Performance of activities of daily living in a sample of applicants for home modification services

Home modification services are provided to support persons with functional limitations to live independently at home. It is not well known what causes individuals to apply for home modifications, or in what kind of life situation this need appears. The aim of this study was to examine the relationship between performance of activities of daily living, housing and living situation, and the home modification applied for in a sample of home modification applicants. Further, the aim was to examine differences in performance of activities of daily living between subgroups with different social support. A total of 102 participants were included in the study. Data on performance of activities of daily living was collected through interviews in the participants' homes, using structured instruments. The participants reported high levels of independence in activities of daily living, and were using assistive devices to a large extent. However, the applicants clearly experienced difficulties in performing activities related to the applied home modification. The study indicates that the main reason for applying for Home Modification Grants was perceived difficulties in performance of activities of daily living. This stresses the importance of including other aspects besides independence when trying to understand persons' activity performance and planning for occupational therapy interventions.     

Performance of activities of daily living in a sample of applicants for home modification services

Home modification services are provided to support persons with functional limitations to live independently at home. It is not well known what causes individuals to apply for home modifications, or in what kind of life situation this need appears. The aim of this study was to examine the relationship between performance of activities of daily living, housing and living situation, and the home modification applied for in a sample of home modification applicants. Further, the aim was to examine differences in performance of activities of daily living between subgroups with different social support. A total of 102 participants were included in the study. Data on performance of activities of daily living was collected through interviews in the participants’ homes, using structured instruments. The participants reported high levels of independence in activities of daily living, and were using assistive devices to a large extent. However, the applicants clearly experienced difficulties in performing activities related to the applied home modification. The study indicates that the main reason for applying for Home Modification Grants was perceived difficulties in performance of activities of daily living. This stresses the importance of including other aspects besides independence when trying to understand persons’ activity performance and planning for occupational therapy interventions.     

Relationship of normal levels of activity of daily living and daily habits among elderly women at home

PURPOSE: The relationship of activities of daily living (ADL) with daily habits and age was investigated with a focus on the results of measurements of the normal speed (ordinary level: OL) and maximum speed (maximum capacity: MC) in performing items on a functional fitness test. The significance of the measurement of the ordinary level was also discussed. METHODS: The subjects were 69 women, aged 60-90 years old, who participated in a health workshop for the elderly sponsored by a local municipality and who performed at least 4 items on a functional fitness test. Public health nurses asked subjects about habitual life style, subjective health status and degree of satisfaction in daily life. The ADL level was measured using the tests of functional fitness developed by Oida et al and partially revised by ourselves and physical fitness tests (grip strength, sit and reach, and balancing on one leg with opened eyes). OL was measured as the time needed to perform functional fitness items at normal speed, and MC as the time needed when performing these tasks as quickly as possible. RESULTS: All functional fitness items were accomplished significantly faster with MC than OL. Correlation coefficient values between OL and MC were high significant. Age was found to be significantly related to the hand working test (Hand-T) to evaluate dexterity and the rope working test (Rope-T) to evaluate self-care, except with the MC. An analysis of covariance with age as the covariant revealed that, with OL, there were relationships between Hand-T and Rope-T and the item "active at home," and between the zigzag walking (Zigzag-T) and Rope-T and "walking or riding a bicycle to go shopping." With MC, there were relationships between Hand-T and "active at home," and between Zigzag-T and "walking of riding a bicycle to go shopping." Regarding physical capacity, relationships were seen between both hands and "high level of physical fitness" and "walking fast" and grip strength (Left hand), respectively. CONCLUSION: The ADL items measured in the preset study were related to the daily activities of elderly people. As the OL and MC results demonstrated a high correlation and the ADL items related with OL were found to have almost the same link with MC, we conclude that OL is suitable for testing with the advantage of safety. However, we could not explain differences in relationships between measurements and daily activities, pointing to a need for further research. Elderly people must maintain their capacity for ADL to support a good quality of life, and we have demonstrated the utility of measurements that include normal levels of activity as indicators.     

Performance of activities of daily living among hospitalized cancer patients

Background: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. Methods: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). Results: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. Results from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments. Conclusion: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.     

高血压性脑卒中患者日常生活活动能力与生存质量的关系

目的探讨高血压性脑卒中患者日常生活活动能力与生存质量的关系。方法选取2016年6月至2018年10月在本院门诊或住院部就诊的原发性高血压合并脑卒中患者232例。收集患者人口学特征,使用Barthel指数评定量表评估患者的日常生活活动能力,使用简明健康状况调查表(SF-36)评估患者的生存质量。结果年龄<60岁的患者日常生活活动能力得分为(80.93±17.11),明显高于M60岁患者的(72.76±15.08),差异有统计学意义(P<0.05);不同受教育程度和月收入患者的日常生活活动能力和总体健康水平之间比较差异均有统计学意义(均P<0.05)。脑力劳动者和医保患者的日常生活活动能力和总体健康水平明显高于体力劳动者和自费患者,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,日常生活活动能力与总体健康、生理功能、情感功能、生理职能、躯体疼痛、精神健康及活力呈正相关(均P<0.05),与社会功能无明显相关性(P>0.05)。多元逐步回归分析显示,受教育程度、职业类型、医保类型、月收入是患者日常生活活动能力和总体健康水平的独立影响因素(均P<0.05)。结论髙血压性脑卒中患者日常生活活动能力和生存质量均偏低,应针对受教育程度、职业类型、医保类型及月收入不同的患者制订针对性干预措施。     

高压氧舱内气管切开患者的护理干预研究

目的探讨不同吸痰护理方式对气管切开患者高压氧治疗（HBO）的影响。方法 52例行HBO治疗的气管切开患者分为两组各26例,在对治疗的各个环节进行护理质量管理控制的基础上,A组行气切套管下吸痰,B组行深部吸痰,比较两组生命体征指标、呼吸机相关性肺炎（VAP）及其他并发症情况。结果 A组吸痰间隔时间为（84.2±13.3）min,B组为（37.5±18.2）min,A组吸痰间隔时间明显长于B组（P〈0.05）;A组VAP、其他呼吸道并发症发生率为3.85%、15.38%,B组为30.77%、61.54%,A组VAP、其他并发症发生率低于B组（P〈0.05）。结论行HBO治疗的气管切开患者采用气切套管下吸痰的方式,能够延长吸痰间隔时间,减少VAP及其他并发症发生率。     

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.     

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     

Reliance on others for food-related activities of daily living

Reliance on others for help with food-related activities (grocery shopping and meal preparation) [FADL] can influence food intake and can be considered part of the concept of food security for older adults. Data collected from 193 community-living seniors identified that 29.5% of these seniors required help with these activities. Covariates independently associated with FADL were: muscle strength/size, gender, avoidance of activities due to a fear of falling and occurrence of functionally limiting diagnoses. Mediation analysis identified variables that explain the "how and why" of the association between FADL and food intake. Mediators included informal supports, frequency of informal support, perceived health status, and number of medications. By specifically analyzing covariates and mediators of reliance for FADL, there is further understanding of the relationship between this reliance and food intake in older adults.     

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。     

Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Relationship between keeping a companion animal and instrumental activity of daily living (IADL). A study of Japanese elderly living at home in Satomi Village

OBJECTIVE: The purpose of this study was to clarify the relationship between the companionship of an animal and the level of Instrumental Activity of Daily Living (IADL) of elderly people living at home, and to consequently determine beneficial effects on the overall health of the elderly. METHODS: For this study, 400 elderly people aged 65 years and over were randomly selected from among the 1,345 citizens of Satomi Village, Ibaraki Prefecture. Self-administered questionnaires were mailed to the selected subjects in March of 1999. In the survey, the respondents were asked if they could accomplish all seven IADL activities. Subjects for whom this was the case were classified as having no IADL disability. Elderly who answered "No" for even one were listed as having an IADL disability. Using the existence of an IADL disability as a dependent variable and various factors related to companion animals as independent variables, a logistic regression analysis was performed. RESULTS: Out of the 400 individuals, 84.8% responded. With respect to the possession of a companion animal, the number of participants who never had a companion animal was 115 (35.8%); while 118 (36.8%) possessed a companion animal in the present. With regard to factors relevant to IADL of elderly people, the odds ratio (OR) adjusted for age and sex for participants who owned dogs was 0.53 (95% confidence interval [CI] 0.27-0.99) relative to those who never had a companion animal: The difference was significant. For those respondents who indicated that their companion animals were their best friends, the OR was 0.48 (95% CI 0.23-0.99), and again significant. The OR tended to decrease with increase in the duration of owning a companion animal. CONCLUSION: In this study, owning a dog and everyday contact with the companion animal were related to the IADL of the elderly living at home. It is possible that keeping a companion animal may be linked to better overall health in the elderly.     

家庭氧疗患者氧疗知识调查

目的　了解目前上海市家庭氧疗患者对氧疗知识了解的情况。方法　由医务人员对201 例家庭氧疗患者上门询问,详细填写调查问卷。结果　对氧疗知识比较了解的患者只有少数,大部分患者对氧疗知识一知半解,氧疗知识很少直接从医务人员获得。COPD 患者和其他肺部疾病患者得分要稍高于其他疾病患者,知识问卷得分情况与年龄、病程、动脉血氧饱和度均不相关。结论　由于缺乏对氧疗的正确认识,患者在氧疗过程中存在一些不当之处,应加强对患者及其家属家庭氧疗的宣教。     

Antibiotic therapy of catheter infections in patients receiving home parenteral nutrition

Fifty-eight episodes of catheter-related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram-positive cocci, 25% were Gram-negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram-negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram-positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase-negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram-negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter-related infections caused by coagulase-negative staphylococcus.     

Sleep-wake rhythm and physical fitness in relation to activities of daily living in stroke survivors residing at home

To clarify the relationship between sleep-wake rhythm, physical fitness, and competence level of elderly stroke survivors living at home, thirty-seven stroke survivors living at home (65.4 ± 7.3 years) voluntarily participated in a cross-sectional study with an interview survey and measurement of physical fitness. All subjects lived in a community and received community home health care services. Sleep-wake rhythm and competence were evaluated by the questionnaire method. Physical fitness in relation to daily living activities was measured by both die time needed to walk 10 meters and that needed to stand up from bed rest position. There was a significant positive correlation between rising time and the 10 meter walking time. Regarding rising time and the competence score, there was a significant negative correlation. Stroke survivors who actively participated in community activities arose earlier than those who had a negative attitude toward participation in community activities. The sleep-wake rhydim, especially rising time, and the participation in community activities were related to the high competence level of stroke survivors living at home. Strengthening the synchronization of the sleep-wake rhythm and increasing the social network may serve as useful procedures to improve the competence of stroke survivors living at home.     

Factors affecting activity of daily living (ADL) in stroke patients at home

To examine the effects of housing conditions, health care, age, functional status and other demographic factors on the Activity of Daily Living (ADL), an interview survey of the caregivers of 68 cerebral stroke patients was performed. All patients received care at home for 6-128 (mean 40) months after discharge from hospitals and were 56-91 (mean 79) years old at the time of the survey. During the home care, ADL improved in 28 patients (improved ADL group), and did not change or deteriorated in 26 patients (unchanged/deteriorated ADL group). Three variables, i.e. reconstruction of bathroom (bathing facility and not toilet) in the patient's house after starting the home care, the patient whose main caregiver was his or her spouse, and consultation with a physician at a hospital (not a clinic), were significantly more frequent in the improved ADL group than in the unchanged/deteriorated ADL group. Similarly, the ADL level at the start of home care and age at the time of survey were significantly lower in the improved ADL group. The results of multiple logistic regression analysis indicates that the level of ADL when home care was started (p less than 0.01) and reconstruction of the bathroom (p less than 0.05) were major factors affecting the improvement in ADL.