Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke

Lu W-S, Chen CC, Huang S-L, Hsieh C-L. Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke.ObjectiveTo estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [FAI]) in patients with chronic stroke.DesignTest-retest reliability study.SettingPhysical rehabilitation units of 5 hospitals.ParticipantsChronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months.InterventionsNot applicable.Main Outcome MeasuresBoth measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 × √2 × Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs).ResultsThe SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89).ConclusionsBecause of substantial SRD values of the NEADL and the FAI, prospective users should be cautious in using both measures to detect real change for a single subject.     

A test-retest reliability study of the Barthel Index, the Rivermead Mobility Index, the Nottingham Extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients.

PURPOSE: To assess the test-retest reliability of a range of outcome measures in stroke patients. METHOD: Twenty-two patients > 1 year post-stroke were tested twice at an interval of 1 week using the Barthel Index (BI); the Rivermead Mobility Index (RMI); the Nottingham Extended Activities of Daily Living Scale (NEADL); and the Frenchay Activities Index (FAI). The mean difference (bias) and reliability coefficient (random error) were calculated for the total scores. Percentage agreement and the kappa coefficient were used to analyse individual items. RESULTS: The mean differences and reliability coefficients were BI 0.4 +/- 2.0, RMI 0.3 +/- 2.2, the NEADL 0.6 +/- 5.6, FAI -0.6 +/- 7.1. There was little bias between assessments. The performance of the BI and RMI were better with lower random error. The NEADL and FAI did not perform as well having larger random error components. Percentage agreements were generally high especially for the BI (>75%) and RMI (>85%), but there was considerable variation in the kappa coefficients. CONCLUSION: Measurement of basic activities of daily living and mobility as measured by the BI and RMI is reliable post-stroke. Measurements used to assess extended activities of daily living were less reliable in this study.     

Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation

Wu C-Y, Chuang L-L, Lin K-C, Lee S-D, Hong W-H. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living scale in patients with improved performance after stroke rehabilitation.

Objectives

To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation.

Design

Secondary analyses of patients who received stroke rehabilitation therapy.

Setting

Medical centers.

Participants

Patients with stroke (N=78).

Interventions

Secondary analyses of patients who received 1 of 4 rehabilitation interventions.

Main Outcome Measures

Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC₉₀), and MCID on the NEADL score and percentages of patients exceeding the MDC₉₀ and MCID.

Results

The SRM of the total NEADL scale was 1.3. The MDC₉₀ value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC₉₀ and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively.

Conclusions

The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates.     

Health-related quality of life of Turkish stroke survivors

Stroke is a major, chronically disabling neurological disease, which often radically and permanently changes the lives of the victims. Improvement of motor coordination and the degree of independence achieved in activities of daily living have been the usual criteria used to measure outcome in stroke rehabilitation. The objective of our study is to compare health-related quality of life (HRQOL) between stroke patients 6 months after rehabilitation and a control group who did not have any major illness. The associations of several factors with the quality of life were also examined. Sixty consecutive stroke patients and 58 healthy control participants were included in the study. Functional independence measure (FIM), Nottingham health profile (NHP) and demographic variables were used as the main outcome measures. There were significant improvements in both motor coordination and functional status as measured by FIM at discharge and also 6 months after stroke and these variables were significantly associated with the HRQOL. The NHP, which is a validated quality-of-life measurement in Turkish patients, was used and the scores were compared with the healthy control participants. The scores of NHP domains (energy level, emotional reactions, sleep, social isolation and physical mobility) of the stroke patients were higher than those of the healthy group (P<0.01). Age, marital status, lesion side and multiple stroke history showed no significant correlation with NHP scores. Being a woman, lower educational status, tendency to depression and the presence of several comorbidities were significantly correlated with the NHP scores. Stroke survivors in our society have lower HRQOL than healthy individuals. HRQOL is correlated with the functional status in the stroke population. Additionally, the reduced HRQOL after stroke appears to be related to several demographic properties such as sex, education, comorbidities and psychological factors.     

A test-retest reliability study of the Barthel Index,the Rivermead Mobility Index,the Nottingham extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients

Purpose : To assess the test-retest reliability of a range of outcome measures in stroke patients. Method : Twenty-two patients >1 year post-stroke were tested twice at an interval of 1 week using the Barthel Index (BI); the Rivermead Mobility Index (RMI); the Nottingham Extended Activities of Daily Living Scale (NEADL); and the Frenchay Activities Index (FAI). The mean difference (bias) and reliability coefficient (random error) were calculated for the total scores. Percentage agreement and the kappa coefficient were used to analyse individual items. Results : The mean differences and reliability coefficients were BI 0.4 &#45 2.0, RMI 0.3 &#45 2.2, the NEADL 0.6 &#45 5.6, FAI -0.6 &#45 7.1. There was little bias between assessments. The performance of the BI and RMI were better with lower random error. The NEADL and FAI did not perform as well having larger random error components. Percentage agreements were generally high especially for the BI (>75% ) and RMI (>85% ), but there was considerable variation in the kappa coefficients. Conclusion : Measurement of basic activities of daily living and mobility as measured by the BI and RMI is reliable poststroke. Measurements used to assess extended activities of daily living were less reliable in this study.     

A randomized controlled trial of outpatient CAncer REhabilitation for older adults: The CARE Program

BackgroundLarge numbers of older adults (aged 65 years or older) are surviving cancer; however, many survivors report decreased quality of life (QOL) and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) both during and after treatment [1–3]. Occupational and physical therapy (OT/PT) are services focused on improving functional status and QOL that are largely unexplored and underutilized in cancer survivorship care [4,5].Methods/DesignThis is a randomized, single-blind, two-arm, single institution pilot study. Eighty-two patients will be recruited from a university-affiliated outpatient oncology clinic. Inclusion criteria include the following: aged 65 years or older, diagnosis of cancer within 5 years, English speaking, has at least one functional deficit, and able to safely participate in an outpatient rehabilitation program. Exclusion criteria are: currently receiving rehabilitation or eligible for hospice. Consented patients will be randomized into two groups: (1) the CARE (CAncer REhabilitation) Program consisting of outpatient OT/PT and (2) standard of care. Primary outcome: change in Nottingham Extended Activities of Daily Living (NEADL) scores from baseline to 3 months between CARE and control.DiscussionThis study is one of the first RCTs aimed at examining the effect of OT/PT in older adults with cancer. If positive, findings from this study will suggest the potential for outpatient OT/PT to improve the functional ability and QOL of older adults with cancer.     

Quality of life in adults with congenital ichthyosis

BACKGROUND: Little is known about the quality of life of people with congenital and generalized skin diseases. Describing life history and quality of life from an individual perspective could increase understanding of living with generalized congenital ichthyosis for nursing staff and others. AIM: The aim of our study was to illustrate how middle-aged and older people with lamellar ichthyosis or epidermolytic hyperkeratosis describe the effects of their disease on their quality of life. METHODS: Six women and four men aged 56-80 years participated. A global clinical assessment of the severity of the disease was performed. The Nottingham Health Profile (NHP) questionnaire was used to investigate quality of life. Participants were interviewed face-to-face about childhood and adulthood experiences of living with a skin disease. Interview data were analysed using content analysis. RESULTS: Interview data were assigned to two categories, childhood and adulthood, and organized under 16 themes. All interviewees reported that their skin disease had affected them negatively to varying degrees during their entire lives, and that the most problematic period was childhood. Coping strategies used during childhood were hiding of the skin and developing shyness. There were no correlations between objective signs of ichthyosis and the NHP scores. CONCLUSIONS: Congenital ichthyosis appears to affect several aspects of life negatively, and it is hoped that an understanding of the effects of the disease will lead to more efficient nursing care.     

Survey on quality of life of patients undergoing dialytic treatment

The Nottingham Health Profile (NHP) was administered to 85 dialysis patients treated at Mestre Hospital, to assess their quality of life and compare any differences between haemodialysis (HD) and peritoneal dialysis (PD) patients. The two groups were similar for the main characteristics. Overall dialysis patients do not enjoy a good quality of life. Comparing baseline demographic and clinical scores, 72.9% patients have problems with energy and 69.4 with mobility, 47.1% refer pain and 54.1% sleep disorders. The main differences between HD and PD patients concern psychological reactions, where 42.9% of HD patients report "at risk/compromised" scores compared to 17.2% of PD patients. NHP showed to be an easy to administer and efficient instrument in identifying areas of concern for dialysis patients.     

Measuring health status of people who are wheelchair-dependent: validity of the Sickness Impact Profile 68 and the Nottingham Health Profile

Purpose : Several questionnaires measuring health status are available, but their validity and correspondence between them in people with severe physical disabilities is not well known. In this study, the equivalence of the Nottingham Health Profile (NHP) and the Sickness Impact Profile 68 (SIP68) was examined. Methods : Patients were 111 people who were wheelchair-bound due to spinal cord injuries (45%), rheumatic diseases (27%) or other causes (28%). Internal consistency, associations between scales of both questionnaires and with criterion variables (reflecting upper and lower extremity function, perceived health, social functioning and well-being) were examined. Results : Both the NHP and the SIP68 were of acceptable clinimetric quality (Cronbach's alpha 0.53-0.85). Agreement between scales of both questionnaires was moderate for scales reflecting emotional health (0.56) and for scales reflecting physical (0.22-0.68) and social functioning (0.28-0.35). Conclusion : The NHP reflects perceived health, whereas the SIP68 reflects functional health status. In rehabilitation research, a careful choice between available health status measures must be made.     

Validity and community utility of the Canadian Occupational Performance Measure

This study addressed the validity and community utility of the Canadian Occupational Performance Measure (COPM) (Law et al., 1991; 1994; 1998): a measure that now represents a national standard in clinical practice and research in occupational therapy in Canada. The study employed a crossectional design. Participants for the study were former consumers of occupational therapy services, recruited from the Queen's University catchment area (Kingston, North Bay, Oshawa, Perth, Peterborough). A sample of 61 disabled individuals living in the community were recruited. Each individual was sent a package of self-administered measures including the Satisfaction with Performance Scaled Questionnaire, the Reintegration to Normal Living Index, the Life Satisfaction Questionnaire, and the Perceived Problems List. An interview was also arranged with the project coordinator, which was based on the COPM and the Consumer Utility Questionnaire. Multivariate analyses showed that construct validity was supported; scores on the COPM were significantly related to theoretically related constructs: satisfaction with performance, reintegration to normal living and life satisfaction. In addition, criterion validity was supported. A majority of participants (53%), when asked about problems of daily living, spontaneously reported at least one of the problems raised on the COPM. Community utility was evaluated highly by participants, 75% of whom found the COPM useful in identifying and rating their problems, and 100% of whom reported no problems in understanding the COPM.     

加拿大作业表现量表在偏瘫患者作业活动康复中的应用观察

目的:观察基于加拿大作业表现量表(COPM)评估结果开展的作业治疗对偏瘫患者作业活动和生活质量的影响。方法:将符合入选标准的脑卒中后偏瘫患者48例,随机分为观察组和对照组各24例。2组患者均接受为期3个月的常规康复治疗,对照组在此基础上接受常规日常生活活动训练,观察组在常规康复的基础上辅以COPM评估患者在日常生活活动、生产活动和休闲活动方面的功能障碍,并以COPM评估结果为依据实施针对性的作业活动康复。于治疗前和治疗3个月后分别采用改良Barthel指数(MBI)、世界卫生组织生活质量测定量表简表(WHOQOL-BREF)和COPM对2组患者进行评估。结果:治疗3个月后,2组MBI评分、WHOQOL前28项得分和第103项得分较治疗前均明显提高(均P<0.01),且观察组MBI评分、WHOQOL前28项得分和第103项得分均明显高于对照组(均P<0.05);观察组COPM表现得分和满意度得分较治疗前和对照组均明显提高(P<0.01,0.05),对照组治疗前后COPM表现得分和满意度得分比较差异均无统计学意义。结论:在脑卒中后偏瘫患者常规康复中辅以加拿大作业表现量表应用(评估和康复干预),可以明显改善患者的基础性日常生活活动能力,并提升患者的住院期间作业活动恢复的满意度。     

Measuring health status of people who are wheelchair-dependent: validity of the Sickness Impact Profile 68 and the Nottingham Health Profile

Purpose: Several questionnaires measuring health status are available, but their validity and correspondence between them in people with severe physical disabilities is not well known. In this study, the equivalence of the Nottingham Health Profile (NHP) and the Sickness Impact Profile 68 (SIP68) was examined. Methods: Patients were 111 people who were wheelchair-bound due to spinal cord injuries (45%), rheumatic diseases (27%) or other causes (28%). Internal consistency, associations between scales of both questionnaires and with criterion variables (reflecting upper and lower extremity function, perceived health, social functioning and well-being) were examined. Results: Both the NHP and the SIP68 were of acceptable clinimetric quality (Cronbach's alpha 0.53-0.85). Agreement between scales of both questionnaires was moderate for scales reflecting emotional health (0.56) and for scales reflecting physical (0.22-0.68) and social functioning (0.28-0.35). Conclusion: The NHP reflects perceived health, whereas the SIP68 reflects functional health status. In rehabilitation research, a careful choice between available health status measures must be made.     

Health-related quality of life in chronic refractory reflex sympathetic dystrophy (complex regional pain syndrome type I)

The aim of this study was to find out which aspects of health-related quality of life (HRQL), measured with generic instruments, are important to patients with reflex sympathetic dystrophy (RSD) affecting the arm or leg. The Sickness Impact Profile 68 (SIP68), the Nottingham Health Profile (NHP), and the EuroQol-5D (EQ-5D) were completed by 54 patients suffering from RSD (33 arm, 21 leg). The scores of the three questionnaires for patients with an affected arm or leg are presented. Aspects relevant to patients with RSD of the arm include the NHP1 dimensions of pain (mean score: 63%), sleep (58%), and energy (45%), and the EQ-5D dimensions of pain (67% extreme), usual activities (76% some problems), and self care (76% some problems). Aspects relevant to patients with RSD of the leg include the SIP68 dimensions of social behavior (51%) and mobility control (46%), the NHP 1 dimensions of pain (mean score: 86%), mobility (54%), energy (53%), and sleep (52%), and the EQ-5D dimensions of mobility (81% some problems), pain (71% extreme), and usual activities (71% some problems). The study showed that applying generic HRQL instruments and measuring treatment effect with the dimensions scoring high provides a responsive instrument which at the same time gains information concerning dimensions not maximally responsive to a specific disease. Some dimensions which, on the basis of their label, might be expected to be important were found not to be so. After using this approach, clinicians can more directly focus treatment on specific areas that have been shown to affect a patient's HRQL.     

Impact of age on improvement in health-related quality of life 5 years after coronary artery bypass grafting

The aim of this study was to describe the relief of symptoms and improvement in other aspects of health-related quality of life 5 years after coronary artery by-pass grafting in relation to age. Patients in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Health-related quality of life was estimated with 3 different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP), Psychological General Well-Being Index (PGWB). Prior to surgery patients were approached either in the ward or by post and 5 years after surgery they were approached by post. A total of 1719 patients were available for the survey, of whom 876 (51%) responded to the survey both prior to and after 5 years. Among the 876 respondents 287 were <60 years, 331 were 60-67 years and 258 were >67 years. In terms of physical activity, chest pain and dyspnoea, a similar improvement was observed regardless of age. In terms of health-related quality of life questionnaires, there was an inverse association between age and improvement when using PAS and a similar trend was observed with NHP and PGWB. In conclusion, 5 years after coronary artery bypass grafting relief of symptoms and improvement in physical activity was not associated with age, whereas improvement in other aspects of health-related quality of life tended to be less marked in elderly people. Overall age seemed to have a small impact on the improved well-being 5 years after coronary surgery. However, due to the limited response rate the results may not be applicable to a non-selected coronary artery bypass grafting population.     

Assessment of quality of life in haemodialysis patients: A comparison of the Nottingham Health Profile and the Short Form 36

This study aimed to compare the psychometric properties of the Nottingham Health Profile (NHP) and the Medical Outcomes Study Short Form Health Survey (SF‐36), which evaluates health‐related quality of life in haemodialysis patients. Data were gathered using the NHP and the SF‐36. Quality of life scores obtained from the NHP and the SF‐36 were compared according to sociodemographic characteristics. It was found that the internal consistency values of the NHP and the SF‐36 were similar. The floor effect of the two NHP subscales and the ceiling effect of all the NHP subscales were higher than those pertaining to the. It was observed that the NHP mean subscale scores were higher than those of the SF‐36, except for one subscale of the SF‐36. There was a significant positive correlation between the similar subscales of the NHP and the SF‐36 and between the total scores. These results seem to support the utility of the NHP and the SF‐36 in evaluating quality of life in haemodialysis patients.     

Cognitive deficits in vasculitis of the nervous system: a cross-sectional study

Objectives: To identify the cognitive and functional deficits in a well-characterized group of patients with vasculitis of the nervous system.

Methods: Sixty-seven patients diagnosed with Central Nervous System (CNS) or Peripheral nervous System (PNS) vasculitis over a 14-year period were retrospectively identified. Data on clinical presentation, laboratory, radiographic and tissue biopsy investigations, and treatment were collated. Cognitive, functional and quality of life evaluation assessments were performed in 31 patients who agreed to participate and included Addenbrooke’s Cognitive Examination-revised (ACE-R), Nottingham Extended Activities of Daily Living (NEADL) and EQ-5D-3L quality of life questionnaires.

Results: CNS vasculitis patients exhibited cognitive impairment, with a mean ACE-R score of 74/100 (standard deviation (SD) 16). NEADL and EQ-5D-3L scores were in the impaired range at 41/66 (SD 21) and 57/81 (SD 22), respectively. Patients with just PNS vasculitis exhibited fewer cognitive deficits with ACE-R and NEADL scores of 87 (SD 8) and 46 (SD 16) respectively. EQ-5D-3L score was in the impaired range of 65 (SD 22).

Conclusions: Vasculitis of the nervous system and, in particular, CNS vasculitis causes cognitive impairment and deficits in functional ability. Such patients should be targeted for cognitive rehabilitation.     

A comparison of the Canadian Occupational Performance Measure and the Health Assessment Questionnaire.

The Canadian Occupational Performance Measure (COPM) is receiving international attention as an important assessment for directing occupational therapy interventions and measuring client-centred outcomes. The COPM measures individuals' perceptions of disability by identifying those tasks that are important to them and difficult to perform. The Health Assessment Questionnaire (HAQ) has been used extensively with persons with arthritis and measures individuals' perceived difficulty in performing predetermined tasks of daily living. The HAQ has been shown to correlate with actual performance and has reported concurrent validity with a number of similar scales. In this study, 13 participants diagnosed with rheumatoid arthritis were assessed with the COPM and the disability dimension of the HAQ. Participants scored performance limitations on both the COPM and the HAQ; the correlation coefficient between the scores was not statistically significant. However, when the COPM and the HAQ scores for similar activities were compared, a statistically significant correlation was found. These findings support the use of the COPM as a valid measure of self-reported performance.     

Quality of life after hip fracture: a comparison of four health status measures in 208 patients

Objectives: We compared four health status measures for the evaluation of quality of life after hip fracture. Methods: Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated. Results: At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning. Conclusions: To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.     

Day-case surgery patients' health-related quality of life

This study describes the health-related quality of life (HRQoL) of day-surgery patients and aims to identify factors associated with HRQoL. The cross-sectional questionnaire survey data were collected from day-surgery patients being discharged from hospitals in one Finnish hospital district in 2001 using the Nottingham Health Profile (NHP). The analysis was based on statistical methods. Day-case surgical patients had the best HRQoL in the social dimension and mobility. The NHP scores showed moderate distress in sleep and energy, and demonstrated pain. Older age and vocational education were associated with higher scores as measured with the NHP, indicating more problems in the measured variables. The patients who have been operated as day cases recovered satisfactorily and the operation did not weaken their perceived HRQoL. More emphasis should be put on evaluating day-case surgery patients' pain. Patient's age should be taken into account in planning type of surgery. The NHP is also a useful tool for the purposes of studying the HRQoL of day-case surgery patients.     

Assessment of physical health status and quality of life among Saudi older adults

[Purpose] This study investigated physical health status and quality of life among older Saudi adults. [Subjects and Methods] Participants included older adults (N = 55) aged 60–90 years (mean = 67.9± 7.71) from a major hospital in Jeddah. Subjects completed surveys and evaluations including assessments of personal and socio-demographic characteristics, caregiver presence, personal habits, perceived health, primary physical and psychological complaints, physician-diagnosed chronic diseases, and functional capacity (i.e., activities of daily living). [Results] Results showed a significant positive correlation between age and ADL; age and memory problems, anxiety, and loneliness; and sleep disturbance and falls. Main factors contributing to quality of life decline were chronic disease, falls, sedentary lifestyle, sleep disturbances, and financial concerns. Participants with diabetes mellitus (58.18%) and hypertension (29.0%) had a very high fall rate. Participants engaged in minimal physical activity (63%), often due to bone and joint pain (90.0%), and led sedentary lives (69%). Single sensory impairments were significantly and independently linked to high depression risk and decreased self-sufficiency. [Conclusion] Healthy lifestyle and behavioral changes should be promoted through community-based health education programs for older Saudi adults. Chronic disease screening programs for the elderly population (especially diabetes and hypertension) are recommended.Key words: Elderly, Falls, Depression