Impact of Mixed Cognitive Intervention Training on Early Onset Dementia

ObjectivesThe aim of this study was to investigate the impact of mixed cognitive intervention training using spaced retrieval training, and errorless learning in participants with early onset dementia. This was based on reality orientation therapy for cognitive function, depression, and occupational performance of patients.MethodsTwo early onset vascular dementia patients (> 65 years) with mild or moderate impairment were enrolled in a pre-test - post-test single-subject research design study. Prior to the study, the caregivers were interviewed about meaningful times, people, places, and areas of interest for the participant. A list of individual training words were selected based upon this information, and the participant was instructed to recall them after a 45-second, 90-second, 6-minute, and 12-minute delay. Baseline (3 sessions), intervention (20 sessions), and a second baseline period (3 sessions) were conducted. Activities of daily living were measured, and cognition was measured using the Consortium to Establish a Registry of Alzheimer’s Disease Korean version, whilst depression was measured using the Korean Form Geriatric Depression Scale, and task performance and satisfaction measured by the Canadian Occupational Performance Measure.ResultsAfter intervention, both participants showed improvements in activities of daily living (ADL), word list memory/recognition, trail making A, occupational performance, and satisfaction improvement, which was clinically significant in 1 participant who also had a reduced score in the scale of depression classifying him as not depressed.ConclusionSpaced retrieval training and errorless learning based on reality orientation therapy is an effective intervention in patients with early onset dementia and mild or moderate impairment.     

Occupation-focused interventions for well older people: An exploratory randomized controlled trial

Abstract

Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions. Methods: One hundred and seventy seven persons, 77–82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen’s d, were calculated. Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small. Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.     

A client-centred ADL intervention: three-month follow-up of a randomized controlled trial

Abstract

Objective: The aim was to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usual ADL intervention (UADL) in people with stroke regarding: independence in ADL, perceived participation, life satisfaction, use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, life satisfaction, and informal care. Methods: In this multicentre study, 16 rehabilitation units were randomly assigned to deliver CADL or UADL. The occupational therapists who provided the CADL were specifically trained. Eligible for inclusion were people with stroke treated in a stroke unit ≤3 months after stroke, dependent in ≥two ADL, not diagnosed with dementia, and able to understand instructions. Data were collected at inclusion and three months thereafter. To detect a significant difference between the groups in the Stroke Impact Scale (SIS) domain “participation”, 280 participants were required. Intention-to-treat analysis was applied. Results: At three months, there was no difference in the outcomes between the CADL group (n = 129) and the UADL group (n = 151), or their significant others (n = 87/n = 93) except in the SIS domain “emotion” in favour of CADL (p = 0.04). Conclusion: The CADL does not appear to bring about short-term differences in outcomes and longer follow-ups are required.     

Associations of perceived stigma,perceived environmental inaccessibility,and self-compassion among people with physical disability in Hong Kong

BackgroundPeople with physical disability are chronically stigmatized. They might internalize ableist attitudes and behaviors that they perceive from others, which can negatively affect social participation and well-being. It is essential to explore potential risk and protective factors associated with stigma perceptions.ObjectiveThe present study proposed and tested the positive associations of perceived environmental inaccessibility and self-coldness with perceived stigma, and the negative associations of self-warmth with perceived stigma, respectively, among people with physical disability in Hong Kong.MethodsA cross-sectional sample of 98 adults with physical disability (42.3% female, mean age = 36.4 years) from 10 nongovernmental organizations in Hong Kong participated in the study. They filled in a self-report questionnaire on perceived stigma, perceived environmental inaccessibility, self-compassion, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and demographics.Main resultsHierarchical multiple regression showed that ADL and IADL alone (Model 1) did not significantly predict perceived stigma. The full model of ADL, IADL, perceived environmental inaccessibility, self-warmth, and self-coldness to predict perceived stigma (Model 2) was significant and explained 53.9% variance in perceived stigma. Perceived environmental inaccessibility and self-coldness were significantly and positively associated with perceived stigma, respectively. Self-warmth was significantly and negatively associated with perceived stigma.ConclusionsThe findings supported the important associations of both external contexts (i.e., as environmental inaccessibility) and internal resources (i.e., as self-compassion) with perceived stigma among people with physical disability. The findings inform future research and three-pronged design approaches to stigma reduction programs for people with physical disability.     

The Occupation-Based Intervention of Bathing: Cases in Home Health Care

Abstract

Although bathing skills can be an indicator of long term placement, documentation of occupational therapists doing bathing as an occupation-based intervention is limited. Five clients were referred to a hospital-based home health agency with various diagnoses and at different levels of functioning. Each client was assessed at admission and discharge using the Outcomes and Assessment Information Set and the occupational therapists used the Activities of daily living (ADL) of bathing as the intervention based on client centered expressed needs. Findings reveal a statistically significant change in individuals pre- and post-assessment of bathing (Z?=?–2.032, p?=?.042) supporting occupation-based interventions, specifically bathing, should be further researched as a means of significantly improving the functional status of clients.     

Towards an ADL Taxonomy for Occupational Therapists

One of the main concepts in occupational therapy is human occupation. In occupational therapy there is a need for a common conceptual framework to assess and describe the ability of patients to perform occupational activities of daily living. The aim of this report was to develop a taxonomy concerning the activities of daily living (ADL). In the taxonomy, occupation has been defined and related to common concepts of disability. Ordinary ADL terms have been categorized into three levels: occupational forms, activities and actions. Different actions are components of and subordinated to superior activities. Experience shows that the ADL taxonomy contributes to a valid (content and construct) assessment of ADL, a common language for OTs and to a clearer picture of the patient's performance in daily life activities. Key words: ADL, conceptual framework, assessment.     

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

ObjectivesImpairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States.DesignLongitudinal panel.SettingDetailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone.ParticipantsA nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years.MeasuresAbility to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability.ResultsThe presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map.Conclusions/ImplicationsOur findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.     

Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities

Aim:  The purpose of this study was to evaluate the effects of an occupational therapy intervention program on activities of daily living (ADL) ability and awareness of disability.
Methods:  Six persons with intellectual disabilities participated in the study, which was based on a single-case design. Assessment of Motor and Process Skills and Assessment of Awareness of Disability were used as evaluation tools.
Results:  Activities of daily living performance improved in five of the six participants after implementation of the program, with improvement across both motor and process skills. However, no clear improvement in awareness of disability was found following implementation of the program.
Conclusion:  It may be concluded from this study that persons with intellectual disabilities can benefit from occupational therapy interventions to improve ADL ability, even in the absence of any change in their awareness of disability.     

The Effectiveness of a Health Promotion Program for the Low-Income Elderly in Taipei,Taiwan

This study assessed the effectiveness of a health promotion program for low-income elderly provided by trained low-income home health aides. Indicators of the effectiveness of this program included improvement in physical health, psychosocial health and functional status, including activities of daily living (ADL) and instrumental activities of daily living (IADL) as well as changes in perceived health promotion needs. This evaluation study used a single group pre- and post-test experiment design. After informed consent forms were signed by participants, 89 purposively selected low-income elderly (aged 64–96) completed pre-test structured surveys, while 60 participants (aged 68–96) completed post-test surveys. Post-test scores indicated improved nutritional status (paired t = 2.64, p < .05) and chore management of IADL abilities (paired t = 2.83, p < .01). No significant difference in psychosocial status were found between pre- and post-test scores. Perceived needs for health promotion services decreased after the intervention. The results show that the health promotion services were effective in improving health status and decreasing perceived needs for services among low-income elderly in Taipei. Recommendations based on this study for developing services for the low-income elderly must take health promotion intervention into consideration.     

Practice,Knowledge and Needs of Occupational Therapy Practitioners Providing Services to Parents with Physical Impairments: A Pilot Study

Abstract

This survey study describes practice patterns, knowledge, skills, resources, and needs of occupational therapy practitioners providing services to parents with physical impairments. Participants (n?=?51) primarily worked in outpatient rehabilitation (30%), inpatient rehabilitation (21%), and acute care (15%) settings. Participants reported evaluating and providing interventions for nine role-focused parenting activities. All participants agreed addressing the instrumental activities of daily living (IADL) of parenting should be part of occupational therapy practice. Adaptive equipment and techniques were utilized to increase participation of parents with physical impairments in child rearing. Lack of resources for childcare equipment and need for more training were barriers. Ninety-eight percent of participants agreed advancing the role of occupational therapy for parents with physical impairments is needed.     

Disability Associated With Obesity,Dynapenia and Dynapenic-Obesity in Chinese Older Adults

ObjectivesWhether the combination of obesity and low muscle strength (dynapenic-obesity) would cause greater impairment of the activities of daily living (ADL)/instrumental activities of daily living (IADL) than obesity alone and low muscle strength alone (dynapenia) remains unclear. The aim of this study was to reveal the possible independent and additive effects of dynapenia and obesity on ADL/IADL disability in an older Chinese population.MethodsA cross-sectional study, including 616 community-dwelling older adults, was conducted in China from 2010 to 2012. Based on the World Health Organization Asian Criteria of Obesity and handgrip strength tertiles, 4 independent groups were identified as follows: nondynapenia/nonobesity, dynapenia alone, obesity alone, and dynapenic-obesity. The Katz Index of Independence in ADL was used to assess ADL disability, whereas 6 IADL items of the Older Americans Resources and Services (OARS) multidimensional functional assessment questionnaire were used to assess IADL disability.ResultsThe prevalence of ADL and IADL disability was 21.1% and 28.9% in the dynapenic-obesity group, 15.5% and 22.6% in the dynapenia alone group, 13.1% and 19.6% in the obesity alone group, and 11.9% and 12.9% in the nondynapenia/nonobesity group, respectively. After adjusting for the covariates, in comparison with the dynapenic-obesity group, the adjusted odds ratios (95% confidence interval) for ADL disability were 0.36 (0.13–0.73) in the nondynapenia/nonobesity group, 0.51 (0.20–0.78) in the dynapenia-alone group, and 0.40 (0.11–0.61) in the obesity-alone group. The corresponding data for IADL disability were 0.55 (0.20–0.93), 0.82 (0.39–0.98), and 0.61 (0.30–0.91), respectively.ConclusionDynapenia, obesity, and dynapenic-obesity were associated with an increased risk of ADL/IADL disability. Dynapenic-obesity was associated with a greater risk of ADL/IADL disability in comparison with dynapenia or obesity alone.     

Relationships between occupational engagement and status of and satisfaction with sociodemographic factors in a group of people with schizophrenia

Abstract

The present study is part of a larger project investigating occupational engagement and health in a group of people with schizophrenia. This study was aimed at extending this knowledge base with regard to occupational engagement and sociodemographic factors. Seventy-four outpatients participated in the study. The Profile of Occupational Engagement in People with Schizophrenia, the Lancashire Quality of Life Profile scale and a standardized questionnaire were used to gather data. Contrary to what was expected, occupational engagement was not associated with a certain type of schizophrenia, being younger or older, or gender. The results showed that a high level of occupational engagement was related to greater satisfaction with the participants' social and living situation, having a reliable alliance and a close friend, school-leaving age, living in a flat, and working or studying. Satisfaction with living independently, having had a recent experience of accomplishment, and working together explained 55% of the variance in occupational engagement. Occupational therapists should thus focus on and promote social engagement appropriate to the client's level of engagement, the client's opportunity and ability to work, his/her experience of accomplishment, and, most importantly, satisfaction with the home and living situation.     

Disparities in self-reported activities of daily living and instrumental activities of daily living disability among Asian American subgroups in the United States: results from the National Health Interview Survey 2001-2003

BackgroundThe purpose of this study was to compare disability and functional limitations among elderly Asian American subgroups using datasets from the National Health Interview Survey 2001−2003.MethodsThis retrospective cross-sectional study analyzed whether activities of daily living (ADL) and instrumental ADL (IADL) disabilities were different among Asian American subgroups in the United States using data retrieved from the 2001−2003 National Health Interview Survey. For comparing all Asian American subgroups, χ² analysis was applied for the bivariate comparisons.ResultsRates of 7.1% and 12.2% for ADL and IADL disability, respectively, within Asian American group were found. The elder Chinese subgroup accounted for the highest ADL and IADL disability (11.6% and 17.3%, respectively, p < .05). Being female, not married, and older was associated with higher ADL and IADL disability (p < .05).ConclusionsThe findings of the study highlight the intergroup variability among the elder Asian American subpopulations.     

Influence of cognition and symptoms of schizophrenia on IADL performance

Abstract

People with schizophrenia experience difficulties with instrumental activities of daily living (IADL), which are required for independent living. Yet, factors that influence IADL performance are still poorly understood. Identification of such factors will contribute to the rehabilitation process and recovery. The present study aimed to examine the influence of cognitive abilities, schizophrenia symptoms, and demographic variables on IADL functioning during acute hospital admission. The participants were 81 adults with DSM-IV chronic schizophrenia. They were assessed on the Revised Observed Tasks of Daily Living (OTDL-R), the Positive and Negative Syndrome Scale (PANSS), the Neurobehavioral Cognitive Status Examination (Cognistat), and the Kitchen Task Assessment (KTA) at acute hospitalization. The prediction model of IADL performance at this time consists of executive functioning (explained 21% of variance), memory and abstract thinking (explained 13.5%), negative symptoms (explained 13%), age of illness onset and years of education (explained 8%). The total explained variance is 53.5%. These results provide evidence-based guidelines for the evaluation process in inpatient settings. Such guidelines are important since planning of intervention processes and appropriate community integration programs often occurs during acute hospitalization, while the structured nature of inpatient settings limits natural variability in occupational performance.     

我国老年人临终前的失能发展轨迹固定队列研究

目的 探索我国老年人临终前的失能发展轨迹。方法 利用2002-2018年中国老年人健康长寿影响因素调查中的日常生活活动能力（ADL）数据拟合纵向项目反应理论（LIRT）模型,通过其中的难度阈值参数分析我国老年人ADL失能顺序;进而拟合混合效应模型分析老年人临终前失能水平的变化轨迹。结果 共纳入2002年进入队列的5 817名老年人,其中男性占41.81%,基线年龄为（86.80±12.40）岁,随访时间M（Q₁,Q₃）为4（3,8）年。LIRT分析结果显示,基本日常生活活动能力（BADL）中难度阈值参数最低的是洗澡部分受限（0.41±0.05）、最高的是室内移动完全受限（6.19±0.16）;而工具性日常生活活动能力（IADL）中难度阈值参数最低的是乘坐公共交通工具部分受限（-3.01±0.07）,最高的是探访邻居完全受限（1.51±0.07）。失能发展轨迹中,临终前男性较女性平均失能水平更低（P<0.001）,独居老人较非独居老人失能水平更低（P<0.001）;文盲老人失能水平高于非文盲老人（P<0.001）。失能水平随时间的线性变化率与二次项系数的估计值分别为0.231（P<0.001）与0.002（P<0.001）。结论 我国老年人失能过程存在一定的规律性,IADL失能早于BADL,失能项目中下肢为主的项目比上肢为主的项目易失能,复杂项目比简单项目易失能。失能轨迹的增速会随时间加快,对失能人群的干预重点应放在女性、非独居、文盲老年人上。     

Ethical Dilemmas Encountered by Community-based Occupational Therapists in Home Care Settings

This study of occupational therapists practising in the field of gerontology was conducted to determine the subjects' conception of Instrumental Activities of Daily Living (IADL). and current practice in relation to assessment and treatment of their clients. A survey method was used to obtain data from 135 practising occupational therapists. The results showed that many of the subjects were unfamiliar with the term “instrumental activities of daily living.” In addition, the study showed that occupational therapists actually did spend a considerable portion of their practice time in the area of IADL, reporting that the most common tasks for intervention were meal preparation, light housework, transportation, shopping and use of the telephone. When reporting on methods and accuracy of assessment procedures, subjects agreed that “observation of performance” and standardized assessment tools were the most accurate forms of assessment. With the rapidly ageing population, and government policy for keeping people in their own homes for as long as possible. IADL is set to become a significant part of occupational therapy (OT) evaluation and intervention.     

Physical ill health, disability, dependence and depression: results from the 2007 national survey of psychiatric morbidity among adults in England

BackgroundThe relationship between physical ill health, disability, and depression is not straightforward. Both cross-sectional and longitudinal studies have clearly shown that medical illness and physical disability are strongly associated with depression.ObjectiveTo test the hypothesis that disability is associated with an increased prevalence of depression irrespective of physical health problems and that this is proportionate to the severity of disability (measured in terms of the number of difficulties in daily activities and the degree of dependence on others).MethodsUsing a random probability sample design, 7460 respondents were interviewed for the third national survey of psychiatric morbidity of adults in the private household population in England. Fieldwork was carried out throughout 2007. The prevalence of depression was established by the administration of the revised Clinical Interview Schedule (CIS-R), while disability was measured by reported difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsDisability was associated with depression even after adjustment for physical ill health. The number of ADL/IADL difficulties was directly related to the likelihood of respondents having depression. Dependence on others was not associated with depression once severity of disability had been accounted for.ConclusionAll ADL/IADL limitations are significantly associated with depression and there seems to be a cumulative effect irrespective of whether the limitation is in personal care or in instrumental activities such as mobility problems.