking speed, executive functioning was no longer independently associated with IADL performance. Such findings have important implications in terms of screening older persons at risk for IADL disability.

Abstract 16628: Cognitive Dysfunction, Instrumental Activities of Daily Living, and Health-related Quality of Life in Heart Failure

Introduction: Cognitive dysfunction is common in heart failure (HF), but relationships are unclear among cognitive dysfunction, performance-based instrumental activities of daily living (IADL), and health-related quality life (HRQL). Objectives: Guided by HRQL and IADL theories, hypotheses were: 1) worse cognitive function in global cognition, memory, executive function is associated with worse performance in IADL; 2) worse performance in IADL is associated with worse HRQL; and 3) IADL mediates the relationship between cognitive dysfunction and HRQL. Methods: In a cross-sectional analysis, baseline data were used from a randomized controlled trial of cognitive training in HF (N=256, mean age 66; 54% women; EF 49%; NYHA Class I=9%, II=36%, III=55%). Measures were: global cognition-Montreal Cognitive Assessment; memory-Hopkins Verbal Learning Test; executive function-Category fluency; IADL-Everyday Problem Test; and HRQL-Living with Heart Failure Questionnaire. Higher scores of cognitive and IADL measures indicate better performance. Higher scores of HRQL indicate worse HRQL. Covariates were age, gender, education, NYHA, and depressive symptoms. Multiple linear regressions were used to test hypotheses. Results: Hypothesis 1 was supported. Worse cognitive function in global cognition, memory, executive function was associated with worse IADL (β=0.38~0.45, p&lt;.001, R 2 =0.19~0.22). Age and education were significant covariates. Hypothesis 2 was supported. Worse IADL was associated with worse HRQL (β =0.79, p &lt;.001, R 2 =0.55). Gender, NYHA Class, and depressive symptoms were significant covariates. Hypothesis 3 was not tested because cognitive function was not significantly related to HRQL. Conclusions: Cognitive dysfunction was associated with worse performance in IADL. Worse performance in IADL was associated with worse HRQL. Interventions to improve HRQL may need to target improving performances in both cognitive function and IADL.

Effects of modified version of the Hospital Elder Life Program on post-discharge cognitive function and activities of daily living among older adults undergoing total knee arthroplasty

ObjectivesThis study aimed to investigate the effects of a modified Hospital Elder Life Program (mHELP) on post-discharge cognition and physical function among older adults undergoing total knee arthroplasty (TKA), and to evaluate the incidence of postoperative delirium. DesignNon-randomized intervention trial. Setting and participantsA total of 140 patients aged 60 years and older scheduled for elective orthopedic surgery at our institution between August 2017 and December 2018 were included. MethodsWard-level stratification was used with one surgical ward receiving mHELP (intervention group), including orientation communication, early mobilization, vision/hearing impairment equipment, and dehydration prevention, and another ward providing usual care (control group). All participants were assigned to two surgical wards. Outcome measures were collected using MMSE telephone version (tMMSE), activities of daily living (ADL) and instrumental activities of daily living (IADL) instruments at 1, 6, and 12 months after discharge. Multiple linear regression analysis was used to measure effects of mHELP intervention on mean differences in tMMSE, ADL and IADL scores from baseline to 1-, 6- and 12-months. ResultsEffects of mHELP intervention significantly preserved cognitive function at 1 and 12 months, but not at 6 months, compared with controls, regardless of adjustments for confounders. However, no intervention effects were noted in ADL and IADL scores. Postoperative delirium in the whole cohort was 3.6 % (2.5 % in intervention group, 5.1 % in control group, P = 0.41). ConclusionsmHELP intervention preserves post-discharge cognitive function, but has no notable effect on ADL and IADL function in older adults undergoing elective TKA surgery.

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.

Instrumental activities of daily living and neuropsychological functioning among patients with different types of cancer.

The ability to perform instrumental activities of daily living (IADL) is important for maintaining independent living, and optimal health-related quality of life and well-being. Neuropsychological measures are predictors of IADL ratings. The aims of the present study were to measure ability to perform IADL in patients with cancer and to explore the relationship between IADL and neuropsychological functioning. We evaluated IADL in 182 patients with four different types of cancer (thyroid, colorectal, breast and prostate cancer) and examined the relationship between IADL and neuropsychological functioning 6months after chemotherapy treatment. Our results showed that patients with breast cancer had significantly greater difficulty in performing IADL compared to patients with other types of cancer. There were no differences in IADL performance among the other three study groups. In addition, we found that neuropsychological score was a predictor of IADL; the greater the patients' disability, the lower their performance on neuropsychological measures. This is in accordance with the literature that suggests neuropsychological measures to be predictors of IADL ratings. The present findings are important because, although many researchers have studied the relationship between IADL and neuropsychological functioning in cancer, few studies have investigated IADL in different types of cancer. Optimal neuropsychological functioning is connected with better ability with regard to IADL.

Frailty as a predictor of future falls and disability: a four-year follow-up study of Chinese older adults

BackgroundFrailty, which is defined as aging-related multisystem impairments, can lead to adverse health outcomes. However, evidence for such a connection in Chinese older adults remains lacking. This study examined the association between frailty and future falls and disability among community-dwelling Chinese older adults.MethodsData were obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were aged 60 years and above at baseline in 2011 and completed the follow-up survey in 2015. Outcome measures were future falls, incident disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and worsening performance of ADLs and IADLs. A multivariate logistic regression was conducted to examine the association between frailty phenotype and falls, incident disability, and worsening disability during a four-year period.ResultsWe found that frail participants were at increased risk at follow-up for: falls (OR 1.54, 95% CI, 1.14–2.08); developing new ADL difficulties (OR 4.10, 95% CI, 2.79–6.03) and IADL difficulties (OR 3.06, 95% CI, 2.03–4.61); and worsening ADLs performance (OR 2.27, 95% CI, 1.27–4.06), after adjusting for potential confounders. Prefrailty was also significantly associated with future falls, incident disability in ADLs and IADLs, but with a lower magnitude of effect.ConclusionsFrailty phenotype is an independent predictor of future falls, incident disability, and worsening performance in ADLs among Chinese older adults. The association suggests the need to pay special attention in caring for frail and prefrail elders and improving individuals’ frailty status.

Use of a Persona to Support the Interdisciplinary Design of an Assistive Technology for Meal Preparation in Traumatic Brain Injury

Abstract User-centered design (UCD) facilitates the creation of technologies that are specifically designed to answer users’ needs. This paper presents the first step of a UCD using a persona, a fictitious character representing the targeted population, which in this case is people having sustained a traumatic brain injury (TBI). The persona is used to better understand the possible interactions of a TBI population with a prototype of a technology that we wish to develop, namely the Cognitive Orthosis for coOKing (COOK). COOK is meant to be an assistive technology that will be designed to promote independence for cooking within a supported-living residence. More specifically, this paper presents the persona’s creation methodology based on the first four phases of the persona’s lifecycle. It also describes how the persona methodology served as a facilitator to initiate an interdisciplinary collaboration between a clinical team and a computer science team. Creation of personas relied on a clinical model (Disability Creation Process) that contextualized the needs of this population and an evaluation tool [Instrumental Activities of Daily Living (IADL) Profile] that presented a wide range of cognitive assistance needs found in this same population. This paper provides an in-depth description of some of the most frequent everyday difficulties experienced by individuals with TBI as well as the persona’s abilities, limitations and social participation during the realization of IADL, and an evaluation of the manifestations of these difficulties during IADL performance as represented through scenarios. The interdisciplinary team used the persona to complete a first description of the interactions of a persona with TBI with COOK. This work is an attempt at offering a communication tool, the persona, to facilitate interdisciplinary research among diverse disciplines who wish to learn to develop a common language, models and methodologies at the beginning of the design process.

Cognition and Daily Functioning: Results from the Hispanic Community Health Study/Study of Latinos (SOL) and Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA).

Among older adults, poorer cognitive functioning has been associated with impairments in instrumental activities of daily living (IADLs). However, IADL impairments among older Hispanics/Latinos is poorly understood. To characterize the relationships between cognition and risk for IADL impairment among diverse Hispanics/Latinos. Participants included 6,292 community-dwelling adults from the Study of Latinos - Investigation of Neurocognitive Aging, an ancillary study of 45+ year-olds in the Hispanic Community Health Study/Study of Latinos. Cognitive data (learning, memory, executive functioning, processing speed, and a Global cognitive composite) were collected at Visit 1. IADL functioning was self-reported 7 years later, and treated as a categorical (i.e., risk) and continuous (i.e., degree) measures of impairment. Survey two-part models (mixture of logit and generalized linear model with Gaussian distribution) and ordered logistic regression tested the associations of cognitive performance (individual tests and composite z-score) with IADL impairment. Additionally, we investigated the moderating role of age, sex, and Hispanic/Latino background on the association between cognition and IADL impairment. Across all cognitive measures, poorer performance was associated with higher odds of IADL impairment 7 years later. Associations were generally stronger for the oldest group (70+ years) relative to the youngest group (50-59 years). Sex and Hispanic/Latino background did not modify the associations. Across the full sample, lower scores on learning, memory, and the Global cognitive composite were also associated with higher degree of IADL impairment. Across diverse Hispanics/Latinos, cognitive health is an important predictor of everyday functioning 7 years later, especially in older adulthood.

Frailty Status and Dependence in Head and Neck Cancer Patients Receiving Concurrent Chemoradiation

Abstract Date Presented 03/26/20 This exploratory study found frailty and instrumental activities of daily living (IADL) performance worsen for head and neck cancer patients after radiation treatment. A moderate negative correlation was identified between frailty status and IADL performance. This conclusion indicates a need for OT services to address and reduce functional deficits in this population. Primary Author and Speaker: Cheryl Porzi Additional Authors and Speakers: Jennetta Siracuse, Kerry Bourke, Ashley Evans Contributing Authors: Kathryn Eberle Cohen, Elizabeth Wendel, Anurag Singh, Andrew Ray

Mild chronic kidney disease and its relation to functional disability in Korean elderly population.

Studies have demonstrated that chronic kidney disease (CKD) is significantly associated with the increased risk of functional difficulty in daily activity and mobility. However, data are less available for association between CKD and functional disability in Asians. Using a data from Korea National Health and Nutrition Examination Survey III, we investigated the association of CKD with functional disability in 882 subjects over the age of 65. Disability was identified in activity of daily living (ADL), instrumental ADL (IADL), and visual, hearing, and walking function. The prevalence of disability was evaluated according to the stage of CKD, and multivariate logistic regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence interval (CI) [adjusted ORs (95% CI)] of CKD stage 3a for disability in ADL, IADL, visual, hearing, and walking function. Individuals with CKD stage 3-4 had the higher prevalence of disability ADL, IADL, visual, hearing, and walking function than individuals without CKD. CKD stage 3a was significantly associated with abnormal ADL [1.63 (1.04-2.54)] and visual impairment [1.39 (1.01-1.93)] even after adjusting for DM, hypertension, education, income, marital status, age, and sex. The presence of mild CKD was significantly associated with disability in daily activity and multiple function.

Development of a model on factors affecting instrumental activities of daily living in people with mild cognitive impairment \u2013 a Delphi study

IntroductionThe level of function of instrumental activities of daily living (IADL) is crucial for a person’s autonomy. A clear understanding of the nature of IADL and its limitations in people with mild cognitive impairment (MCI) is lacking. Literature suggests numerous possible influencing factors, e.g. cognitive function, but has not considered other domains of human functioning, such as environmental factors. Our aim was to develop a comprehensive model of IADL functioning that depicts the relevant influencing factors.MethodsWe conducted a four-round online Delphi study with a sample of international IADL experts (N = 69). In the first round, panelists were asked to mention all possible relevant cognitive and physical function factors, as well as environmental and personal factors, that influence IADL functioning. In the subsequent rounds, panelists rated the relevance of these factors. Consensus was defined as: 1) ≥70% agreement between panelists on a factor, and 2) stability over two successive rounds.ResultsResponse rates from the four rounds were high (83 to 100%). In the first round, 229 influencing factors were mentioned, whereof 13 factors reached consensus in the subsequent rounds. These consensual factors were used to build a model of IADL functioning. The final model included: five cognitive function factors (i.e. memory, attention, executive function, and two executive function subdomains -problem solving / reasoning and organization / planning); five physical function factors (i.e. seeing functions, hearing functions, balance, gait / mobility functions and functional mobility functions); two environmental factors (i.e. social network / environment and support of social network / environment); and one personal factor (i.e. education).ConclusionsThis study proposes a comprehensive model of IADL functioning in people with MCI. The results from this Delphi study suggest that IADL functioning is not merely affected by cognitive function factors, but also by physical function factors, environmental factors and personal factors. The multiplicity of factors mentioned in the first round also underlines the individuality of IADL functioning in people with MCI. This model may serve as a basis for future research in IADL functioning in people with MCI.

Effects of home-based occupational therapy telerehabilitation via smartphone for outpatients after hip fracture surgery: A feasibility randomised controlled study

Introduction This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. Methods This was a feasibility randomised controlled trial with two groups – an experimental group and a comparison group – and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks. Results Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables. Discussion This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.

Pre-Morbid IQ Moderates the Relationship between Cognitive Performance and Performance-Based Functional Status in Older Adults

ABSTRACT Objectives: The current study sought to evaluate the relationship between cognitive performance and Instrumental Activities of Daily Living (IADL) performance in a population of community dwelling older adults, and assess to what extent this relationship is moderated by cognitive reserve (Premorbid-IQ) Methods: 123 community-dwelling older adults completed a general cognitive assessment, a word-reading based premorbid-IQ estimate (PMIQE) measure, and the performance-based Direct Assessment of Functional Status, Revised (DAFS-R). Moderated regression analysis was used to assess the influence of PMIQE on the relationship between cognitive performance and IADLs. Results: There was a significant main effect of cognitive performance on IADLs, and no main effect of PMIQE on functional IADLs. There was a significant moderating effect of PMIQE on the relationship between cognitive performance and IADLs performance, such that at higher levels of PMIQE, cognitive performance scores became slightly less predictive of weaknesses in IADLs. Conclusions: Results suggest that for individuals with high reserve, assessment of cognitive performance alone may not be robust a predictor of IADLs functioning. Clinical implications: In estimating functional abilities as a consequence of cognitive performance, consideration should be given to premorbid-IQ/cognitive reserve.

Daily Living Performance in Schizophrenic Patients in Correlation with Positive and Negative Symptoms

Background : Schizophrenia is a global mental health problem. Patients experience problems in their daily-living performance. Positive and negative symptoms have been part of characteristics of schizophrenia that are absent in normal individuals, which include a distinctive fundamental distortion of thoughts and perception (positive symptoms) and loss of normal function and behavior (negative symptoms). This study aimed to explore the correlation between positive and negative symptoms and daily-living performance in schizophrenia. Methods : A correlative analytical study with a cross-sectional approach was conducted using secondary data from the Outpatient Clinic of the Mental Hospital of West Java Province. Data on socio-demographic characteristics were collected and positive and negative symptoms as assessed by Positive and Negative Syndrome Scale or Subscales (PANSS) were correlated with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which were further analyzed by Spearman’s correlation test. Results : In total, 31 male schizophrenic patients aged between 24-45 years old. There was no significant correlation between ADLs dependency levels and both positive and negative symptoms. However, there was a significant correlation between IADLs function and positive symptoms and not with negative symptoms. Conclusions : Even though no correlation was identified between ADLs dependency levels with positive and negative symptoms, the ADLs and IADLs assessments should be considered as important tools for schizophrenic patients for rehabilitation to improve daily-living functioning.

Daily Living Performance in Schizophrenic Patients in Correlation with Positive and Negative Symptoms

Background : Schizophrenia is a global mental health problem. Patients experience problems in their daily-living performance. Positive and negative symptoms have been part of characteristics of schizophrenia that are absent in normal individuals, which include a distinctive fundamental distortion of thoughts and perception (positive symptoms) and loss of normal function and behavior (negative symptoms). This study aimed to explore the correlation between positive and negative symptoms and daily-living performance in schizophrenia. Methods : A correlative analytical study with a cross-sectional approach was conducted using secondary data from the Outpatient Clinic of the Mental Hospital of West Java Province. Data on socio-demographic characteristics were collected and positive and negative symptoms as assessed by Positive and Negative Syndrome Scale or Subscales (PANSS) were correlated with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which were further analyzed by Spearman’s correlation test. Results : In total, 31 male schizophrenic patients aged between 24-45 years old. There was no significant correlation between ADLs dependency levels and both positive and negative symptoms. However, there was a significant correlation between IADLs function and positive symptoms and not with negative symptoms. Conclusions : Even though no correlation was identified between ADLs dependency levels with positive and negative symptoms, the ADLs and IADLs assessments should be considered as important tools for schizophrenic patients for rehabilitation to improve daily-living functioning.

Occupational Therapy Practice Guidelines for Older Adults With Low Vision.

The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision. This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation. We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research. Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice. Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation. This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.