The performance of instrumental activities of daily living scale in screening for cognitive impairment in elderly community residents

A retrospective analysis of Short Orientation-Memory-Concentration (OMC) and Lawton's IADL data was performed to assess the association between instrumental activities of daily living (IADL) and a rating of cognitive impairment, and to test whether IADL measures can be used to screen for dementia. The study analyzed data from 1,095 elderly community residents who were regarded as potentially benefiting from care coordination. Three IADL items (telephone use, self-medication, and handling finances) were statistically associated with cognitive impairment (OMC cutoff 10/11), independent of age and sex. An IADL indicator based on these items had only modest power in predicting cognitive impairment, its highest sensitivity being 0.71. Specificity was 0.75 at this point, but increased to 0.97 if higher indicator scores were used to define a positive result. In conclusion, the usefulness of an IADL indicator seems limited to ruling out further cognitive assessment rather than positively identify those with dementia.     

Development of an instrument for measuring activities of daily living in persons with suspected cognitive impairment

Background According to the Swedish National Board of Health and Welfare, structured assessment of function and activity has high priority when evaluating suspected cognitive impairment or dementia. Aim/objectives The aim was to develop and psychometrically test an instrument to measure the ability to perform activities of daily living tasks in patients with suspected cognitive impairment. Material and methods The Cognitive Impairment in Daily Life (CID) instrument (for self-reported and informant-based assessments) has been developed in several phases. Content validity was achieved through five expert panels using a Content Validity Index (CVI). The content was tested further in a pilot study of 49 patients and 49 relatives from primary care or a specialist memory clinic. Results Content validity was good with a CVI index of 0.83. All patients considered that the included activities were relevant to them and reflected the difficulties they were experiencing. Most relatives considered the activities included in the instrument as adequate and captured the patients’ difficulties in daily life. Some adjustments of the tasks and scale were suggested and these were implicated after each phase. In general, relatives reported that patients had more difficulties performing the activities than the patients reported themselves. Conclusion The CID instrument seems promising in terms of content validity. Further testing of reliability and construct validity is ongoing.     

中国老年人的失能水平到底有多高?--多个数据来源的比较

目的了解上海市松江区老年人日常生活能力现状。方法采用多阶段随机抽样方法抽取调查对象,采用统一的调查问卷收集相关信息,采用卡方检验分析不同特征老年人口失能率之间的差异。结果本次调查共计收集到4 003份有效调查问卷,调查结果显示松江区老年人平均的失能率为11.8%。人群工具性日常生活能力失能率高于躯体性日常生活能力的失能率。不同性别、年龄、文化程度、婚姻状况等特征老年人的日常生活能力失能率之间差异有统计学意义。结论高龄是老年人生活能力丧失的主要危险因素,女性的失能率高于男性;城区、具有较高受教育水平及在婚状态的老年人其生活能力较完备。     

Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.     

The loss of independence in activities of daily living: the role of low normal cognitive function in elderly nuns.

OBJECTIVES. This study investigated the role of low normal cognitive function in the subsequent loss of independence in activities of daily living. METHODS. Of the 678 elderly nuns who-completed cognitive and physical function assessments in 1992/93, 575 were reassessed in 1993/94. Mini-Mental State Examination scores were divided into three categories and related to loss of independence in six activities of daily living. RESULTS. Participants with low normal cognitive function at first assessment had twice the risk of losing independence in three activities of daily living by second assessment relative to those with high normal cognitive function. This relationship was largely due to a progression from low normal cognitive function at first assessment to impaired cognitive function at second assessment and was associated with an elevated risk of losing independence in the six activities. CONCLUSIONS. Progression from low normal to impaired cognitive function was associated with loss of independence in activities of daily living. Thus low normal cognitive function could be viewed as an early warning of impending cognitive impairment and loss of physical function.     

Characteristics of functional training and effects on physical activities of daily living

PURPOSE: The effects of functional training on physical Activities of Daily Living (ADL) based on the Health and Medical Service Law for the Elderly have been controversial. The aim of the present study was to explore its characteristics and influence with a large sample. SUBJECTS AND METHODS: 669 participants and 1,110 non-participants in functional training were recruited from 54 cities and villages in 1998. The effects of functional training on physical ADL were evaluated by comparing the baseline ADL and 1-year follow-up ADL in the "index of Activities of Daily Living for bedridden elderly (1993)". RESULTS: 1. The change in physical ADL in participants was significantly better than that in non-participants after adjusting for age. 2. Significant effects of functional training were observed in both sexes, in all three age groups, and in ranks J, A and B. 3. There was no significant difference between the sexes in terms of the influence of functional training. Functional training was more effective in the younger group, in stroke subjects, and individuals suffering from any disease within one year prior to the baseline. 4. A total of 16.4% of the participants demonstrated increased physical ADL, while 7.2% of the participants also had increased mobility. CONCLUSION: Functional training has a significant positive effect on increase of physical ADL. Functional training based on the Health and Medical Service Law for the Elderly is an effective program especially for homebound and/or frail people who are at risk of becoming bedridden. Further longitudinal studies are now needed to improve functional training for increasing ADL and QOL.     

多状态模型在轻度认知损害向阿尔茨海默病转归研究中的应用

目的 将多状态Markov模型引入到轻度认知损害(MCI)向阿尔茨海默病(AD)转归研究中,探讨影响MCI转归的因素并进行转归预测,为老年人AD的预防和早期干预提供理论依据.方法 利用MCI患者6次随访资料,以MCI为状态1,中重度认知损害为状态2,AD为状态3,拟合一个时间离散、状态离散的三状态齐性Markov模型,分析MCI向AD转归不同发展阶段的影响因素.模型拟合优度评价后预测不同状态间的转移概率和生存曲线.结果 经多因素筛选,在α =0.05的检验水准下,性别(HR=1.23,95％CI:1.12～1.38)、年龄(HR=1.37,95％CI:1.07～1.72)、高血压(HR=1.54,95％CI:1.31～2.19)对状态1→状态2转移有统计学意义;年龄(HR=0.78,95％CI:0.69～0.98)、文化程度(HR=1.35,95％CI:1.09～1.86)和常读书看报(HR=1.20,95％CI:1.01～1.41)对状态2→状态1转移有统计学意义;性别(HR=1.59,95％CI:1.33～1.89)、年龄(HR=1.33,95％CI:1.02～1.64)、高血压(HR=1.22,95％CI:1.11～1.43)、糖尿病(HR=1.52,95％CI:1.12～2.00)、ApoEε4等位基因(HR=1.44,95％CI:1.09～1.68)对状态2→状态3转移有统计学意义.基于多状态Markov模型估计了协变量取值为平均水平下,从基线起到3年后的转移概率.结论 为延缓MCI疾病进程,应该根据各阶段转移的主要影响因素,开展分阶段重点疾病防治;多状态Markov 能够模拟疾病的自然史,在动态地评价多因素、多阶段的慢性疾病进展方面具有很大的优势.     

都匀市1994～1998年冷饮食品监测结果分析

为切实加强对冷饮食品的卫生管理,防止肠道传染病的发生,我们于1994～1998年对全市冷饮食品进行了抽样监测,结果报告如下。一、监测内容与方法:每年从4月份开始,定期对我市冷饮生产厂家(包括外省雪糕)和销售点随机抽样,按照ＧＢ4789·21-94《清凉饮料检验》进行感官、理化、微生物检验,各项监测指标均按ＧＢ2759-81《冷饮食品卫生标准》评价。二、结果:(1)1994～1998年全市各类冷饮食品合格率由1994年的60.87%逐年提高到1998年的82.47%(1995、1996、1997年合格率为77.88%、69.39%、76.67%),各年度间合格率差异有非常显著性(χ2=15.29,Ｐ<0.0…     

心血管疾病与睡眠呼吸暂停综合征的相关研究

睡眠呼吸暂停综合征(OSAS)易诱发高血压、心肌缺血、心律失常以及猝死,我们对1998年以来收治的高血压、冠心病、心律失常患者与OSAS的关系进行了分析。 1.对象与方法:冠心病患者共306例,男225例,女81例,平均年龄(61.5±9.7)岁,诊断符合WHO冠心病诊断标准,分为稳定型劳累性心绞痛、急性冠脉综合征(包括ST段抬高急性心肌梗死、非ST段抬高急性心肌梗死、不稳定型劳累性心绞痛)。其中稳定型劳累性心绞痛69例,急性冠脉综合征256例,全部接受夜间睡眠7h paradise p600型多导睡眠呼吸监测仪检查,OSAS诊断条件符合每晚7 h的睡眠中呼吸     

Early impact of depression symptoms on the decline in activities of daily living among older Japanese: Y-HALE cohort study

Objective  

It is well known that depression deteriorates basic activities of daily living (ADLs), such as eating and bathing, among the elderly, but little is known about the early impact of depression symptoms on the next higher level of functioning, namely higher-levels ADLs, such as instrumental self-maintenance, intellectual activities, and social roles. The objective of this study was to determine whether symptoms of depression are associated with a subsequent decline in higher-level ADLs within a 12-month period of time.     

The decline in activities of daily living at discharge (DADLD) index: stratifying patients at lower and higher risk

Background

Decreased ability to perform Activities of Daily Living (ADLs) during hospitalisation has negative consequences for patients and health service delivery.

Objective

To develop an Index to stratify patients at lower and higher risk of a significant decline in ability to perform ADLs at discharge.

Design

Prospective two cohort study comprising a derivation (n=389; mean age 82.3 years; SD± 7.1) and a validation cohort (n=153; mean age 81.5 years; SD± 6.1).

Patients and setting

General medical patients aged ?? 70 years admitted to three university-affiliated acute care hospitals in Brisbane, Australia.

Measurement and main results

The short ADL Scale was used to identify a significant decline in ability to perform ADLs from premorbid to discharge. In the derivation cohort, 77 patients (19.8%) experienced a significant decline. Four significant factors were identified for patients independent at baseline: ??requiring moderate assistance to being totally dependent on others with bathing??; ??difficulty understanding others (frequently or all the time)??; ??requiring moderate assistance to being totally dependent on others with performing housework??; a ??history of experiencing at least one fall in the previous 90 days prior to hospital admission?? in addition to ??independent at baseline??, which was protective against decline at discharge. ??Difficulty understanding others (frequently or all the time)?? and ??requiring moderate assistance to being totally dependent on others with performing housework?? were also predictors for patients dependent in ADLs at baseline. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of the DADLD dichotomised risk scores were: 83.1% (95% CI 72.8; 90.7); 60.5% (95% CI 54.8; 65.9); 34.2% (95% CI 27.5; 41.5); 93.5% (95% CI 89.2; 96.5). In the validation cohort, 47 patients (30.7%) experienced a significant decline. Sensitivity, specificity, PPV and NPV of the DADLD were: 78.7% (95% CI 64.3; 89.3); 69.8% (95% CI 60.1, 78.3); 53.6% (95% CI 41.2; 65.7); 88.1% (95% CI 79.2; 94.1).

Conclusions

The DADLD Index is a useful tool for identifying patients at higher risk of decline in ability to perform ADLs at discharge.     

A technique for precisely measuring activities of daily living

Summary A technique is developed that permits the concurrent measurement of activities of daily living in the elderly in three situations—without physical aids and personal assistance, with aids only and with both aids and assistance. The result of a pilot study involving 93 persons of 75 years and over, on the list of a group general practice in Kingston-on-Thames, England, are reported. Important differences in the results of performance of a particular activity in the three different situations are revealed. This is so especially for the activities of walking outdoors, using the bath and toilet and for doing shopping, housework and cooking. The importance of precise measurements of activities in specified circumstances in thus highlighted. As a result, the development of summary indices of disability with greater validity and utility than those in current use can be anticipated. Department of Community Medicine and Health Services Research Unit, St Thomas's Hospital Medical School     

老年人轻度认知功能障碍患病调查

目的 了解浙江省宁波市社区老年人轻度认知功能障碍(MCI)的流行病学特征.方法 采用随机整群分层分阶段抽样的方法对宁波市6个社区,年龄≥60岁的老年人进行现况调查及筛查,完成调查问卷及简易精神状况量表;临床诊断,对有明显记忆障碍者及简易精神状态量表(MMSE)分数低于界值者进一步进行临床检查,并由2名精神科医师进行最后诊断;同时进行总体衰退量表、Hachinski缺血指数量表、临床痴呆评定量表等评定.结果 调查1 227人,男性536人,女691人,MMSE阳性者131例,占10.68％,确诊为MCI者107例,患病率为8.72％;不同年龄段、文化程度、职业,居住及文化生活情况的老年人,其MCI患病率差异均有统计学意义(P＜0.05).结论 高龄、低文化水平、嗜烟、不喝酒或嗜酒、少吃鱼及海产品、单独居住以及少阅读等患MCI的危险性增加.