Older person behavioral and psychological symptoms (BPS) and functional limitations mediate the association between older person cognitive impairment and depressive symptoms in the caregiver

We assess for the mediation of the association between older person cognitive impairment and caregiver depressive symptoms through older person BPS and functional limitations, and whether the mediation varies by caregiver–older person relationship (spouse/adult child). Data for 1111 older person (aged 75+ with activity of daily living (ADL) limitation)–caregiver dyads from Singapore were used. The outcome variable was dichotomous (caregiver clinically significant depressive symptoms [CSDS]: yes/no) in the primary analysis and continuous (caregiver depressive symptoms score) in the sensitivity analysis. The causal steps approach assessed for the mediation of the association between older person cognitive impairment (yes/no) and the outcome variable through the two potential mediators. A bootstrapping approach calculated point estimates and confidence intervals (CIs) of the indirect (∼mediated) effects. Variation of the indirect effects by caregiver–older person relationship was also assessed. In the primary analysis, the causal steps approach supported older person BPS and functional limitations as mediators. The bootstrapping approach confirmed both as significant mediators, though BPS (indirect effect odds ratio (OR) 1.32 [95% bootstrap CI 1.19,1.48]; %mediation: 70.6%) was a stronger mediator than functional limitations (1.04 [1.01,1.11]; %mediation: 11.5%). Variation of the indirect effects by caregiver–older person relationship was not supported. Results of the sensitivity analysis confirmed these results. We conclude that while caring for an older person with cognitive impairment is detrimental for the caregiver's mood, management of associated BPS and functional limitations, especially the former, among such older persons may reduce depressive symptoms among their caregivers. Spouse as well as adult child caregivers benefit.     

The Independent Contributions of Cognitive Impairment and Neuropsychiatric Symptoms to Everyday Function in Older Adults

The everyday functional capacities of older adults are determined by multiple factors. The primary goal of the present study was to evaluate whether apathy and depression have unique influences on degree of functional impairment, independent of the effects of specific cognitive impairments. Participants included 344 older adults (199 normal, 87 with MCI, 58 with dementia). The Everyday Cognition (ECog) scales were used to measure both global and domain-specific functional abilities. Neuropsychiatric symptoms of depression and apathy were measured by the Neuropsychiatric Inventory (NPI), and specific neuropsychological domains measured included episodic memory and executive functioning. Results indicated that worse memory and executive function, as well as greater depression and apathy, were all independent and additive determinants of poorer functional abilities. Apathy had a slightly more restricted effect than the other variables across the specific functional domains assessed. Secondary analysis suggested that neuropsychiatric symptoms may be more strongly associated with everyday function within cognitively normal and MCI groups, while cognitive impairment is more strongly associated with everyday function in dementia. Thus, a somewhat different set of factors may be associated with functional status across various clinical groups.     

Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community

Purpose.?Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home.

Methods.?Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA.

Results.?Analyses revealed that assessments of CSHCN with the greatest or least amount of activity limitations exhibited the greatest agreement. The greatest disagreement occurred when assessors faced children with moderate to moderately severe activity limitations. Specific ADLs, where the greatest and least agreements occurred, varied by the level of the child's overall activity limitation.

Conclusions.?These results imply that the most serious challenges to the reliability of home-based assessment of ADLs among CSHCN occur in cases of children with moderate or moderately severe activity limitations.     

Long-term gait pattern assessment using a tri-axial accelerometer

In this article, we present a pervasive solution for gait pattern classification that uses accelerometer data retrieved from a waist-mounted inertial sensor. The proposed algorithm has been conceived to operate continuously for long-term applications. With respect to traditional approaches that use a large number of features and sophisticated classifiers, our solution is able to assess four different gait patterns (standing, level walking, stair ascending and descending) by using three features and a decision tree. We assess the algorithm detection performances using data that we retrieved from a validation group composed by nine young and healthy volunteers, for a total number of 36 tests and 12.5?h of recorded acceleration data. Experimental results show that in continuous applications the proposed algorithm is able to effectively discriminate between standing (100%), level walking (～99%), stair ascending (～84%), and descending (～85%), with an average classification accuracy for the four patterns that exceeds 92% in continuous, long-lasting applications.     

The effect of having a partner on activities of daily living in men and women aged 82-87 years

Background

Physical functioning is an important determinant of mortality and morbidity in older adults and there may be differences by gender and marital status. This study compared disability, measured by the ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs), between older men and women who are either partnered or not partnered.

Methods

Participants included 5497 women and 1072 men aged 82–87 years from cross sectional surveys conducted in 2008 (the Health in Men Study and the Australian Longitudinal Study on Women's Health). Ordinal logistic regression was used to examine the relationship between disability and gender by marital status, adjusting for self-reported chronic conditions.

Results

Women reported a higher prevalence of most chronic conditions than men. Unpartnered men had significantly higher odds of reporting difficulty in dressing the lower body and doing heavy housework, and significantly lower odds of reporting difficulty managing money and preparing meals than partnered men. Unpartnered and partnered women had significantly lower odds of reporting difficulty in dressing the lower body, walking inside the house, using the toilet, preparing meals, taking medications, using the telephone and performing leisure activities than partnered men. However, unpartnered and partnered women had significantly higher odds of reporting difficulty with eating, shopping, and doing light or heavy housework than did partnered men.

Conclusions

Differences between partnered and unpartnered older men and women in difficulty with ADLs and IADLs were identified, with women reporting less difficulty overall, regardless of partner status.     

Attitudes Toward Disability

The work of health rofessionals is directly influenced by somatopsychological attitudes. Expectations from the disabled person, from health professionals, and from society play an important part in adjustment to disability. Role theory has helped us look at the "sick role" versus the disabled role and we now realize that role confusion often interferes with the adjustment process. It is important that students be made aware of these different theories to help them get in touch with their own feelings about disability and develop an understanding of attitudes which will facilitate the adjustment process. An instrument measuring attitudes toward the disabled was administered to two successive junior occupational therapy classes, at the beginning and the end of the school year. Change in attitudes was analyzed and positive significant results were discussed in relation to implications for education and practice.     

Cognitive predictors of functional decline in vascular dementia

BACKGROUND: This study examined changes in cognitive-functional relationships in vascular dementia (VaD) over the course of one year. METHODS: Twenty-four patients with probable VaD were administered the Dementia Rating Scale (DRS). Caregivers completed an informant-based measure of instrumental (IADL) and basic activities of daily living (BADL). Follow-up assessment was conducted one-year post-baseline. RESULTS: Logistic regression revealed that changes in the DRS Initiation/Perseveration and DRS Memory subscales were significantly associated with declines in IADLs and BADLs, respectively. CONCLUSIONS: Among patients with VaD, longitudinal changes in IADLs and BADLs are most strongly associated with changes in executive functioning and memory abilities, respectively. Findings suggest that different cognitive functions subserve complex instrumental and rote, habituated basic functional activities, and neuropsychological screening measures are useful in the prediction of such functional changes.     

Functional Status Outcome Measures in Home Health Care Patients with Heart Failure

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches.     

Exceptional Human Longevity

Exceptional longevity represents an extreme phenotype. Current centenarians are survivors of a cohort who display delayed onset of age-related diseases and/or resistance to otherwise lethal illnesses occurring earlier in life. Characteristics of aging are heterogeneous, even among long-lived individuals. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life. Careful observations in the oldest old offer some empirical strategies that favor increased health span and life span, with implications for compression of disability, identification and implementation of lifestyle behaviors that promote independence, identification and measurement of more reliable markers associated with longevity, better guidance for appropriate health screenings, and promotion of anticipatory health discussions in the setting of more accurate prognostication. Comprehensive PubMed literature searches were performed, with an unbiased focus on mechanisms of longevity. Overall, the aggregate literature supports that the basis for exceptional longevity is multifactorial and involves disparate combinations of genes, environment, resiliency, and chance, all of which are influenced by culture and geography.