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Journal ArticleDOI

Instrumental Activities of Daily Living as a Potential Marker of Frailty A Study of 7364 Community-Dwelling Elderly Women (the EPIDOS Study)

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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Citations
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17 Feb 2014
TL;DR: Policymakers, managers and professionals within health and social care are suggested to further promote the establishment of comprehensive continuum of care for frail older persons, in order to enhance quality of care from the older persons’ perspective.
Abstract: Frail older persons are often dependent on care and support from several different care providers, including hospital and primary health care as well as municipal health and social care. The increasing complexity of care requires attention to quality issues. The overall aim of this thesis was to explore quality of care for frail older persons in regard to continuum of care. The focus was on organizing integrated care (i.e. structure), older persons’ influence on care-planning meetings (i.e. process) as well as the older persons’ views of quality of care and life satisfaction (i.e. outcome). Paper I included official reports on ways of organizing integrated care in Sweden during the past decade. Data for Papers II-IV were collected in an interdisciplinary intervention project, including assessment of need for health/social care and rehabilitation at the hospital, interprofessional teamwork, a municipal case manager, the organizing of care-planning meetings in the older persons’ homes and support for relatives. The data analyses consisted of a meta-analysis of cases (Paper I), qualitative content analysis of audio-recorded care-planning meetings (Paper II) as well as statistical analyses of frail older persons’ views of quality of care (Paper III) and life satisfaction (Paper IV). The development of organizing integrated care over the past decade included several different strategies, some of them implying a direction towards enhanced integration, but others a direction towards fragmentation of care. Reported goals focused on the care providers’ perspective rather than the older persons’ perspective. Furthermore, the organizing of care-planning meetings in the older persons’ own homes appeared to enable older persons’ participation. However, their possibilities to obtain real influence over the way of delivering or organizing home care were restricted by organizational rules, regardless of where the meetings took place. The intervention had a positive effect on older persons’ own evaluations of quality of care. Those who received the intervention rated higher quality on all items of care planning and they also had better knowledge of whom to contact. In addition, the intervention had a positive effect on the older persons’ life satisfaction, including satisfaction with functional capacity, psychological health and financial situation. Policymakers, managers and professionals within health and social care are suggested to further promote the establishment of comprehensive continuum of care for frail older persons, in order to enhance quality of care from the older persons’ perspective.

12 citations


Cites result from "Instrumental Activities of Daily Li..."

  • ...In line with other researchers, I have adapted a more comprehensive approach to frailty, including physical, psychological and social functioning (Gobbens et al. 2010, Nourhashémi et al. 2001)....

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Journal ArticleDOI
TL;DR: Physical, cognitive, functional, and psychosocial factors each contribute to the risk profile for both the development of frailty and the likelihood of experiencing UI.

12 citations

Journal ArticleDOI
TL;DR: In this article, the authors examine gender differences in the experience of difficulties carrying out basic and instrumental activities of daily living (ADLs) in community-living people over the age of 65, using Chile as a case study.
Abstract: Discourses on successful ageing have changed the way older age is viewed and the possibilities associated with it. However, such discourses do not always take into account differential capacities and resources that may shape disadvantage for women. The aim of this article is to examine gender differences in the experience of difficulties carrying out basic and instrumental activities of daily living (ADLs) in community-living people over the age of 65, using Chile as a case study. We also examine the effect of healthcare provider on performance of ADLs. We carried out logistic regressions on cross-sectional data from a sample of over 33,000 men and women, drawn from the 2015 National Socioeconomic Characterisation Survey, conducted by the Ministry of Social Development of the Government of Chile. We found significant gender differences in experiences of performing ADLs for older people in Chile, with women consistently reporting more problems than men. The affiliation with the public health provider was also associated with gender differences. The results of our study indicate that women in Chile experience structural disadvantage in their efforts to age successfully, reporting higher levels of functional limitations. We argue that it is important that gender-sensitive public health initiatives be developed, focusing on the prevention of functional disability.

12 citations


Cites methods from "Instrumental Activities of Daily Li..."

  • ...For the purposes of our analysis, the last four categories were grouped together under the category ‘with difficulty’ (for similar binary response options, please see Dunlay et al., 2015; Nourhashémi et al., 2001; Reijneveld, Spijker, & Dijkshoorn, 2007)....

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Journal ArticleDOI
TL;DR: This Review describes the methods currently available for nonspecialist evaluation of aging individuals, including behavioral, interview and questionnaire assessments, and focuses on those measurements that are fairly comprehensive yet concise, easy to administer in an office setting, and available in English.
Abstract: Many forms of functional decline are preventable, treatable or manageable, but a screening tool that can identify frail or vulnerable patients is much needed. This Review describes the methods currently available for non-specialist evaluation of patients at risk of functional decline, including behavioral, interview and questionnaire assessments. The normal course of aging is associated with gradual declines in a number of functional abilities. Patients who are at high risk of functional decline are described as frail or vulnerable. A screening tool to identify such patients is needed, as it has been shown that intervention can delay the onset and/or slow the progression of functional decline. This Review describes the methods currently available for nonspecialist evaluation of aging individuals, including behavioral, interview and questionnaire assessments. Such assessments can be undertaken during routine physician visits. In recognition of the time pressures on physicians, this article focuses on those measurements that are fairly comprehensive yet concise, easy to administer in an office setting, and available in English.

11 citations


Cites background from "Instrumental Activities of Daily Li..."

  • ...IADL questions 8-item scale evaluating ability to carry out IADLs “Because of a health or physical problem, do you have any difficulty using the telephone?” 7,364 women aged >75 years Nourhashemi et al. (2001)23...

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References
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Journal ArticleDOI
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

Journal ArticleDOI
Eric Pfeiffer1
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

Journal ArticleDOI
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

Journal ArticleDOI
10 Jul 1987-Science
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

Journal ArticleDOI
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