上海市某社区老年慢性病人对日常生活功能综合影响分析

目的 研究上海市某社区老年人慢性病对日常生活功能（ＡＤＬ和ＩＡＤＬ）的影响。方法 问卷询问和体格检查相结合,对上海市某社区９６６名≥６０岁的老年人进行慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析慢性病对老年人日常生活功能损害作用的大小。结果 慢性病患病率为５７．８％,ＡＤＬ损害率为９．４％,ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障和慢性阻塞性肺部疾患;对ＩＡＤＬ损害影响显著的疾病依次为脑血管疾病、冠心病和慢性阻塞性肺部疾患。结论 慢性病患病率高低与老年人日常生活功能损害率无对应关系,而受疾病性质、严重程度和躯体活动能力影响较大;对老年人日常生活功能损害作用显著的疾病的分布有一定地区性。     

Prediction of Falls in Subjects Suffering From Parkinson Disease,Multiple Sclerosis,and Stroke

Objective

To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.

Improvement of Risk Prediction After Transcatheter Aortic Valve Replacement by Combining Frailty With Conventional Risk Scores

Objectives

This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores.

高龄老人日常生活活动能力多维度影响因素研究

目的多维度研究高龄老人日常生活活动能力的影响因素。方法选取7个长寿地区的百岁老人,并匹配选取同性别90～99岁、80～89岁高龄老人。通过问卷调查所有老人社会人口学、行为生活方式、功能状态与患病情况、基本日常生活活动（ADL）能力和器具性日常生活活动（IADL）能力调查。测量腰围和血压,测定生化指标。采用多因素logistic回归分析ADL和IADL的影响因素。结果年龄、民族、婚姻状况、居住方式、缺乏身体活动、休闲活动、腹型肥胖、舒张压、甘油三酯水平、认知受损和脑血管疾病是影响ADL的因素,OR（95％CI）值分别为5．10（2．78,9．37）、5．39（2．08,13．91）、0．48（0．25,0．91）、0．25（0．13,0．49）、2．01（1．34,2．98）、0．23（0．15,0．34）、2．34（1．56,3．52）、0．98（0．96,0．99）和0．72（0．54,0．99）、2．16（1．26,3．70）和3．46（1．40,8．52）。影响IADL功能的因素包括年龄、性别、民族、自评经济状况、休闲活动、总胆固醇水平和认知受损,OR（95％CI）值分别为3．08（1．67,5．68）、1．79（1．11,2．89）、1．86（1．12,3．11）、0．46（0．27,0．79）、0．19（0．07,0．55）、1．19（1．02,1．39）和3．11（1．93,5．00）。结论年龄增加、汉族、缺乏身体活动、腹型肥胖、认知受损、脑血管疾病是ADL受损的危险因素,在婚、独居、休闲活动、较高的舒张压和甘油三酯水平是ADL受损的保护因素。年龄增加、汉族、女性、总胆固醇水平和认知受损是IADL功能受损的危险因素,经济状况自评较好和休闲活动是IADL的保护性因素。     

Health-related services use and the onset of functional disability: 10 year follow-up study

This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55–77% less likely to be IADL disabled, and were 54–81% less likely to be ADL disabled, and were also 59–89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased.     

Ability to manage everyday technology: a comparison of persons with dementia or mild cognitive impairment and older adults without cognitive impairment

Purpose.?The ability to manage technology is important for performance and participation in everyday activities. This study compares the management of technology in everyday activities among people with mild-stage dementia or mild cognitive impairment (MCI) with older adults without known cognitive impairment (OA).

Method.?Persons with mild-stage dementia (n?=?38), MCI (n?=?33) and OA (n?=?45) were observed and interviewed when managing their everyday technology at home by using the Management of Everyday Technology Assessment (META). A computer application of a Rasch measurement model was used to generate measures of participants' ability to manage technology. These measures were compared groupwise with ANCOVA.

Results.?The management of everyday technology was significantly more challenging for the samples with mild-stage Alzheimer's disease (AD) or MCI compared to the OA sample (AD – OA, p?<0.001; d?=?1.87, MCI – OA, p?<0.001; d?=?0.66). The sample with MCI demonstrated a significantly higher ability to manage technology than the sample with mild-stage AD (AD – MCI, p?<0.001; d?=?1.23). However, there were overlaps between the groups and decreased ability appeared in all groups.

Conclusions.?Persons with cognitive impairment are likely to have decreased ability to manage everyday technology. Since their decreased ability can have disabling consequences, ability to manage technology is important to consider when assessing ability to perform everyday activities.     

Determinants and characteristics of help provision for elderly people living at home and in relation to quality of life

The aim of this study was to investigate determinants of help from informal or formal caregivers or a combination of both among people aged 75 or more and living at home, and the characteristics of the recipients, the help they received and their quality of life (QoL). The sample for this study was 448 elderly people, 75-99 years of age, living at home and receiving help with activities for daily living, instrumental or both instrumental and personal. Regression analysis showed high QoL not to be significantly related to who was providing the help, whilst it was related to higher age, living with someone, lower number of complaints and managing to be alone at home. Multinomial regression analysis showed age, number of children, number of complaints, the ability to stay alone at home and living alone to predict receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living together with someone, whilst those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were single and were living alone more often than the other recipients. Thus the responsibility for help for elderly people rests heavily on informal caregivers, whom it seems essential to support. As public service at home is preferably given to those living alone or able to stay alone at home, those without relatives may not be able to remain at home when their need of help increases.     

Country of birth,instrumental activities of daily living,self-rated health and mortality: a Swedish population-based survey of people aged 55-74

There is scant knowledge of the effects of country of birth on the health of individuals in the years prior to and after retirement. The aim of this study was to consider country of birth in relation to health status, instrumental activities of daily living (IADL) and all-cause mortality when adjusted for socioeconomic status (SES). Cross-sectional data were collected between 1986 and 1991 on 8959 individuals between the ages of 55 and 74. Self-reported data were analysed using a logistic regression model while the mortality data were analysed by means of a proportional hazard model. In the present study, immigrants from Southern Europe, Eastern Europe and Finland carried significantly increased risks of poor health even after adjustment for SES. Southern Europeans, refugees from Developing countries and Finns exhibited an increased risk of impaired IADL compared to Swedes, even after adjustment for SES. In conclusion, country of birth was associated with poor health status and impaired IADL. This association remained after adjustment for SES. In accordance with pre-study expectations, mortality was predicted by impaired IADL and male gender. Country of birth was not associated with all-cause mortality.     

Proline-rich polypeptides in Alzheimer's disease and neurodegenerative disorders - Therapeutic potential or a mirage?

The development of effective and safe drugs for a growing Alzheimer disease population is an increasing need at present. Both experimental and clinical evidence support a beneficial effect of proline-rich polypeptides in a number of neurodegenerative diseases, including Alzheimer disease. Experimental data have shown that proline-rich polypeptides isolated from bovine neurohypophisis possess neuroprotective and neuromodulatory properties in mice with aluminum neurotoxicosis or neuronal damage caused by venoms and toxins. Proline-rich polypeptides from ovine colostrums, so called Colostrinin, have been shown to produce cognitive improvement in an experimental model and in patients with Alzheimer disease. However, the precise mechanism underlying the neuroprotective action of proline-rich polypeptides is not very well established. Moreover, studies pointing at a neuroprotective effect of proline-rich polypeptides from bovine neurohypophisis in humans have not been reported thus far. The authors conclude that more detailed information on the mode of action of proline-rich polypeptides is needed as well as confirmation of their efficacy in broad clinical trials before this approach can really show its potential in the treatment of neurodegenerative disorders.     

Changes in everyday function in individuals with psychometrically defined mild cognitive impairment in the Advanced Cognitive Training for Independent and Vital Elderly Study

OBJECTIVES: To examine trajectories of change in everyday function for individuals with cognitive deficits suggestive of mild cognitive impairment (MCI). DESIGN: Using data from the longitudinal, multisite Advanced Cognitive Training for Independent and Vital Elderly Study allowed for post hoc classification of MCI status at baseline using psychometric definitions for amnestic MCI, nonamnestic MCI, multidomain MCI, and no MCI. SETTING: Six U.S. cities. PARTICIPANTS: Two thousand eight hundred thirty-two volunteers (mean age 74; 26% African American) living independently, recruited from senior housing, community centers, hospitals, and clinics. MEASUREMENTS: Mixed-effect models examined changes in self-reported activities of daily living and instrumental activities of daily living (IADLs) from the Minimum Data Set Home Care Interview in 2,358 participants over a 3-year period. RESULTS: In models for IADL performance, IADL difficulty, and a daily functioning composite, there was a significant time by MCI classification interaction for each MCI subtype, indicating that all MCI groups showed faster rates of decline in everyday function than cognitively normal participants with no MCI. CONCLUSION: Results demonstrate the importance of MCI as a clinical entity that not only predicts progression to dementia, but also predicts functional declines in activities that are key to autonomy and quality of life. MCI classification guidelines should allow for functional changes in MCI, and clinicians should monitor for such changes. Preservation of function may serve as a meaningful outcome for intervention efforts.