THE use of formal devices for assessing function is becoming standard in agencies serving the elderly. In the Gerontological Society's recent contract study on functional assessment (Howell, 1968), a large assortment of rating scales, checklists, and other techniques in use in applied settings was easily assembled. The present state of the trade seems to be one in which each investigator or practitioner feels an inner compusion to make his own scale and to cry that other existent scales cannot possibly fit his own setting. The authors join this company in presenting two scales first standardized on their own population (Lawton, 1969). They take some comfort, however, in the fact that one scale, the Physical Self-Maintenance Scale (PSMS), is largely a scale developed and used by other investigators (Lowenthal, 1964), which was adapted for use in our own institution. The second of the scales, the Instrumental Activities of Daily Living Scale (IADL), taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence. Both of the scales have been tested further for their usefulness in a variety of types of institutions and other facilities serving community-resident older people. Before describing in detail the behavior measured by these two scales, we shall briefly describe the schema of competence into which these behaviors fit (Lawton, 1969). Human behavior is viewed as varying in the degree of complexity required for functioning in a variety of tasks. The lowest level is called life maintenance, followed by the successively more complex levels of func-

/pdf/assessment-of-older-people-self-maintaining-and-instrumental-5ae69dd93j.pdf

Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living

THE use of formal devices for assessing function is becoming standard in agencies serving the elderly In the Gerontological Society's recent contract study on functional assessment (Howell, 1968), a large assortment of rating scales, checklists, and other techniques in use in applied settings was easily assembled The present state of the trade seems to be one in which each investigator or practitioner feels an inner compusion to make his own scale and to cry that other existent scales cannot possibly fit his own setting The authors join this company in presenting two scales first standardized on their own population (Lawton, 1969) They take some comfort, however, in the fact that one scale, the Physical Self-Maintenance Scale (PSMS), is largely a scale developed and used by other investigators (Lowenthal, 1964), which was adapted for use in our own institution The second of the scales, the Instrumental Activities of Daily Living Scale (IADL), taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence Both of the scales have been tested further for their usefulness in a variety of types of institutions and other facilities serving community-resident older people Before describing in detail the behavior measured by these two scales, we shall briefly describe the schema of competence into which these behaviors fit (Lawton, 1969) Human behavior is viewed as varying in the degree of complexity required for functioning in a variety of tasks The lowest level is called life maintenance, followed by the successively more complex levels of func-

Assessment of older people: self-maintaining and instrumental activities of daily living

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients

PURPOSE This study assessed the impact of a low cost, multicomponent physical activity intervention for older adults with lower extremity osteoarthritis. DESIGN AND METHODS A randomized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence (n = 80) to a wait list control group (n = 70). Assessments were conducted at baseline and at 2 and 6 months following randomization. The training program consisted of range of motion, resistance training, aerobic walking, and education-group problem solving regarding self-efficacy for exercise and exercise adherence. All training group participants developed individualized plans for posttraining adherence. RESULTS Relative to the persons in the control group, individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy, a 48.5% increase in exercise adherence, and a 13.3% increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months. Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months (p =.052). In contrast, persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures. No adverse health effects were encountered. IMPLICATIONS These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis.

Impact of the Fit and Strong Intervention on Older Adults With Osteoarthritis

https://www.jpsmjournal.com/article/0885-3924(94)00066-T/pdf

A critique of instruments and methods to detect, diagnose, and rate delirium

Our results show that the mental and physical functional status of institutionalized aged persons are highly interrelated. The relationship is seen within each of the 3 types of institutions studied, and for all age groups. In the different types of institutions it was found that persons tended to have disabilities consistent with the type of services to be expected in the institution. Thus, patients in state hospitals had the largest number with poor mental functional status, while there was predominance of persons with poor physical functional status found in the nursing homes. Nevertheless, institutions of a given type differed widely from each other. Some homes for the aged and nursing homes had a larger proportion of persons with poor mental status than did some state hospitals, while some state hospitals and homes for the aged had more persons with poor physical functional status than did some nursing homes. Therefore, it is possible to make a more accurate prediction of a person's mental status on ...

R. L. Kahn

Papers

The relationship of mental and physical status in institutionalized aged persons