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Journal ArticleDOI

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

21 Sep 1969-Gerontologist (Oxford University Press)-Vol. 9, Iss: 3, pp 179-186
TL;DR: Two scales first standardized on their own population are presented, one of which taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence, and the other taps a schema of competence into which these behaviors fit.
Abstract: 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-

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TL;DR: This paper views caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed.
Abstract: This paper views caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed. Primary stressors are hardships and problems anchored directly in caregiving. Secondary stressors fall into two categories: the strains experienced in roles and activities outside of caregiving, and intrapsychic strains, involving the diminishment of self-concepts. Coping and social support can potentially intervene at multiple points along the stress process.

3,922 citations

Journal ArticleDOI
TL;DR: These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old.

3,631 citations

Journal ArticleDOI
TL;DR: Some of the first estimates of the extent of the public health problem posed by sarcopenia are provided, independent of ethnicity, age, morbidity, obesity, income, and health behaviors.
Abstract: Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.

3,478 citations


Cites background or methods from "Assessment of Older People: Self-Ma..."

  • ..."Moderate" physical disability was defined as self-reported difficulty in performing three or more of the six physical activity items on the IADL scale ( 13 ): walking distances, shopping for groceries, preparing meals, doing housework, making home repairs, and doing laundry....

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  • ...The Activities of Daily Living (12) and Instrumental Activities of Daily Living (LADL) ( 13 ) scales were used to measure self-reported disability....

    [...]

Journal ArticleDOI
TL;DR: To establish the prevalence of sarc Openia in older Americans and to test the hypothesis that sarcopenia is related to functional impairment and physical disability in older persons is established.
Abstract: OBJECTIVES: To establish the prevalence of sarcopenia in older Americans and to test the hypothesis that sarcope- nia is related to functional impairment and physical dis- ability in older persons. DESIGN: Cross-sectional survey. SETTING: Nationally representative cross-sectional sur- vey using data from the Third National Health and Nutri- tion Examination Survey (NHANES III). PARTICIPANTS: Fourteen thousand eight hundred eigh- teen adult NHANES III participants aged 18 and older. MEASUREMENTS: The presence of sarcopenia and the relationship between sarcopenia and functional impairment and disability were examined in 4,504 adults aged 60 and older. Skeletal muscle mass was estimated from bioimped- ance analysis measurements and expressed as skeletal mus- cle mass index (SMIskeletal muscle mass/body mass � 100). Subjects were considered to have a normal SMI if their SMI was greater than -one standard deviation above the sex-specific mean for young adults (aged 18-39). Class I sarcopenia was considered present in subjects whose SMI was within -one to -two standard deviations of young adult values, and class II sarcopenia was present in subjects whose SMI was below -two standard deviations of young adult values. RESULTS: The prevalence of class I and class II sarcope- nia increased from the third to sixth decades but remained relatively constant thereafter. The prevalence of class I (59% vs 45%) and class II (10% vs 7%) sarcopenia was greater in the older ( � 60 years) women than in the older men ( P � .001). The likelihood of functional impairment and disability was approximately two times greater in the older men and three times greater in the older women with class II sarcopenia than in the older men and women with a normal SMI, respectively. Some of the associations be- tween class II sarcopenia and functional impairment re- mained significant after adjustment for age, race, body mass index, health behaviors, and comorbidity. CONCLUSIONS: Reduced relative skeletal muscle mass in older Americans is a common occurrence that is signifi- cantly and independently associated with functional im- pairment and disability, particularly in older women. These observations provide strong support for the prevailing view that sarcopenia may be an important and potentially re- versible cause of morbidity and mortality in older persons. J Am Geriatr Soc 50:889-896, 2002.

2,710 citations

Journal ArticleDOI
TL;DR: The intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients, suggesting that primary prevention of delirium is probably the most effective treatment strategy.
Abstract: Background Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium. Methods We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital. Patients from one intervention unit and two usual-care units were enrolled by means of a prospective matching strategy. The intervention consisted of standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Delirium, the primary outcome, was assessed daily until discharge. Results Delirium developed in 9.9 percent of the intervention group, as compared with 15.0 percent of the usual-care group (matched odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.92). The total number of days with delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 9...

2,411 citations

References
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Journal ArticleDOI
TL;DR: It was found that persons tended to have disabilities consistent with the type of services to be expected in the institution, and 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.
Abstract: 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 ...

72 citations

Journal ArticleDOI
06 Nov 1965-BMJ
TL;DR: The authors conclude that the " achillogram " is reliable as radioiodine uptake and better than the B.M.R. and the serum cholesterol and also reliable in a given patient when the results of treatment are being followed over a period.
Abstract: This monograph from the School of Nancy deals with muscular disorders associated with thyroid dysfunction. It is perhaps the only book to cover the ground so fully in this field. Good clinical accounts aregiven of the conditions which are undoubtedly due to thyroid disorder, such as acute and chronic thyrotoxic myopathy. There is also a good account of the relationship between thyrotoxicosis and periodic familial paralysis, with its surprisingly high incidence in Japan. No fewer than 250 ot the published cases come from that country, whilst only 30 have been recorded in Europe and the United States altogether. The writers also refer to the association between myasthenia gravis and thyrotoxicosis, and they side with those who do not believe in the so-called see-saw relationship by which myasthenia is said to worsen if the thyrotoxicosis is treated. They find strong support in the literature for the view that the two disorders often behave quite independently of each other. In considering all these conditions the authors base themselves mainly on published material, which they analyse and discuss fully. There is little contribution from their own experience. Their particular interest has been the duration of the ankle jerk in the diagnosis of thyroid dysfunction. They have used the measurement in milliseconds (ms.) from the moment of percussion of the tendon to a point half-way down the relaxation gradient. This empirical end-point was used because the end of relaxation is blurred on the tracing and cannot be precisely defined. Undoubtedly there is a fairly wide overlap, so that 25%/ of hyperthyroid patients are in the doubtful 260-280 ms. range, whilst as many as 30% of myxoedematous patients are in the equally doubtful 320-360 ms. range. The diagnostic value of the test is therefore greater in excluding rather than in proving a given thyroid dysfunction. The authors conclude that the \" achillogram \" is reliable as radioiodine uptake and better than the B.M.R. and the serum cholesterol. The test is also reliable in a given patient when the results of treatment are being followed over a period. This book has an extensive bibliography, no fewer that 705 references being given. The Anglo-Saxon and German literatures are widely and accurately quoted as well as, of course, the French. As a reference book it will be of great value to the neurologist as well as the endocrinologist.

56 citations


"Assessment of Older People: Self-Ma..." refers methods in this paper

  • ...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....

    [...]

  • ...Among the many scales for measuring activities of daily living that have been devised, the one developed at the Langley-Porter Neuropsychiatric Institute by Simon, Lowenthal, and their associates (Lowenthal, 1964) has frequently been utilized by later investigators....

    [...]

Book
21 Jan 1964

34 citations