Predictors of instrumental activities of daily living in community-dwelling older adults

Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.     

Predictors of subjective age in community-dwelling older adults in Korea

Subjective age, or felt age, is highly related to one's actual health and survival. This study was conducted to explore subjective age in community-dwelling older adults in Korea, and to identify predictors of subjective age. Participants were 616 Korean older adults who were living in the community. A multiple regression analysis with a stepwise method was conducted to analyse subjective age. On average, the participants felt 7.8 per cent younger than their actual age. A multiple regression analysis revealed that less severe depression, having better perceived health, having no visual impairment, having higher handgrip strength, and living in a metropolitan area were associated with younger subjective age. Further studies are needed to determine the factors associated with subjective age in older adults. Based on this study, conceptual analyses of subjective age or longitudinal studies to determine the factors affecting subjective age are advisable.     

Predictors of life satisfaction: perceptions of older community-dwelling adults

The purpose of this study was to investigate variables that predict life satisfaction in elderly individuals. A convenience sample of 70 older community-dwelling adults participated in the study. Instruments used included the Life Satisfaction Index A Scale, three subscales from the Self-Evaluation of Life Function Scale, the Perceived Control Scale, Hollingshead's Two Factor Index of Social Position, and the Self-Rated Health Subscale of the Philadelphia Geriatric Center Multilevel Assessment Instrument. When the influence of health and social position was held constant, social interaction was the only additional significant predictor of life satisfaction. When health and social position were not held constant, social interaction, perceived control, and social position were significant predictors of life satisfaction. The findings indicate that nursing practice, education, and research should focus on assessment and interventions relative to promoting and maintaining health, perceived control, and social interaction among elderly individuals living in the community.     

Perceptions of living alone among older adult women

This exploratory study examines older women's perceptions of living alone. Older adult women (N = 53) living alone were interviewed. Findings show tremendous variability in the perceptions of this sample. Whereas some women showed significant levels of loneliness and depression, many did not. Thirteen percent of the participants (n = 7) negatively perceived living alone, 49.1% (n = 26) neutrally perceived living alone, and 37.7% (n = 20) positively perceived living alone. Participants' most enjoyed aspects of living alone were being one's own boss/being independent (51%) and keeping one's own schedule (49%). Common responses for least enjoyable aspects of living alone were lack of companionship (62%), no one to help with housework (36%), and fear of falling or getting hurt (30%). Nurses should be aware that although some have perceived older adult women living alone as a vulnerable population, one cannot make assumptions based on living arrangements.     

Social support as a predictor of health status among older adults living alone in Japan

The purpose of this study was to determine social support as a predictor of health status among older adults living alone, based on a 2-year longitudinal study in a rural area of Japan. The self-reported questionnaires were distributed to 624 older adults living alone and were collected during home visits by welfare commissioners as baseline survey. After the follow-up survey of 493 respondents as the baseline survey, we analyzed 340 persons who lived alone over the last 2 years. Women had significantly higher emotional and instrumental support scores than men. Receiving positive support from the neighborhood had a significant effect on retaining activities of daily living for older women living alone. Our results suggest that receiving social support from the neighborhood brought an improvement in the health status of older adults, particularly women living alone.     

Self-care activities captured through discussion among community-dwelling older adults.

Four separate focus group sessions were conducted in the Detroit metropolitan area to invite vital elders to speak freely about their health, health problems, health practices, and how they maintain their bio-psycho-social and spiritual well-being. Twenty-eight participants were interviewed. The majority were African American, female, widowed, Protestant, and had achieved a high school or greater educational level. Field notes and taped interviews were transcribed for data analysis. Together, two raters completed data reduction and coding for theme identification and categorization. A holistic nursing model was used to guide the content analysis. Five themes were revealed that described the context of well-being for community-dwelling elders: faith ways, positive energy, support systems, wellness activities, and affirmative self-appraisal. Well-being depended on an awareness of how lifestyle impacted the physical, psychological, social, and spiritual health of each individual. This study lends credence to interventions aimed at promoting holistic health care for community-dwelling elders.     

Factors associated with nutrition risk among community-dwelling older adults in Thailand

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94–25.11), low income (OR: 2.35, 95% CI = 1.15–4.78), living alone (OR: 2.02, 95% CI = 0.20–0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30–15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23–11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14–5.48), poor physical performance (OR: 1.49, 95% CI = 1.70–3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21–4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.     

活动能力测试对社区老年人跌倒风险的预测价值

目的 研究一个预测模型,用于社区居家老年人跌倒筛查,并量化活动能力与跌倒的关系.方法 随机选取北京四个社区65岁以上老年人144例,根据过去1年是否跌倒分为跌倒组和非跌倒组,其中跌倒组50例,非跌倒组94例.对两组受试者进行功能性步态测试(FGA)、Berg平衡量表(BBS)评定、功能性伸展测试(FRT)、感觉整合和平衡的临床改良测试(CISIB)、单腿站立(OLS)、记时起立行走实验(TUGT)、10米步行时间,功能性伸展实验.跌倒组和非跌倒组之间各项测试的差异进行分析,除了睁眼、闭眼平地站立和睁眼抬头平地站立外,其余均具有统计学差异,并对其进行logistic回归分析.结果 2组受试者除睁眼平地站立、闭眼平地站立和睁眼抬头平地站立外,其余各项测试组间比较,差异均有统计学意义(P＜0.05).Logistic模型结果显示,FGA总分和mCISIB中的睁眼站立海绵垫上对跌倒的预测最有意义,其中敏度性为80％,特异度为74.2％.FGA和睁眼站立海绵垫上的敏感度和特异度分别为76％,74.2％和56％,81.6％.模型的受试者工作特征曲线(ROC曲线)下面积为0.845.结论 该模型可用于社区居家健康老年人跌倒的筛查,预测社区老年人跌倒的敏感性优于FGA和睁眼站立海绵垫上,特异性与FGA相似.量化社区居家老年人活动能力与跌倒的关系,为跌倒预防提供数据.     

Predictors of depressive symptoms in older adults living in care homes in Thailand

BACKGROUND

Thai culture traditionally abhors elders living in care homes due to the belief that this represents a dereliction of filial piety by their children, thus care homes are stigmatized as the domain of poor older adults with no family. This may impact negatively on psychological wellbeing of residents, although little is known about the key factors influencing depressive symptoms. Therefore, this study explores factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among older adults residing in care homes in Thailand.

An occupational therapy perspective on falls prevention among community-dwelling older adults

BACKGROUND: Prevention of falls among community-dwelling older adults is an important area of research because of the serious consequences that can result from falls for this population. The risk factors associated with falls tend to be categorized into two groups: intrinsic, or personal factors, such as fear of falling, age, gender, and extrinsic, or environmental factors, such as lighting or slippery surfaces. METHOD: The current falls prevention literature was reviewed using an occupational therapy perspective. RESULT: It revealed that there are only a few brief examples of the relationship between occupation and falls in the literature. The profession of occupational therapy appears to be underrepresented in the current falls prevention literature. The review highlights the important contributions that occupational therapists could make to this functional problem. PRACTICE AND RESEARCH IMPLICATIONS: For occupational therapy, important areas for consideration when attempting to prevent falls among older adults living in the community include using a client-centred approach, compliance, and follow up on recommendations. There is a need for more occupational therapy research specifically on occupation and falls, that explores their relationship and influence upon one another.     

Sleep quality,depression and frailty among Chinese community-dwelling older adults

We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.     

Nurses' perceptions of gross self-neglect amongst older people living in the community

Self-neglect in older people has an established medical literature but receives surprisingly little attention in the nursing literature. Hospital and community nurses were interviewed using a semistructured questionnaire. All the nurses were able to identify patients who had shown features of 'gross self-neglect'. Poor nutrition was a prominent feature: links with the literature are explored.     

Predictors of self-reported health among older African-American central city adults

Relationships between holistic factors and self-reports of health were examined. Ninety-two African-American older adults were sampled. Comorbid health conditions, higher pain intensity ratings, and more depressive symptoms were significantly related to lower self-rated health scores while age, marital status, education, and spiritual factors were not significantly related.     

Systematic review of occupational engagement and health outcomes among community-dwelling older adults

We conducted this systematic review, one of four related to productive aging, to explore the existing evidence for the health benefits of engagement in occupations and activities among older adults. The review incorporates the breadth of areas of occupation in which older adults engage and the range of health benefits derived from that engagement. The results of this review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities. Additionally, the results of this systematic review support occupational therapy's historical ideologies and core philosophies linking occupational engagement to improved health and well-being. The findings suggest an increasing role for occupational therapy service delivery in community-based health promotion and prevention efforts to meet the everyday activity and health needs of the growing older adult population.     

Predictive value of intrinsic capacity on adverse outcomes among community-dwelling older adults

ObjectiveTo examine the predictive value of intrinsic capacity on one-year incident adverse outcomes among community-dwelling older adults.MethodsA total of 756 community-dwelling older adults aged ≥ 60 years were followed up after 1 year. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. Adverse outcomes included incident disability, recurrent falls, hospitalization, emergency department visits, and poor quality of life. Multivariate logistic regression models were performed to evaluate the predictive value of intrinsic capacity domains on adverse outcomes.ResultsCognitive decline, limited mobility, visual impairment and depressive symptoms predicted incident disability. Visual impairment predicted recurrent falls. Cognitive decline and limited mobility predicted emergency department visits. Limited mobility predicted poor quality of life.DiscussionIntrinsic capacity could predict incident adverse outcomes among community-dwelling older adults. Assessing intrinsic capacity would facilitate early identification of older adults at high risk of adverse outcomes and prompt targeted interventions.