The performance test of activities of daily living.

A structured-performance test requiring patients to demonstrate selected activities of daily living was designed to objectively measure the self-care capacity of geriatric psychiatric patients. The background, rational, usefulness, and specific administration and scoring procedures are presented. The test is simple to administer and promises to be a useful diagnostic and prognostic tool.     

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.     

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.     

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.     

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.     

Stability of performance of activities of daily living using the MDS

The Minimum Data Set (MDS) requires assessment of performance of activities of daily living (ADLs) by newly admitted nursing home residents over all shifts for a 7-day period, for a total of 21 assessments. This study evaluated within-subject equivalence of multiple assessments of 42 residents' admission MDS ADL performance. Friedman two-way analysis of variance for ranks documented no significant within-subject differences among repeated measurements for all 13 MDS ADL variables. Thus, fewer than 21 assessments may accurately assess ADL performance.     

Effects of resistance training on the performance of activities of daily living in patients with Alzheimer's disease

Aim: The objective of this study was to investigate the effects of resistance training in activities of daily living performance in Alzheimer's disease (AD) patients. Methods: An exploratory and longitudinal study, lasting for 16 weeks, with the participation of 34 patients divided equally in: the training group (TG), who participated in a resistance training protocol (three sets of 20 repetitions in five exercises); and the social gathering group (SGG), who participated in a social interaction protocol (i.e. group dynamics, writing and reading activities). Results: We observed significant differences between the groups in moving around the house, climbing stairs, standing up from the floor and putting on socks tests. Conclusion: This study showed that resistance training improves agility, lower limb strength, balance and flexibility in AD patients, while SGG protocol is important to improve the agility. Geriatr Gerontol Int 2013; 13: 322–328 .     

Gender differences in the performance of activities of daily living among patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) limits the ability to perform activities of daily living (ADL). The Pulmonary Functional Status and Dyspnoea Questionnaire (PFSDQ) measures general dyspnoea, dyspnoea during ADL (dyspnoea score) and loss of functional performance (activity score) for a large number of activities commonly performed by adults. The questionnaire is only validated for male patients. The aim of our study was therefore to validate the PFSDQ for women with COPD. We then wanted to investigate possible gender differences in responses to the PFSDQ and whether associations between the PFSDQ and pulmonary function, exercise capacity, health related quality of life (HRQoL) and general quality of life (QoL) were influenced by gender. This cross-sectional, observational study included 110 COPD patients. Sixty-five men and 45 women, referred to pulmonary rehabilitation participated. Pulmonary function and six-minute walking distance (6MWD) were measured. Patients completed PFSDQ, St George's Respiratory Questionnaire (SGRQ, HRQoL) and Perceived Quality of Life Scale (PQoL, QoL). No gender differences were found in pulmonary function (% of predicted), 6MWD, SGRQ or PQoL. Most items in the PFSDQ were found relevant by both women and men. Activity Scores were only different for men and women for items concerning home management; women had changed their functional performance the most, particularly for the heaviest chores. No gender differences were found in dyspnoea scores. Moderate correlations were found between PFSDQ and 6MWD, SGRQ and PQoL. Multiple linear regression analyses showed that these relations were not influenced by gender. We consider PFSDQ as applicable to women as to men as a comprehensive measure of functional performance and dyspnoea. The questionnaire gives information complementary to measures of exercise capacity, HRQOL and QOL. The larger loss of functional performance in home management among women should be taken into account in the treatment of COPD patients.     

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.     

Usefulness of functional gait reserve relative to activities of daily living in the elderly people

AIM: The purpose of this study was to develop the index of functional gait reserve relative to gait endurance and gait conformability, and to examine the relationship between functional gait reserve and activities of daily living (ADL) in elderly individuals. METHODS: Subjects comprised 107 community-dwelling elderly individuals (mean age, 72.5 +/-5.0 years). We evaluated gait function using the timed "Up and Go" test (TUG), 10-m walking time, 6-minute distance (6MD), physiological cost index (PCI) and ratings of perceived exertion (RPE), and investigated Tokyo Metropolitan Institute Gerontology-Index of Competence as an index of ADL. TUGs were performed at a comfortable speed (TUG(com)) and maximum speed (TUG(max)), and TUG Reserve (TUG-R) was derived from the ratio of the difference between TUG(max) and TUG(com) as an index of functional gait reserve. RESULTS: Intraday reliability of TUG-R was high (intraclass correlation coefficient (1, 2)=0.82), and TUG-R was correlated to 6MD, PCI and RPE, which was reflected in gait endurance and gait conformability. Scores for TUG-R were significantly lower in elderly individuals with ADL dependence than in independent elderly individuals. Multiple logistic regression analysis showed TUG-R as associated with performance of outdoor activities. CONCLUSION: TUG-R offers a reliable and useful index of functional gait reserve related to gait endurance and ADL in elderly individuals.     

老年人日常生活活动能力流行病学研究进展

本文阐述日常生活活动能力的概念与评价工具,综述老年人日常生活活动能力流行病学研究进展及影响因素,指出目前我国相关研究的潜在不足,以期为今后的研究和老年人日常生活活动能力受损的早期预防提供参考依据.