Personal Activities Of Daily Living Research Articles

Gender differences in the quantitative and qualitative assessment of chronic pain among older people.

Pain, regardless of its causes, is a subjective and multidimensional experience that consists of sensory, emotional and cognitive factors that cannot be adequately captured by a single number on a pain scale. The aim of the study was to understand gender differences in the assessment of quantitative and qualitative chronic pain among older people. The study used a questionnaire that included questions about demographic and social characteristics as well as the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Depression Scale (GDS-15), McGill Pain Questionnaire (MPQ). The pain rating index based on rank values of adjectives was higher among women than men (18.36 ± 7.81 vs. 17.17 ± 9.69, p = 0.04). The analysis of the frequency of selection of individual adjectives describing the sensory aspects of pain showed that men described the pain as "stabbing" more often than women (26.1% vs. 14.3%, p < 0.05). Women chose adjectives from the emotional category more often than men (59.8% vs. 75.4%, p < 0.05), describing the pain as "disgusting" (8.9% vs. 1.4%, p < 0.05), "unbearable" (19.6 vs. 4.3, p < 0.05). In the subjective category, there was a difference between women and men in terms of describing pain as "terrible" (23.2% vs. 7.2%, p < 0.05) and as "unpleasant" (11.6% vs. 23.3%, p < 0 0.05). When referring to pain, women tend to employ more detailed and factual language, indicative of heightened emotional sensitivity. Men tend to use fewer words and focus on the sensory aspects of pain. Subjective aspects of pain were demonstrated by both women and men.

Social support in maintaining mental health and quality of life among community-dwelling older people with functional limitations in Malaysia: a population-based cross-sectional study

ObjectiveThis study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia.SettingThe Malaysian...

Long-term functional disabilities in intensive care unit survivors: A prospective cohort study

BackgroundFunctional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups. ObjectivesThe objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors. MethodsThis prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL). ResultsA total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14–3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03–2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12–0.95). ConclusionIn a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities.ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status.

Caregiver Enablement Training to Support Homecare: A Study from India

AbstractHomecare is the prevalent model of dementia care in India and ‘attendants,’ who are non‐trained lay workers are often employed in Indian households to assist with personal care, ADL and other support which the family may need. Providing training to these attendants can support continued dementia care at home. We present initial data from a caregiver enablement program (CEP) being provided in India.MethodsThe (CEP) consists of a minimum of 6‐8 individually tailored sessions beginning with a clinical evaluation. Using a collaborative approach, challenging areas of caregiving are identified and prioritized. Across the sessions, information about what may be contributing to these challenges and tips for providing care are provided by a dementia trained specialist. Attendants and family members are encouraged to use these approaches and feedback was discussed in an iterative manner to improve the caregiving process and address emerging issues.ResultsTen families availed the caregiver enablement program, out of those 2 patients were living with their 24 hours attendant and 8 patients were living with family and attendants. The caregiver enablement program was conducted online, offline and in hybrid mode, 5 of them were online sessions, 4 offline sessions and one hybrid session (session conducted at home and online). Patients had moderate to severe stage dementia (Hindi MMSE Mn = 13.3, SD = 5.7; Caregiver burden: Zarit burden interview Mn = 29.8 SD = 19.6).Key areas where enablement was required were basic understanding of dementia, acceptance of the illness by the family and that they need external support, how to manage challenging behaviours like toileting, bathing, dressing, incontinence, transferring and feeding, how to engage the patient in meaningful activities and the need for environment modifications to improve safety and managing challenging behaviours. Psycho educational skill building, multi component intervention was found to be effective in the present study to combat the concerns shared by the attendants/family members.ConclusionThis study demonstrates how up‐skilling lay workers through training on dementia and management of challenging behaviours can support home care. Supporting the informal care system with specialised training can be an effective way of providing dementia care in low resource settings.

Occupational therapy practice to support executive function impairment after acquired brain injury: A UK clinical survey

Introduction: This study explored treatment of executive functioning impairment in adults after acquired brain injury (ABI), clinician’s confidence and support received, in a sample of occupational therapists in the United Kingdom. Methods: A 24-item online questionnaire was sent to 750 members of the Royal College of Occupational Therapists Specialist-Section in Neurological Practice. Data was collected at a nominal and ordinal level and included yes/no Likert-type scale and free field comments. Descriptive statistical analysis was completed. Results: Seventy-six occupational therapists working in a range of neurological settings completed the survey. Frequently used interventions included education ( n = 57, 75%), task modification ( n = 56, 73%), instrumental activities of daily living (ADL) ( n = 54, 71%), personal ADL ( n = 53, 70%) and goal setting ( n = 53, 70%). Seventy-one percent used metacognitive strategies. Occupation-based metacognitive approaches were rarely used. Thirty-one (41%) participants reported being fairly confident and 28 (37%) were very confident. Support for clinical practice was accessed most frequently through joint clinical sessions ( n = 30, 39%). Findings: Participants used various clinical interventions to treat service users with executive dysfunction after ABI. Meta-cognitive strategies were employed; however, occupation-based metacognitive approaches were infrequently utilised, suggesting uncertainty in adopting these in practice. The need for further training on evidence-based interventions and knowledge translation support was highlighted.

Energy expenditure during typical household and community activities of daily living in persons with lower limb amputation: A pilot study.

Knowledge about the energy expenditure of typical activities of daily living (ADL) in persons with lower limb amputation (LLA) is lacking. This study investigated the following: (1) oxygen consumption per unit distance (V̇O2; mL·kg-1·min-1), (2) proportion utilization of peak oxygen consumption (%V̇O2peak), (3) oxygen cost (energy cost; mL·kg-1·m-1), and (4) perceived exertion (rating of perceived exertion) of ADL in persons with LLA and able-bodied controls. Participants (21 with LLA/12 controls) performed 2 household ADL experiments: in-house walking and vacuuming and 3 community ADL experiments: marked shopping, fast walking, and stair negotiation. V̇O2peak was assessed with arm crank ergometry, and ambulatory activity was monitored for 7 days with a StepWatch. Participants with LLA performed in-house walking, marked shopping, vacuuming, and stair negotiation at a similar V̇O2 as controls, while their self-selected walking speed (WS) was significantly lower. Participants with LLA had significantly higher %V̇O2peak than controls during in-house walking and reported a significantly higher rating of perceived exertion for vacuuming and marked shopping. The highest possible WS of participants with LLA during fast walking was significantly lower than that of controls, but V̇O2 was also significantly lower, indicating a limited capacity to walk at higher WS. Participants with LLA had a significantly lower daily step count, significantly lower-proportion high-intensity ambulation, but significantly higher-proportion low-intensity ambulation than controls, indicating that persons with LLA also walked at lower WS in daily life. The results indicate that persons with LLA have increased physical and perceived effort during performance of ADL compared with persons without amputation, which has consequences for community participation, and hence independence and quality of life.

1600 COMMUNITY-BASED COMPLEX INTERVENTIONS TO SUSTAIN INDEPENDENCE IN OLDER PEOPLE: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract Introduction Sustaining independence is important for older people, but there is insufficient guidance about which community services to implement. Methods Systematic review and network meta-analysis (NMA; PROSPERO CRD42019162195) to synthesise effectiveness evidence from randomised or cluster-randomised controlled trials of community-based complex interventions to sustain independence for older people (mean age 65+) living at home, grouped according to their intervention components. Main outcomes: Living at home, activities of daily living (ADL), care-home placement, and service/economic outcomes at one year. We searched five databases and two registries, and scanned reference lists. A random-effects NMA was used. We assessed risk of bias, inconsistency, and certainty of evidence. Results We included 129 studies (74,946 participants). Nineteen intervention components, including ‘multifactorial-action’ (individualised care planning), were identified in 63 combinations. Few studies contributed to each comparison. High risk of bias and imprecision meant results were very low certainty (not reported) or low certainty (unless otherwise stated). Findings may not apply to all contexts. For living at home, evidence favoured ‘multifactorial-action and review with medication-review’ (odds ratio (OR) 1.22, 95% CI 0.93 to 1.59; moderate certainty), and three other interventions: ‘multifactorial-action with medication-review’; ‘cognitive training, medication-review, nutrition and exercise’; and ‘ADL, nutrition and exercise’. Four interventions may reduce odds of remaining at home. For instrumental ADL (IADL), evidence favoured ‘multifactorial-action and review with medication-review’ (standardised mean difference (SMD) 0.11, 95% CI 0.00 to 0.21; moderate certainty). Two interventions may reduce IADL. For personal ADL, evidence favoured ‘exercise, multifactorial-action and review with medication-review and self-management’ (SMD 0.16, 95% CI -0.51 to 0.82). Among homecare recipients, evidence favoured addition of multifactorial-action and review with medication-review (SMD 0.60, 95% CI 0.32 to 0.88). Other findings were inconclusive. Conclusions The intervention combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Unexpectedly, some combinations may reduce independence.

Longitudinal trajectories of functional recovery after hip fracture.

There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.

Factors Correlating with Functional Capacity in Older People with Chronic Pain.

Chronic pain in older people is a global health problem not only in terms of a negative subjective feeling, but also as a social and economic factor. Deterioration of functional capacity is one of the main symptoms of chronic pain; therefore, it should be assessed as a basic parameter in the life of older people. The aim of the study was to analyze the factors which have an impact on the functional capacity of older people with chronic pain. The study was conducted among 181 people over 65 suffering from chronic pain lasting more than 6 months. The study used a questionnaire that included questions about demographic and social characteristics and the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Pain Measure-24 (GPM-24). In the study group, a positive correlation was found between: coexisting diseases and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A positive correlation was also found between the Geriatric Depression Scale (GDS) and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A significantly negative correlation was found between: AMTS, ADL, IADL performance and: withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of total GPM-24 score. Chronic pain is more common in people with disabilities in basic and complex activities of daily living, with limited efficiency in cognitive functions and an increased sense of depression. The standard in everyday practice and clinical trials should be taking a history of chronic pain in every older person, monitoring the pain's intensity and accompanying characteristics by using a multidimensional scale for assessing pain in older people.

PREDICTING DYADIC RELATIONSHIP STRAIN IN INDIVIDUALS WITH DEMENTIA

Abstract Recent literature has addressed the perceptions of individuals with dementia to understand how they experience their illness, with evidence suggesting these perceptions are impactful. Few studies, however, have used a conceptual model to explore different aspects of the illness. One aspect to consider is dyadic relationship strain, or feelings of tension, manipulation, and stress between the individual and caregiver. Little work has addressed this strain from the perspective of the individual with dementia who may have different feelings about the quality of the relationship. Cognition and function are two hallmark symptoms in dementia, however little work has addressed how the perception of these two areas impacts the illness experience. Perceptions of difficulties in these two areas may impact dyadic relationship strain as they necessitate increased care and changes in the relationship. Guided by the Stress Process Model for Individuals with Dementia, this study assessed potential predictors of dyadic relationship strain, finding personal activities of daily living (PADLs) to be impactful. In a multiple regression, PADLS (b=.319, p = 02) predicted strain above and beyond two measures of cognition: objective cognitive impairment (b =-.011, p =.93) and perceived memory difficulty (b=.003, p=.311) suggesting that perceived function is impactful for dyadic relationship strain. Because PADLS include more hands-on assistance, the perception of difficulty may create more feelings of embarrassment or stress and impact the perception of relationship strain. Future intervention work may target perceptions of function to improve the dyadic relationship by using techniques such as open communication about difficulties.

Does Elevated Alcohol Consumption Delay the Diagnostic Assessment of Cognitive Impairment among Older Adults?

Introduction: The time from symptom debut to assessment of cognitive impairment (TSA) is usually substantial, and many factors can influence the length of this interval. Our objective was to discern whether elevated alcohol consumption is associated with TSA. Methods: Alcohol consumption was measured among 3,236 older Norwegians assessed for cognitive impairment. Elevated consumption was defined as drinking 4–7 times a week. TSA was defined as the number of months between symptom debut and assessment. The association between alcohol consumption and TSA was examined with a multiple regression analysis controlled for sociodemographic and clinical covariates. Results: Mean (SD) and median TSA were 34.8 (35.8) and 24.0 months, respectively. Elevated alcohol consumption was not associated with TSA. Longer TSA was associated with being male, having a high education level, being retired or unemployed, being single, having low scores on the Mini-Mental State Examination (MMSE) or Personal Activities of Daily Living (PADL), having high subsyndrome scores of depression or agitation on The Neuropsychiatric Inventory – Questionnaire (NPI-Q), or having a spouse/cohabitant as the designated next of kin. Conclusion: This study indicates that elevated alcohol consumption does not influence TSA. Possible explanations are discussed, but further research is needed to determine the effect of alcohol definitively. We did identify other novel characteristics associated with TSA which may be important in minimizing the risk of delayed cognitive assessments and should be kept in mind when considering assessment.

Dependency in Activities of Daily Living During the First Year After Stroke.

Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation.Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke.Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed.Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke.Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.

EFFECT OF DIRECT ACTING ANTIVIRAL (SOFOSBUVIR) ON DAILY LIVING ACTIVITIES OF PATIENTS WITH HEPATITIS C VIRUS

Background: chronic hepatitis C virus is a major cause of liver-related morbidity and mortality and is known to impair activities of daily living. Direct-acting antivirals have demonstrated high efficacy to achieve sustained virological response in chronic hepatitis C patients. Aim: This study aimed to assess effect of direct acting antiviral treatment on daily living activities for patients with hepatitis C virus. Setting: This study conducted at El-Mataria Daqahlia Health insurance hospital in El-Mataria city, Daqahlia and EL-Tadamon Hospital in Port –Said city. A descriptive sample of 100 male and female adult patients were included in the study. Tools of data collection: Three tools were used to collect study data. First tool is a questionnaire used to assess patient's demographic data, medical and surgical history, the second tool is care dependency scale used to assess level of patient dependency and third tool was daily living scale to assess daily living activities of the study patients. Results: the study results revealed that the majority of sample 73%were dependent as an effect of treatment mostly in activities which need more effort or more cognitive abilities as housekeeping and learning ability while 27% were independent independent mainly in personal activities as continence, getting dressed and undressed. Conclusion. The majority of the sample were nearly independent in personal ADL and physical activities, while about one fourth one- fourth were dependent in other activities which need more effort or more cognitive. Recommendations: Assessment of patient physical, psychological, social and spiritual health behaviors should be a part of routine patient's health assessment. Further study is recommended in a larger sample with considering factors could affecting patient's response to viral hepatitis treatment.

Trends in Disability-Free Life Expectancy (DFLE) from 1995 to 2017 in the older Norwegian population by sex and education: The HUNT Study.

Understanding whether increasing Life Expectancy (LE) translates to improved health and function among older adults is essential, but results are inconclusive. We aimed to estimate trends in Disability-Free Life Expectancy (DFLE) in the older Norwegian population by sex and education from 1995 to 2017. National life table data were combined with cross-sectional data on functional ability for 70+ year-olds from the population-based Trøndelag Health Surveys 2-4 (1995-1997, 2006-2008 and 2017-2019) (n=24,733). Self-reported functional ability was assessed on a graded scale by a combination of Instrumental Activities of Daily Living (IADL) such as paying bills, going out or shopping (mild disability) and Personal Activities of Daily Living (PADL) such as washing, dressing or eating (severe disability). LE, DFLE, Mild-Disability LE and Severe-Disability LE at age 70 were estimated by the Sullivan method. From 1995 to 2017 DFLE at age 70 increased from 8.4 to 13.0 years in women, and from 8.0 to 12.1 years in men. DFLE increased in the basic and high educational groups, but more so in the high educational group among men. Educational inequalities in years spent with disability however, remained low. From the mid-1990s and over the past three decades both LE and DFLE at 70 years increased in the older Norwegian population, for both men and women, and across basic and high educational levels. Educational inequalities in DFLE increased, especially in men, but years spent with disability were similar across the three decades.

Item Analysis, Age Trends, and Internal Consistency Reliability of the Children's Occupational Performance Questionnaire (COPQ).

Occupational performance measures are essential for guiding client-centered interventions for children and for measuring progress and program outcomes. To evaluate and report on the psychometric properties of a new assessment tool, the Children's Occupational Performance Questionnaire (COPQ). Descriptive and correlational methods were used. A convenience sample primarily from the northeastern United States was recruited, consisting of the caregivers of 156 children and 25 older children who completed the COPQ as a self-report. Participants' ages ranged from 2 mo to 19 yr. Seventy-five percent of them identified as typically developing, and 25% had a medical condition or disability affecting development. Data from completed questionnaires assessing children with and without disabilities were used to explore aspects of the COPQ's content validity, including age trends and item difficulty. Internal consistency reliability was also examined for each of the five domains: Personal Activities of Daily Living, Instrumental Activities of Daily Living, Social Participation, Play/Leisure, and Education/Work. Each COPQ domain showed strong internal consistency reliability (Cronbach's α = .96-.99). Age trends indicated increasing competency in occupational performance with age across domains and supported occupational performance as a developmental construct. The COPQ shows promise as a reliable occupational performance measure for children for both clinical and research purposes. Potential items for modification or deletion were identified to reduce redundancy and increase efficiency. Further study of the tool's psychometrics and normative data collection are needed. The COPQ addresses all areas of occupational performance and is being developed as a valid, reliable assessment tool for children. It aims to assist in guiding occupational therapy interventions and detecting changes in occupational performance in response to treatment.

Being an older family caregiver does not impact healthcare and mortality: Data from the study 'Good Aging in Skåne'.

Background:Will being a caregiver further impact the health of a group already at risk of adverse health due to old age? This study aimed to answer the questions whether short- and long-term healthcare consumption and mortality differ between informal caregivers and non-caregivers and between high-burden and low-burden informal caregivers.Method:The study population consisted of 423 caregivers and 3444 controls from the Swedish national general population study ‘Good Aging in Skåne’. Caregivers were divided into those reporting high and low caregiver burden and information on caregiver status was collected from questionnaires. Data for mortality and healthcare consumption (inpatient and outpatient visits) were obtained from The National Board of Health and Welfare. Mortality was tested with Cox regression models and healthcare consumption with logistic regression models, adjusted for sociodemographic covariates, Activities of daily living (ADL) and number of chronic diseases.Results:Caregivers were younger than non-caregivers, had higher educational background, more independent in ADL and more often men. Of 423 caregivers, 73 (17.3%) reported experiencing high caregiver burden. High-burden caregivers were older, more dependent in personal ADL and gave more hours of care than those reporting low burden. In adjusted regression models, we found no differences in either consumption of healthcare nor mortality between caregivers and non-caregivers and high-burden v. low-burden caregivers looking at short-term (1 and 3 years) and long-term (10 and 15 years) follow-up periods.Conclusions: Our findings suggest that the characteristic of being a family caregiver does not have an impact on mortality or physical health measured as inpatient admissions or instances of primary care.

The Prevalence of Physical Disability in Elderly SAMPLE in Primary Health Care Centers (PHCs) in AL-Resafa Sector /Baghdad/2018

Background&#x0D; The proportion of older population throughout the world is continuously increasing, and becomes a challenge worldwide, since it may lead to an increasing number of disabled populations, and to a rise of the national health burden, and so there is greater need to look into their physical disability aspects, which is otherwise neglected.&#x0D; Objectives&#x0D; To estimate the prevalence of Activity of Daily Living dependency(ADL) in primary health care centers(PHCs) in AL Resafa health sector in Baghdad, and to find association between dependency and some sociodemographic factors.&#x0D; Method&#x0D; A Descriptive cross- sectional study was carried out in all PHCs in AL Resafa health sector in Baghdad and 250 elderly were interviewed using pretested questionnaire which covered some Sociodemographic factors and Barthal index scale( a 10 item instrument measuring functional independence in personal Activities of Daily Living).&#x0D; Results&#x0D; 250 participants all of them are aged 60 year and older, those aged 60 to 69 years were 47.6%, minority aged 80 years and older , elderly female were slightly more than male (51.6%,48.4% ), Most of participants 97.6% were living in company with their families, 82.0% were not currently employed, 48% overweight , According to Barthal index scale score: 78.0% were independent while ADL with assistance observed in 15.2% and those of ADL with severity 6.8%. There was a significant association between increase in age, Female gender, low education and obesity with decrease in ADL.&#x0D; Conclusion&#x0D; Preserving functional capacity of elderly is a great challenge to public health, subjects categorization on the basis of Barthel index to correlates functional disability will be of value for a better quality of life.

Emergency laparotomy in the older patient: factors predictive of 12-month mortality\u2014Salford-POPS-GS. An observational study

IntroductionAlthough high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients.MethodsObservational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017.Results113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081).ConclusionFrailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

The Cumulative Structure of Personal and Instrumental ADL. A Study of Elderly People in a Health Service District

Katz' Index of ADL has been supplemented by five well-defined instrumental activities, namely cooking, washing, transportation, cleaning, and shopping. Eighty-five persons, mainly elderly, who had consecutively consulted a district occupational therapist, were assessed in their homes in order to study the reliability, the scalability, and the validity of the expanded index. The inter-observer reliability was high. The coefficient of scalability was well above the acceptance level, indicating construct validity. No person was dependent in personal ADL and totally independent in instrumental ADL. Persons who were dependent in both personal and instrumental ADL were older and lived in sheltered accommodation more often than persons who were dependent only in instrumental ADL, indicating external validity. This study shows that there was a cumulative relationship between certain well-defined instrumental activities and between personal and instrumental activities. This supplemented index can be useful for assessing and differentiating the need for personal assistance and homecare among disabled elderly people.

Intervention design for rehabilitation at home after stroke. A pilot feasibility study

This study aimed at identifying the characteristics and feasibility of rehabilitation at home for acute stroke patients in south-west Stockholm. A population-based systematic sample of 16 patients, fulfilling defined criteria, was selected from approximately 1/3 of the stroke patients having been in hospital for one week or more at a neurology department, and offered early discharge in combination with home-based rehabilitation as an alternative to sustained rehabilitation in hospital. Fifteen patients, mean age 68.2 years, male/female ratio 9/6, independent in feeding and continent one week after acute stroke, participated in the study. The most important components of the home-based rehabilitation programme were that: 1) one therapist was selected as case-manager using the other therapists on a consultant basis; 2) the training sessions consisted of different task-specific activities, based on the patients' personal interest; 3) education and individual counselling were offered to all spouses; and 4) adherence to structured training between therapy sessions was promoted. The length of such programmes varied from 4 to 19 weeks after discharge and the mean number of home visits was 11. Reported time for training between therapy sessions for 14 patients was mean 1.2 hours per day. The patients' lifestyle activities, personal and instrumental ADL, and motor capacity at 3, 6 and 12 months after stroke, assessed by validated and reliable methods, followed patterns similar to those reported for other stroke patients. The mean time in hospital for patients in the study was 14 days; for patients with similar ADL capacity but not included in the study it was 27 days.