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.     

Effect of occupation- and activity-based interventions on instrumental activities of daily living performance among community-dwelling older adults: a systematic review

This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults' performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.     

The relationship of cognitive skills performance to activities of daily living in stroke patients

This article reports on two studies that examine the relationship between measurements of activities of daily living (ADL) and cognitive skills performance. Study 1 is a post hoc analysis of ADL improvement scores collected on acute stroke patients who were either given or not given cognitive skills remediation. An examination of individual ADL scores showed significantly higher personal hygiene, bathing, and toilet activity improvement scores for patients receiving cognitive skills remediation. In Study 2, cognitive skills and ADL pre- and posttest scores for stroke patients were measured by occupational therapists, who also implemented an ADL as well as a cognitive skills remediation program as part of the patient's therapy. Some significant positive correlations between initial cognitive skills measurements and ADL outcome were found. The best correlate of patients' ADL performance at discharge was performance on an auditory attention task. Verbal comprehension correlated with overall ADL improvement, and overall cognitive skills improvement correlated with overall ADL improvement. Implications of these two studies are discussed.     

Participation in daily activities and social roles of older adults with visual impairment

Purpose. (1) to document participation in daily activities and social roles of older adults seeking services for visual impairment (VI) and compare it with that of the older population without VI or other disabilities, and (2) to explore correlates of their participation.

Methods. The 64 participants (46 women) had an average age of 79.3 years (SD = 5.9 years) and presented various types of VI. Participants were interviewed at home to collect information regarding their visual function (National Eye Institute Visual Function Questionnaire-25), sociodemographic and clinical characteristics, including depressive symptoms (Geriatric Depression Scale), and participation (Assessment of Life Habits/LIFE-H). Each participant was matched with another person without disabilities randomly recruited from the community. Results for the two populations on the Life-H participation domains were compared using t-tests. In the group with VI, general information (independent variables) was examined in relation to participation main scores (dependent variables), followed by multiple linear regression analyses.

Results. Participation in daily activities and social roles of participants with VI (mean ± SD (/9) = 6.8 ± 1.0 and 5.6 ± 1.6, respectively) was significantly lower than that of participants without VI (8.1 ± 0.4 and 8.3 ± 0.4) (p < 0.0001). Depressive symptoms and perceived quality of distance vision were the strongest correlates and together explained more than 65% of the variance in the participation scores of the subjects with VI.

Conclusions. This study demonstrates the participation restrictions associated with VI and underlines the importance of psychological aspects in participation.     

Correlation of perceptual performance and activities of daily living in stroke patients

Twenty-five male stroke patients were assessed with the use of a battery of perceptual tests (Gross Visual Skills [Baum, 1981]. Adult Visual-Perceptual Assessment [Baylor University Medical Center, Occupational Therapy Department, 1980], Manikin and Feature Profile subtests of the Arthur Point Scale of Performance Tests [Arthur, 1943; Buros, 1974, 1978], Judgment of Line Orientation [Benton, Varney, & DeS. Hamsber, 1978], Bender Visual Motor Gestalt Test [Bender, 1946], Haptic Visual Discrimination Test [McCarron & Dial, 1976, 1979a, 1979b], Block Design and Object Assembly subtests of the Wechsler Adult Intelligence Scale-Revised [Wechsler, 1981], and Test of Three-Dimensional Constructional Praxis [Benton, 1973a; Benton & Fogel, 1962]). Also administered was the Klein-Bell ADL Scale (Klein & Bell, 1982) to measure performance of activities of daily living. The research questions were as follows: (a) To what extent did this sample of stroke patients differ from the nomative samples on perceptual performance? (b) To what extent did any tests of perceptual performance correlate with performance of activities of daily living? and (c) What, if any, instruments were more useful in discriminating the perceptual performance of stroke patients from that of normative samples? The results indicated that stroke patients showed significant deficits in perceptual performance, some of which correlated with activities of daily living performance. Patients with right hemispheric lesions performed similarly to those with left hemispheric lesions except on the Haptic Visual Discrimination Test.     

Impact of depression and activities of daily living on the fear of falling in Korean community-dwelling elderly

This study determined the predictors of the fear of falling (FOF) in 213 South Korean community-dwelling elderly. The Fall Efficacy Scale, Pittsburgh Sleep Quality Index, Korean Geriatric Depression Screening Scale, and Barthel Index were used to measure the FOF, sleep quality, depression, and activities of daily living, respectively. In addition, information regarding the participants' demographic details and the number of types of medication was collected. The data were analyzed by using hierarchical regression. The general regression model, with the FOF as a dependent variable, was statistically significant. The FOF variance was partially explained. Depression and activities of daily living significantly influenced the FOF. Thus, the results indicate that the FOF in community-dwelling elderly Koreans is affected by depression and activities of daily living. Therefore, an older adult with recognized signs of depression must be provided with more appropriate care and the allocation of specific interventional strategies in order to maintain activities of daily living should be developed to manage the FOF.     

Multimorbidity,disability, and mortality in community-dwelling older adults

Objective

To describe factors associated with multimorbidity in community-dwelling older adults; to determine if a simple measure of multimorbidity predicts death over 5 years; and to assess if any effect of multimorbidity on mortality is independent of key covariates.

Design

Analysis of an existing population-based cohort study. Cox proportional hazards models were constructed for time to death.

Setting

Manitoba.

Participants

A total of 1751 community-dwelling adults aged 65 and older were interviewed and followed for 5 years.

Main outcome measures

Age, sex, marital status, living arrangement, education, Mini-Mental State Examination (MMSE) score, Center for Epidemiologic Studies Depression Scale score, and the Older Americans Resource and Services Multidimensional Functional Assessment Questionnaire score were recorded for each participant. Multimorbidity was defined based on a simple list of common health complaints and diseases, followed by an open-ended question about other problems. These were summed and the scores ranged from 0 to 16. Death and time of death were determined during the 5-year interval by death certificate, administrative data, or proxy report.

Results

Multimorbidity was more prevalent in women; older age groups; and those with lower educational levels, lower MMSE scores, more depressive symptoms, and higher levels of disability. Multimorbidity was a predictor of mortality in unadjusted models (hazard ratio 1.09, 95% CI 1.05 to 1.12). In models adjusting for age, sex, education, marital status, living arrangement, and Center for Epidemiologic Studies Depression Scale and MMSE scores, this effect persisted (hazard ratio 1.04, 95% CI 1.00 to 1.08). However, after adjusting for functional status, the effect of multimorbidity was no longer significant.

Conclusion

Multimorbidity predicts 5-year mortality but the effect might be mediated by disability.     

Gender-specific associations between activities of daily living disability and depressive symptoms among older adults in China: Evidence from the China Health and Retirement Longitudinal Study

PurposeTo evaluate the associations between BADL/IADL disability and depressive symptoms from the perspective of gender among older adults in China.MethodsThis cross-sectional study used the data from the second wave of the China Health and Retirement Longitudinal Study (CHARLS). The sample included 3463 older adults aged 60 years and older across China. Multivariable logistic regression models were conducted.ResultsAmong 3463 older adults, 1240 (35.8%) were classified as depressed, the prevalence of BADL and IADL disabilities were 756 (21.8%) and 1194 (34.5%), respectively. After controlling for covariates, BADL/IADL disability was significantly associated with an increased risk of depression prevalence both in men and women among older adults. Compared with IADL independent, IADL disability was about two times more likely to develop depressive symptoms in men (OR = 2.165, 95% CI = 1.661–2.822), which was much higher than that in women (OR = 1.748, 95% CI = 1.415–2.160). In contrast, the odds of being depressed for women with BADL disability (OR = 1.824, 95% CI = 1.447–2.299) were much higher than the odds for men with BADL disability (OR = 1.791, 95% CI = 1.348–2.379).ConclusionsOlder adults with BADL/IADL disability were more likely to have depressive symptoms both for men and women. However, the associations between depressive symptoms and BADL/IADL disability were different in gender. Our results suggest that differential institutional care service and appropriate strategies for improvement in mental health are required.     

Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability follow-back surveys.

BACKGROUND: Accurate assessments of need for disability assistance are essential for effective planning of disability support services, but there is little national data on type and acuity of need. OBJECTIVE: To more fully delineate the type and magnitude of disability assistance needs across the US population, focusing on factors associated with perceived gaps in assistance. RESEARCH DESIGN: Secondary analysis of national household survey. SUBJECTS: Twenty-five thousand eight hundred five adults identified as disabled in the 1994 and 1995 National Health Interview Surveys. MEASURES: Self-reported assistance deficits with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS : An estimated 3.2 million adults with disabilities have at least one assistance deficit, usually involving IADLs like housework. However, approximately 970 thousand adults report one or more assistance deficits with basic ADLs. Compared to adults with met ADL needs, people with ADL assistance deficits are more likely to live alone, to be in poor health, to be a member of a racial or ethnic minority, and to need help with multiple activities. DISCUSSION: These analyses suggest a relatively high rate of unmet and undermet need for disability assistance in the general population. However, only a small number of these adults report assistance deficits with basic ADLs. This group is a logical target for expanded state or federal personal assistance services programming.     

Indoor gardening older adults: effects on socialization, activities of daily living, and loneliness

This study examined the effects of indoor gardening on socialization, activities of daily living (ADLs), and perceptions of loneliness in elderly nursing home residents. A total of 66 residents from two nursing homes participated in this two-phase study. In phase one, experimental group 1 participated once a week for 5 weeks in gardening activities while a control group received a 20-minute visit. While no significant differences were found between groups in socialization or perceptions of loneliness, there were significant pretest-posttest differences within groups on loneliness and guidance, reassurance of worth, social integration, and reliable alliance. The results also demonstrated gardening interventions had a significant effect on three ADLs (transfer, eating, and toileting). Phase two examined differences in the effects of a 5-week versus a 2-week intervention program. Although no significant within-group differences were noted in socialization, loneliness, or ADLs, the 5-week program was more effective in increasing socialization and physical functioning.     

Pain management among older people in need of help with activities of daily living

The aim of this study was to investigate the use of various pain relief methods among older people in chronic pain and in need of help to manage activities of daily living. People who reported pain and were in need of help to manage activities of daily living were included in the study. The Multidimensional Pain Inventory-Swedish version and a modified version of the Pain Management Inventory were used to study pain and methods of pain relief. The respondents used a variety of methods (median = 3) to relieve their pain; pharmacologic methods, rest, and distraction were the predominant strategies employed. A cluster analysis identified 2 main groups of people: people who used a few well-known methods and were significantly older and people who used a larger repertoire of methods to relieve their pain and reported higher pain severity and interference with daily life. About a third of older people reported inadequate pain relief. These findings stress the need for nurses to inform older people about available methods for pain relief and to do systematic pain assessments to evaluate the effectiveness of various pain relief methods.     

Chronic pain states: their relationship to impairment and disability.

Chronic pain patients (101) were assigned ratings of impairment and disability and were assessed for organic pathology and pain behavior through comprehensive testing procedures. As predicted, higher ratings of impairment and disability were significantly associated with higher levels of both physical pathology and pain behaviors. These results indicate that conditioning and pathologic processes significantly influence impairment and disability ratings. Many patients showed higher disability than impairment ratings, which suggests the possibility of gainful employment in less demanding jobs. However, the current disability system rewards sickness and dysfunction and discourages patients from resuming work.     

Exercise interventions for improving physical function,daily living activities and quality of life in community-dwelling frail older adults: A systematic review and meta-analysis of randomized controlled trials

This review reports the most current evidence on the effects of exercise interventions on improving physical function, daily living activities and quality of life in community-dwelling frail older adults. CBMdisc, CNKI, Wanfang, VIP, MEDLINE, Cochrane Central Register of Controlled Trials (Central), Pubmed, Embase, Web of Science and EBSCO were searched from inception to July 2019. Exercise interventions were found to improve knee extension strength and normal speed and were beneficial in lower Time up and go test (TUG) and improving semi-tandem, Berg balance scale (BBS), Short Physical Performance Battery (SPPB), Physical Performance Test (PPT) and Activities of daily living (ADL). Further well-designed studies are needed to explore the most effective intervention type and dose.     

Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers

Tirodkar MA, Song J, Chang RW, Dunlop DD, Chang HJ. Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers.

Objective

To compare incident disability patterns across racial and ethnic groups.

Design

Prospective cohort study with 6-year follow-up (1998-2004).

Setting

National probability sample.

Participants

A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline.

Interventions

Not applicable.

Main Outcome Measure

Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding).

Results

Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31% vs Hispanic-English [8.57%], black [7.54%], white [7.20%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth.

Conclusions

Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.