Instrumental Activities of Daily Living as a Potential Marker of Frailty A Study of 7364 Community-Dwelling Elderly Women (the EPIDOS Study)
01 Jul 2001-Journals of Gerontology Series A-biological Sciences and Medical Sciences (Oxford University Press)-Vol. 56, Iss: 7
TL;DR: The results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls.
Abstract: Background. A number of clinical conditions have been shown to be associated with frailty in elderly people. We hypothesized that incapacities on the Instrumental Activities of Daily Living (IADLs) scale could make it possible to identify this population. We investigated the associations between IADL incapacities and the various known correlates of frailty in a cohort of community-dwelling elderly women. Methods. Cross-sectional analysis was carried out on the data from 7364 women aged over 75 years (EPIDOS Study). The IADL was the dependent variable. Sociodemographic, medical, and psychological performance measures were obtained during an assessment visit. Falls in the previous 6 months and fear of falling were also ascertained. Body composition was measured by dual-energy x-ray absorptiometry. The factors associated with disability in at least one IADL were included in a logistic regression model. Results. Thirty-two percent of the population studied had disability in at least one IADL item. This group was significantly older (81.7 � 4.1 yr vs 79.8 � 3.4 yr), had more frequent histories of heart disease, stroke, depression or diabetes, and was socially less active ( p � .001). These associations persisted after multivariate analysis. Cognitive impairment as assessed by the Pfeiffer test (Pfeiffer score � 8) was closely associated with disabilities on the IADL (OR 3.101, 95% confidence interval [CI] 2.19‐4.38). Falls and fear of falling were also more frequent in the group of women with an abnormal IADL ( p � .001) but only fear of falling remained significantly associated with incapacities on at least one IADL item after logistic regression (OR 1.47, 95% CI 1.28‐1.69). Women with disability on at least one IADL item also had lower bone mineral density, this was independent of the other factors. Conclusion. Our results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls. Disabilities on this scale could be a good tool for identifying individuals at risk of frailty among elderly persons living at home and in apparent good health. This finding requires confirmation by longitudinal studies.
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TL;DR: The objective of this study is to examine the important factors associated with functional disabilities in elderly patients with diabetes mellitus and to identify patients at risk of developing functional disabilities.
Abstract: Background: The objective of this study is to examine the important factors associated with functional disabilities in elderly patients with diabetes mellitus.
Methods: This was a multicenter cross-sectional study. A total of 1135 elderly diabetic outpatients aged over 65 years in 10 hospitals participated in our study. Functional disabilities were assessed with questionnaires on the instrumental activity of daily livings (IADL), intellectual activity and social role using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Cognitive function and well-being were assessed by the mini-mental state examination and morale scale, respectively.
Results: The patients were divided into three age groups. The oldest (≥ 80 years) group reported significant high prevalence of functional disabilities (10% to 36%) compared to the youngest (65–69 years) group (4% to 20%). The number of vascular complications (≥ 4) was associated with a 5.5–8.8 fold increased risk of disabilities relating to the tasks on IADL (using public transportation, shopping, preparing meals and paying bills). Using multiple logistic regression analyses, low scores of morale scales (≤ 7) and mini-mental state examination (≤ 23) were significantly associated with disabilities on the IADL, intellectual activity and social role after adjustment for age, gender, BMI, duration of diabetes, HbA1c, insulin treatment, microangiopathy and macroangiopathy. Insulin treatment and low visual acuity were also associated with the IADL after adjustment for the other variables.
Conclusions: Older age, insulin treatment, low well-being, cognitive impairment, and visual impairment were independently associated with the functional disabilities of elderly patients with diabetes mellitus.
14 citations
TL;DR: Frailty (Gebrechlichkeit) ist eine Einschrankung der physiologischen Reserve bei alteren Patienten with schwerwiegenden individuellen and soziookonomischen Folgen werden durch Frailty nachhaltig beeinflusst.
Abstract: Frailty (Gebrechlichkeit) ist eine Einschrankung der physiologischen Reserve bei alteren Patienten mit schwerwiegenden individuellen und soziookonomischen Folgen. Multiple Aspekte der Patientenbehandlung sowie das Outcome werden durch Frailty nachhaltig beeinflusst. Obwohl mehr als 60 Messinstrumente existieren, sind die Erfassung und Berucksichtigung funktioneller Assessments in der klinischen Routine unzureichend umgesetzt. Das interdisziplinare und interprofessionelle Verstandnis, warum und wie Frailty beurteilt werden sollte, ist die Grundlage fur die dauerhafte Implementierung. Der Artikel zeigt die Auswirkungen von Frailty und Vorteile einer Fruherkennung auf und gibt einen Uberblick uber die wichtigsten Instrumente, die in der Frailty-Erkennung und -Bewertung verwendet werden konnen. Die fruhe praoperative Detektion bietet ein vielfaltiges Optimierungspotenzial fur die peri- und intraoperative Versorgung. Verschiedene Frailty-Assessment-Tools korperlicher, kognitiver und psychosozialer Domanen werden vorgestellt und diskutiert. Frailty-Assessments variieren immens in Bezug auf die erforderliche Zeit, die Ausrustung und das Fachwissen zur Durchfuhrung. Wir empfehlen mindestens einen Test fur die einzelnen Dimensionen von Frailty, um ein holistisches Bild der geriatrischen Patienten zu erhalten. Die Bewertung von Frailty sollte ubergreifend in die interdisziplinaren Strukturen der klinischen Routine implementiert werden, um die Patientensicherheit sowie das kurz- und langfristige Outcome zu verbessern.
13 citations
01 Jun 2011
TL;DR: The relevance of the current operational indicators of frailty are discussed and the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers is given.
Abstract: Even though the efforts in research have detailed further the physiopathology and the dynamics of the frailty process an operational definition of frailty is still far from being unequivocal. Studies carried out from the SAFEs cohort study allowed a pragmatic approach in the identification of the at-risk groups for the lost of independency during the hospital stay and factors influencing their future at short-, mid- and long-term. Based upon these results, we propose to discuss the relevance of the current operational indicators of frailty in order to show that clinical markers or indicators are insufficient to differentiate the frailty process from normal ageing. Finally we give rise to the imperative necessity to detect frailty at a preclinical stage with the help of biological and more particularly inflammatory markers.
13 citations
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TL;DR: With proper patient selection and information, older individuals may obtain the same degree of benefits from cancer prevention and cancer treatment as younger individuals, and age should never be a criteria for health care discrimination.
Abstract: Cancer will become the leading cause of morbidity and death as the global population ages. While health and health care disparities have been well documented in culturally and linguistically diverse patients with cancer, aging involves unique biological, medical, and social considerations that must be further explored as it also influences cancer prevention and cancer treatment in these populations. Further, even though aging is common to all cultures and latitudes, the cultural context in which the experience occurs varies even within the Western context. As such, cancer specialists must learn to not only account for the functional but also for the cultural diversity of the older population in medical decisions related to cancer prevention and cancer treatment. In addition, use of screening instruments such the CGA also represent a milestone in the management of older individuals. It is also currently being modified to become more cost effective and to provide more precise information related to life expectancy and tolerance of cancer treatment. The increase in cultural diversity in the oncology setting also influences cancer treatment. A clinician must be able to act within the boundaries of cultural competence when ministering to older cancer patients. Cultural specific instruments to assess older individuals are particularly desirable in a multicultural society, but also strive to effectively communicate with these individuals in these populations, their families and significant others. With proper patient selection and information, older individuals may obtain the same degree of benefits from cancer prevention and cancer treatment as younger individuals, and age should never be a criteria for health care discrimination.
13 citations
Dissertation•
05 Sep 2014
TL;DR: In this article, the authors present an enquete pluridisciplinaire, which allows the interrogering of 559 seniors of plus de 65 years of niveaux d'autonomie culinaire differents.
Abstract: Comprendre les facteurs jouant sur l’etat nutritionnel du sujet âge est un enjeu fort. Une premiere enquete pluridisciplinaire a permis d'interroger 559 seniors de plus de 65 ans de niveaux d'autonomie culinaire differents. Si un effet de l’âge et des facteurs associes a la dependance est constate sur les performances sensorielles, 42% de l’echantillon ont des capacitesolfactives et gustatives preservees. Trois outils de mesure des rejets et des preferences ont ete developpes afin de mieux prendre en compte les attentes des personnes âgees a l’entree dans la dependance : la mesure de la selectivite alimentaire, le questionnaire des styles de mangeur et le choix du menu prefere. Les facteurs les plus associes a un risque de denutrition sont une mauvaise sante orale ou un etat depressif. Garder du plaisir a manger et de l'interet pour son alimentation sont au contraire des facteurs favorables au maintien du statut nutritionnel. La strategie sensorielle consistant a ameliorer des produits en tenant compte des attentes des personnes âgees plutot qu’en renforcant en saveurs ou en aromes s'est revelee la plus efficace. Les 166 personnes âgees qui ont teste les differentes variantes ont notamment apprecie, pour le produit le plus complexe, la variante amelioree dans toutes ses dimensions sensorielles – etce, quels que soient leurs niveaux de capacites gustatives et olfactives. Meme si le vieillissement s’accompagne d’une baisse des perceptions du gout et des aromes, prendre en compte les attentes des personnes âgees et ameliorer les produits qui leur sont destines est une voie pertinente pour ameliorer le statut nutritionnel tout en contribuant a une plus grande satisfaction.
12 citations
Cites background from "Instrumental Activities of Daily Li..."
...80 is an usual age limit used by scientists in medical literature when focused on the so-called oldest-old (Harris et al. 1989; Manton et al. 1995; Campbell et al. 1999; Nourhashémi et al. 2001; Beckett et al. 2008)....
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References
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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-
14,832 citations
TL;DR: 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.
Abstract: 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.
4,897 citations
TL;DR: Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability.
Abstract: 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...
3,388 citations
TL;DR: Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.
Abstract: Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons. The effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated. Within the category of normal aging, a distinction can be made between usual aging, in which extrinsic factors heighten the effects of aging alone, and successful aging, in which extrinsic factors play a neutral or positive role. Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.
2,809 citations
TL;DR: Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions.
Abstract: Background Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. Methods We conducted a prospective study of a probability sample of 1103 people over 71 years of age who were living in the community. Data on demographic and medical characteristics, use of health care, and cognitive, functional, psychological, and social functioning were obtained at base line and one year later during assessments in the participants' homes. The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up. Patients were assigned to four categories during follow-up: those who had no falls, those who had one fall without serious injury, those who had two or more falls without serious injury, and those who had at least one fall causing serious injury. Results A total of 133 participants (12.1 perce...
1,337 citations