The hierarchical relationship between activities of daily living and instrumental activities of daily living

A three-level hierarchical scale including IADL (shopping and transportation) and ADL (bathing, dressing, transferring, and feeding) was tested and validated based on secondary analysis of three studies of elders in the community: a population-based sample, the Cleveland-GAO, and two service-based samples, the Alternative Health Services Project, a study of Medicaid-eligible elders in Georgia, and the Section 222 Homemaker-Day Care study, a sample of Medicare-eligible elders. Scalability analysis included evaluation of Kronbach's alpha, Guttman analysis, and analysis of the pairwise association of individual items using phi/phi max. Validation included discriminant validity and predictive validity. With respect to discriminant validity, the negative association between functional ability (as measured by the scale) and age was observed. With respect to predictive validity, the negative relationship between functional ability (as measured by the scale) and risk of decline to ADL, death, and hospitalization in a year was observed. A six-level scale similar in structure and detail to the Katz Index of ADL was examined with the three studies. This scale can be used to described a broader range of needs of elders in the community and will be particularly useful to health services planners, practitioners, and researchers.     

住院老年患者日常生活能力受损的相关因素分析

目的分析住院老年患者日常生活能力(ADL)受损相关因素,为老年人群提供合理的医疗照护服务。方法对2016年10月至2017年3月宜宾市第二人民医院老年医学科住院期间的100例老年患者进行老年综合评估,分析ADL受损与慢性疾病、居家照护、老年综合评估间的关系。应用SPSS 22.0软件进行统计学分析。根据数据类型,单因素相关分析连续变量采用Spearman相关分析,二分类变量采用χ2检验,多因素相关分析采用logistic回归法。结果纳入的100例老年患者中,ADL受损共37人,ADL(5.22±1.36)分。ADL受损单因素相关分析显示ADL与年龄、握力、微型营养评定法简版(MNA-SF)、简易精神状态量表(MMSE)、跌倒病史相关(P0.05),多因素相关分析显示ADL与年龄、居家陪护、握力、跌倒病史相关(P0.05);ADL受损程度与性别、MMSE独立相关(P0.05),与其他各组分不能明确有无相关关系。结论针对ADL受损的老人,可以通过锻炼握力、预防跌倒、加强营养、预防痴呆等预防功能状态的下降。     

痴呆患者日常生活能力下降模式的研究

目的 了解痴呆患者日常生活能力(ADL)下降的情况和模式. 方法 收集痴呆患者204例,其中阿尔茨海默病(AD)106例,血管性痴呆(VD) 54例,其他类型痴呆44例;根据简易智能状态检查表(M MSE),轻、中、重度痴呆患者分别为42例、37例、125例.采用Barthel指数(BI)对患者ADL进行测评,比较不同认知程度、AD和VD痴呆及不同文化程度痴呆患者的日常生活能力.结果 痴呆患者ADL保留最多项目的是大便(48.5％)、小便(44.1％)和梳洗(40.2％)三项,能力保留最少的项目是上楼梯(25.5％)和洗澡(18.1％);随着认知损害的加重,痴呆患者的BI得分也是明显下降,其中重度(23.2±29.3)分、中度(65.5±26.4)分、轻度痴呆(87.4±22.7)分,其差异有统计学意义(x2=99.686,P=0.000);AD与VD比较,日常活动能力保留率(16.98％～53.77％)明显高于VD患者(1.85％～33.33％);不同文化程度痴呆患者BI得分小学及以下(40.1±39.0)分、中学组(45.3±39.6)分、大专及以上组(53.1±37.7)分,其差异无统计学意义(x2=3.653,P=0.161). 结论 中国痴呆患者最易丧失的日常生活功能是洗澡、上楼梯,最易保留的是大便、小便和梳洗.日常生活能力受痴呆程度和类型影响,但与文化程度无明显相关性.     

The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese

In order to assess the prevalence of the functional disability defined by activity of daily living (ADL) and instrumental activity of daily living (IADL) and associated factors in elderly Chinese, a population-based cross-sectional study was performed in urban, plain rural and mountain rural regions of Beijing. Of the 3440 subjects, 1707 are males and 1733 are females, with mean age of 71.4+/-7.7 years. Demographic, socio-economic and health aspects were obtained by trained interviewers. The results showed functional disability prevalence was 6.5% on ADL and 7.9% on IADL. Among the three representative areas in Beijing, the plain rural had the highest disability rate, increasing with the progression of age. Bathing and doing heavy housework were the two most difficult functional tasks. The functional disabilities were associated with gender and marital status. Our data suggest that plain rural elderly are most likely to generate functional disability, and bathing and doing heavy housework are two promising predictors to monitor the development of functional disability in the elderly.     

Exercise training improves activities of daily living in elderly patients with congestive heart failure

Exercise training which is one of the multidisciplinary interventions for elderly patients with congestive heart failure, plays an important role for improving the quality of life and reducing the re-admission rate of these patients. We assessed the validity of exercise training for the improvement of patient's skeletal muscle functions and activities of daily living along with monitoring cardiac functions. Exercise training programs were performed in 12 patients with congestive heart failure (New York Heart Association class III or IV), including 5 with valvular disease, 4 with dilated cardiomyopathy and 3 with ischemic cardiomyopathy (mean 79 +/- 9 years). All patients were admitted because of exacerbation of congestive heart failure and were treated conventionally. The exercise training program was started after stabilization of their cardiac condition. The medication was not changed during the training period. After exercise training programs, the cardio-thoracic ratio decreased from 63.8 +/- 7.9% to 60.1 +/- 6.9% (p < 0.01), ejection fraction on echocardiography increased from 47.4 +/- 18.2% to 56.0 +/- 17.5% (p < 0.01), and brain natriuretic peptide decreased from 404.8 +/- 267.5 pg/ml to 313.6 +/- 239.5 pg/ml (p < 0.05). The quadriceps muscle power increased from 0.77 +/- 0.36 Nm/kg to 0.97 +/- 0.41 Nm/kg (p < 0.01). The maximum walking distance on flat surface increased from 149 +/- 164 m to 456 +/- 394 m (p < 0.05). In most patients, the activities of daily living, especially mobility, improved. Appropriate exercise training for the elderly patients with congestive heart failure improves activities of daily living and also reduces the amount of required care by the patients.     

Galantamine maintains ability to perform activities of daily living in patients with Alzheimer's disease

OBJECTIVES: To examine the effect of galantamine on activities of daily living (ADLs) with respect to baseline dementia severity, correlation with cognitive and global function, specific ADLs affected, and maintenance of ADL independence. DESIGN: Secondary analysis of a 5-month randomized, placebo-controlled trial. SETTING: Multiple U.S. clinical centers. PARTICIPANTS: Six hundred fifty-nine patients with mild to moderate Alzheimer's disease (AD) who completed 5 months of treatment. INTERVENTION: Galantamine at a maintenance dose of 16 or 24 mg/d. MEASUREMENTS: The AD Cooperative Study ADL Inventory (ADCS/ADL). RESULTS: Galantamine resulted in more improvement in ADCS/ADL scores than placebo regardless of baseline dementia severity, with the greatest differences occurring in patients with more severe disease. Changes in ADCS/ADL scores correlated significantly with change scores on the cognitive subscale of the AD Assessment Scale (r=-0.24). Galantamine treatment resulted in maintenance or improvement of basic and instrumental ADLs, and change from baseline to Month 5 in scores for each individual ADL item favored galantamine over placebo in three of six basic ADLs and six of 17 instrumental ADLs. CONCLUSION: Galantamine has a favorable effect on ADL performance in patients with AD, detectable after 5 months of treatment, regardless of dementia severity. The ADCS/ADL appears to better measure distinct abilities that may be relevant not only in clinical trials but also in individual patients than do cognitive assessments.     

Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients

STUDY OBJECTIVE: The upper limbs are involved in the activities of daily living (ADLs). Normal subjects usually perform such activities without noticing the energy cost, but patients with COPD report tiredness when performing them. This study was designed to assess the metabolic and ventilatory demands in patients with COPD during the performance of four ADLs involving the upper limbs. DESIGN: The patients were tested on two different days. Oxygen uptake (O(2)), carbon dioxide output (CO(2)), minute ventilation (E), and heart rate were measured while performing four ADLs for 5 min each: sweeping, erasing a blackboard, lifting pots, and replacing lamps. PARTICIPANTS: Ten normal, young, male subjects (mean age, 27.9 years) were selected for testing the reproducibility of the methods, and 9 male patients with COPD (FEV(1), 32.5%; mean age, 58.9 years) entered the study. MEASUREMENTS AND RESULTS: The tests were reproducible for both groups. Patients with COPD presented a significant increase (p < 0.05) in O(2) (mean, 50.2% of maximum O(2)) and in E (mean, 55.7% of maximum voluntary ventilation [MVV]) in relation to initial resting conditions for all four activities. CONCLUSIONS: We conclude that when performing these four activities, patients with moderate-to-severe COPD present a high O(2), which may explain the tiredness reported by them during simple activities involving the upper limbs; the high E/MVV may be associated to dyspnea.     

康复运动对心力衰竭患者日常生活活动能力恢复的影响

目的：探讨康复运动对心力衰竭患者日常生活活动能力恢复的影响。方法：选择住院的心力衰竭（CHF）患者690例，随机分为康复组（350例）和对照组（340例）。评估患者情况，以确定活动类型、强度、持续时间、频率、耐受力，判断恢复活动的潜力。运动前后测心率、心律、脉搏、血压，整个运动过程有专人监护，确保安全。结果：康复组总有效率占80％，对照组总有效率50％。两组经统计学处理，两组之间差异有显著性（x^2=6．84，P〈0．01）。结论：康复运动可使心衰病人的生活质量得到显著提高，适度的康复运动对CHF患者心功能改善是安全有益的。     

Dyspnoea with activities of daily living versus peak dyspnoea during exercise in male patients with COPD

Dyspnoea measurements in chronic obstructive pulmonary disease (COPD) can be broadly divided into two categories: those that assess breathlessness during exercise, and those that assess breathlessness during daily activities. We investigated the relationships between dyspnoea at the end of exercise and during daily activities with clinical measurements and mortality in COPD patients. We examined 143 male outpatients with moderate to very severe COPD. The peak Borg score at the end of progressive cycle ergometry was used for the assessment of peak dyspnoea rating during exercise, and the Baseline Dyspnea Index (BDI) score was used for dyspnoea with activities of daily living. Relationships between these dyspnoea ratings with other clinical measurements of pulmonary function, exercise indices, health status and psychological status were then investigated. In addition, their relationship with the 5-year mortality of COPD patients was also analyzed to examine their predictive ability. Although the BDI score was significantly correlated with airflow limitation, diffusing capacity, exercise indices, health status and psychological status, the Borg score at the end of exercise had non-existent or only weak correlations with them. The BDI score was strongly significantly correlated with mortality, whereas the Borg score was not. Dyspnoea during daily activities was more significantly correlated with objective and subjective measurements of COPD than dyspnoea at the end of exercise. In addition, the former was more predictive of mortality. Dyspnoea with activities of daily living is considered to be a better measurement for evaluating the disease severity of COPD than peak dyspnoea during exercise.     

Activity monitoring in assessing activities of daily living

Individuals who have active lifestyles appear to reap substantial benefits. It is therefore of interest to assess level of activity and to determine whether interventions are capable of altering activities of daily life. Questionnaires are often employed because of their simplicity, but objective measures are sought. Long-term assessment of energy expenditure, either through doubly labeled water analysis or through measurements of expired gases are expensive and often impractical. Activity monitors include pedometers, heart rate monitors, accelerometers and integrated multisensor systems. Rapidly advancing activity monitor technology has enabled long-term use and facilitated downloading of recordings to computers where sophisticated analysis of activity patterns can be made. Accelerometer-based systems have received the most attention. When applied to chronic obstructive pulmonary disease patients, accelerometric monitors have demonstrated low levels of activity; those using long-term oxygen and those having exacerbations are particularly inactive.     

Coping with activities of daily living in different care settings.

OBJECTIVE: To measure the functional capacity of elderly people cared for in different health and welfare care settings, with functional capacity defined in terms of activities of daily living. SUBJECTS AND METHODS: We assessed all people aged > or =65 in health-centre hospitals or nursing homes or receiving home nursing and home help services in Central Finland (n=5652) using the Evergreen activities of daily living index, which comprises nine physical and nine instrumental activities of daily living. RESULTS: Assessments of functional capacity were obtained for nearly all subjects: only 33 forms (0.6%) were returned with incomplete data. The mean activities of daily living sum score (range 0-54) was lowest for women receiving home nursing (17.3), and highest for women in long-term care at health-centre hospitals (48.4). Low scores described good and high scores poor functional capacity. Age showed no association with the mean activities of daily living sum score in any of the care settings. CONCLUSION: The Evergreen activities of daily living index was easy to use and successfully distinguishes between people in different care settings. Policies of assigning older people to different settings appear to be sound and sensible as the main defining criterion is level of functional capacity rather than age.     

Calcium and phosphorus control in patients undergoing hemodialysis: from the view-points of activities of daily living

To determine the compliance with the JSDT guidelines and activities of daily living (ADLs), phosphorus levels, calcium levels and Barthel index of patients under maintenance hemodialysis therapy in Shinrakuen hospital at December 2005 were evaluated. Of 369 patients, 28.7 % were controlled in the range of JSDT guidelines both phosphorus and calcium. Administration of sevelamer hydrochloride were low both in number of patients and also of using dose. Barthel index were higher in the patients with high phosphorus levels and low calcium level. Patients mortality at February 2007 was highest in the group of low phosphorus and high calcium levels in which the ADLs were the lowest. Concerned about vascular complication, patients in the group with target level or higher level of calcium and phosphorus were frequently noted.     

A 3-year follow-up of stroke patients: relationships between activities of daily living and personality characteristics

The importance of some personality characteristics for improvement of activities of daily life (ADL) was studied in sixty-six stroke patients, initially admitted to geriatric rehabilitation (n=37) or the department of medicine (n=29), 3 years after stroke. Outcome measurements were activities of daily life and motor and mental functions assessed using the Activity Index (AI) by Hamrin and Wohlin (1982). Neuroticism and extroversion were measured with the Eysenck Personality Inventory Scale. Preferred coping strategies were assessed from interviews on how the patients handle difficult events. Major improvements of ADL and motor functions were seen the first year after stroke. There was no major differences between patients admitted, either to geriatric rehabilitation or traditional medical wards regarding the outcome measurements except for better eating ability in the former group 3 years later. Subjects living alone showed deteriorated ADL functions after 3 years. Extrovert personality and active coping strategy predicted improved ADL functions. Multiple regression analyses with AI as the dependent variable proved active coping to predict functional outcome. In conclusion; increased knowledge about personality characteristics can improve possibilities for a more individual rehabilitation program.