Background Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. Methods This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Results Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statisticall...

Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability

Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care f

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Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

Objective. —To determine the relationship of brain infarction to the clinical expression of Alzheimer disease (AD). Design. —Cognitive function and the prevalence of dementia were determined for participants in the Nun Study who later died. At autopsy, lacunar and larger brain infarcts were identified, and senile plaques and neurofibrillary tangles in the neocortex were quantitated. Participants with abundant senile plaques and some neurofibrillary tangles in the neocortex were classified as having met the neuropathologic criteria for AD. Setting. —Convents in the Midwestern, Eastern, and Southern United States. Participants. —A total of 102 college-educated women aged 76 to 100 years. Main Outcome Measures. —Cognitive function assessed by standard tests and dementia and AD assessed by clinical and neuropathologic criteria. Results. —Among 61 participants who met the neuropathologic criteria for AD, those with brain infarcts had poorer cognitive function and a higher prevalence of dementia than those without infarcts. Participants with lacunar infarcts in the basal ganglia, thalamus, or deep white matter had an especially high prevalence of dementia, compared with those without infarcts (the odds ratio [OR] for dementia was 20.7,95% confidence interval [95% CI], 1.5-288.0). Fewer neuropathologic lesions of AD appeared to result in dementia in those with lacunar infarcts in the basal ganglia, thalamus, or deep white matter than in those without infarcts. In contrast, among 41 participants who did not meet the neuropathologic criteria for AD, brain infarcts were only weakly associated with poor cognitive function and dementia. Among all 102 participants, atherosclerosis of the circle of Willis was strongly associated with lacunar and large brain infarcts. Conclusion. —These findings suggest that cerebrovascular disease may play an important role in determining the presence and severity of the clinical symptoms of AD.

Brain Infarction and the Clinical Expression of Alzheimer Disease: The Nun Study

A new interview schedule for the diagnosis and measurement of dementia in the elderly is described. The schedule named the Cambridge Mental Disorders of the Elderly Examination (CAMDEX), consists of three main sections: A structured clinical interview with the patient to obtain systematic information about the present state, past history and family history; a range of objective cognitive tests which constitute a mini-neuropsychological battery; a structured interview with a relative or other informant to obtain independent information about the respondent's present state, past history and family history. The CAMDEX is acceptable to patients, has a high inter-rater reliability and the cognitive section has been shown to have high sensitivity and specificity.

CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia.

The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

Assessing Self‐maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living

The Comprehensive Assessment and Referral Evaluation (CARE) is a new assessment technique which is intended to reliably elicit, record, grade and classify information on the health and social problems of the older person. The CARE is basically a semi-structured interview guide and an inventory of defined ratings. It is designated comprehensive because it covers psychiatric, medical, nutritional, economic and social problems rather than the interests of only one professional discipline. The style, scope and scoring of the CARE makes it suitable for use with both patients and non-patients, and a potentially useful aid in determining whether an elderly person should be referred, and to whom, for a health or social service. The CARE can also be employed in evaluating the effectiveness of that service if given.

The Comprehensive Assessment and Referral Evaluation (Care)—Rationale, Development and Reliability:

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.

The performance test of activities of daily living.

A simple performance test was developed and used to evaluate a sample of psychiatric geriatric patients on their capacity for self-care. Evaluations were made by asking the patient to demonstrate certain essential activities of daily living. The objective test, compared with patients' subjective reports, was found to be a more valid measuring instrument of functional impairment and more useful as a diagnostic and prognostic tool Test scores correlated with independent clinical assessments of mental status and physical conditions, as well as with short-term outcome of hospitalization. The scale is easy and quick to administer and has many applications for the treatment and management planning of patients.

The assessment of self-care capacity in geriatric psychiatric patients by objective and subjective methods.

A reexamination of hospital diagnoses made at New York State Psychiatric Institute in 1932–1941 and 1947–1956 (64 in each decade) indicated that the original diagnosticians used a broader concept o...

On trends in the diagnosis of schizophrenia.

A consecutive series of 75 patients over the age of 65 admitted to psychiatric hospitals serving Camberwell, London, was compared with a similar series of 50 patients admitted to psychiatric hospitals serving Queens County, New York City, in order to examine the reported preponderance of organic diagnoses made in New York among patients of this age group. A special schedule for mental state was developed for the aged, and satisfactory reliability for the items of this schedule was shown between the two teams. Psychological and social measures were also taken (to be reported else-where), and physical examinations were under-taken on a proportion of patients, including laboratory tests and X-rays. Patients were examined shortly after admission and one month and three months later, using all the measures, either in the hospital or at home in the community. Results showed that, while the hospitals' diagnosis in Camberwell and Queens on the patients examined differed as expected according to the national statistics, there were no significant differences in the diagnostic proportions found by the Project on either side. Agreement between Project and hospital in Camberwell was good, while that between Project and hospital in Queens showed a significant difference for the organic patients. A tendency for the Project to diagnose more organic patients in Queens than in Camberwell was not significant. When a sample of patients examined in a similar manner in the Camberwell geriatric hospitals and considered as mentally ill by the Project was added to the psychiatric hospital patients, the tendency for there to be a higher proportion of organic patients in the Queens hospitals disappeared. This suggests that in Camberwell, some psychiatric cases of organic origin were being admitted to the geriatric hospitals.

Some evidence is produced for the validity of the Project diagnosis for depression and dementia, in terms of symptom profiles, discharge rates and days spent in hospital. Disorientation is the symptom likely to distinguish most clearly between dementia and depression, and poor memory that most likely to cause confusion; in affective patients, poor memory was in fact the organic symptom most likely to show improvement at follow-up.

Cross-National Study of Diagnosis of the Mental Disorders: A Comparison of the Diagnoses of Elderly Psychiatric Patients Admitted to Mental Hospitals serving Queens County, New York, and the former Borough of Camberwell, London

J. Kuriansky

Papers

The Comprehensive Assessment and Referral Evaluation (Care)—Rationale, Development and Reliability:

The performance test of activities of daily living.

The assessment of self-care capacity in geriatric psychiatric patients by objective and subjective methods.

On trends in the diagnosis of schizophrenia.

Cross-National Study of Diagnosis of the Mental Disorders: A Comparison of the Diagnoses of Elderly Psychiatric Patients Admitted to Mental Hospitals serving Queens County, New York, and the former Borough of Camberwell, London