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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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Journal ArticleDOI
TL;DR: An updated Cochrane review found that multicomponent group exercise programs reduced the risk and rate of falling, as did Tai Chi and home-based individual exercise programs, and multifactorial interventions based on assessment also reduced the rate of falls.

6 citations


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

  • ...Not surprisingly, falling is a marker of frailty and is associated with functional decline.(10) Critically, a fall is also a ‘‘major event in the life of an older person,’’(11) leading to increased risk of depression, isolation, and fear of performing daily activities....

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01 Jan 2019
TL;DR: Una intervencion multiple fisica, nutricional, neurocognitiva y farmacologica desde Atencion Primaria es eficaz en revertir medidas de fragilidad tanto a corto plazo como a los 18 meses.
Abstract: En la presente tesis doctoral se ha evaluado el efecto a corto y largo plazo de una intervencion multifactorial para modificar parametros relacionados con la fragilidad fisica y cognitiva en personas de 65 anos o mas, convivientes de la comunidad; secundariamente se analizo la mortalidad, fracturas, hospitalizaciones e inclusion en programa de atencion domiciliaria (Atdom) en los pacientes reclutados. Se realizo un estudio multicentrico, aleatorizado, ciego simple, de grupos paralelos en ancianos prefragiles y fragiles que viven en la comunidad en Barcelona ciudad. Un total de 352 pacientes, de ≥65 anos con predeteccion de fragilidad positiva fueron asignados al azar en dos grupos para recibir 12 semanas de intervencion multidisciplinar o su atencion habitual, con asignacion oculta. La intervencion consistio en: fisioterapia con ejercicios multicomponente, ingesta de batidos nutricionales hiperproteicos en las semanas de ejercicio fisico, talleres de estimulacion cognitiva y revision de medicacion, en especial farmacos psicotropicos, durante la intervencion. Las medidas realizadas tanto en intervencion (GI) como en control (GC), en el momento basal, a los 3 meses y a los 18 meses se detallan en la seccion de resultados. Tales resultados se evaluaron con analisis multivariante por intencion de tratar, con imputacion de valores perdidos, en ambos cortes. Los resultados revelan que el 98.6% de participantes completaron la primera fase, con un 24% de perdidas de la muestra a los 18 meses. La edad media fue de 77.3 anos, 89 sujetos prefragiles (25.3%) y 75.3% mujeres (n = 265). A los 3 y 18 meses del inicio de la intervencion, la diferencia de medias ajustadas entre los grupos mostro mejoras significativas para el GI en todas las comparaciones fisicas: la media del Short Physical Performance Battery mejoro 1.58 y 1.36 (p 0.8 y >0.7 para la mayoria de los dominios de parametros de fragilidad estudiados en el corte de los 3 meses, aunque tales efectos se atenuan levemente en todos los casos a los 18 meses, con predominio de los mentales. Al finalizar el estudio, hubo mas fallecimientos (6.8% vs 3.4%, p-valor no significativa), fracturas (12.4% vs 6.5%, p=0.062), hospitalizaciones (17.2% vs 5.9%, p=0,001) y progresion a programa Atdom (15.9% vs 6.2%, p=0,004) en el GC respecto al GI. Conclusion: una intervencion multiple fisica, nutricional, neurocognitiva y farmacologica desde Atencion Primaria es eficaz en revertir medidas de fragilidad tanto a corto plazo como a los 18 meses.

6 citations


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

  • ...En un grupo de mujeres ancianas que vivían en la comunidad, con aparente buen estado de salud, la existencia de deterioro en una o más de las actividades instrumentales de la vida diaria (AIVD) se asoció significativamente con la presencia de enfermedades crónicas, deterioro cognitivo, caídas y con una menor actividad social (116)....

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Journal ArticleDOI
TL;DR: Choyc et al. as mentioned in this paper performed a study to determine the levels of depressive symptoms among community elderlies and reveal its related factors, specifically aimed at revealing factors such as social support, family support and physical function.
Abstract: This study was performed to determine the levels of depressive symptoms among community elderlies and to reveal its related factors, specifically aimed at revealing factors such as social support, family support and physical function.The interviews were performed, during the period from April 1st, to June 30th, 2010, to 995 elderlies in Daejeon city. As a results, social support, family support, ADL and IADL was found to be in a positive correlation with depressive symptoms. With the analysis of covariance structure, social support was more influential on the level of depressive symptom than family support and physical function. It was found to have the inter-relational effects that the greater the social support, family support and physical function, the lower the level of depressive symptoms. Key Words : Elderly, Depressive symptom, Social support, ADL, IADL. * 교신저자 : 조영채(choyc@cnu.ac.kr)접수일 11년 10월 04일 수정일 11년 10월 27일 게재확정일 11년 11월 10일 1. 서론 인간은 누구나 연령이 증가함에 따라 자연적인 현상으로 신체적, 심리적, 사회적 노화과정을 거치게 되는데, 노화로 나타나는 두드러진 정신기능변화의 하나로 우울경향의 증가를 들 수 있다 [1]. 특히 노년기에는 배우자나 가족, 친구의 죽음, 퇴직으로 인한 사회적지지의 감소, 경제적 상실, 신체적 건강약화 등과 같은 일들을 경험하게 되는데 이는 노인우울로 발전될 가능성을 높이는 위험요인이 될 수 있다[2].노인들의 우울 수준은 인구사회학적 특성이나 건강상태[3], 기능적 능력[4], 사회적지지[5] 및 가족지지[6] 등

6 citations


Additional excerpts

  • ...노인들의 우울 수준은 인구사회학적 특성이나 건강상 태[3], 기능적 능력[4], 사회적지지[5] 및 가족지지[6] 등...

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Journal ArticleDOI
19 Jan 2020
TL;DR: The aim of this study was to identify the risk factors for falls in an outpatient setting and to describe a wide range of risk factors.
Abstract: Background Falls are one of the major causes of disability in older people. A wide range of risk factors for falls are described according to setting - inpatient, nursing homes and community. The aim of this study was to identify the risk factors for falls in an outpatient setting. Methods In this cross-sectional observational study, 160 consenting subjects were enrolled randomly, from the Geriatric Medicine outpatient department, All India Institute of Medical Sciences, New Delhi, India. Non-ambulatory, seriously ill subjects were excluded. The subjects underwent brief evaluation including falls and geriatric assessment. They were grouped into fallers and non-fallers. A multivariable logistic regression analysis was used to identify the factors associated with falls. Results The prevalence of falls was 23.75% (38/160). Women were proportionately higher (26.31%) in the fallers group vis-a-vis 19.67% in the non-fallers group. After multivariate analysis, opioids (odds ratio [OR] 5.24 [95% CI, 2.0 18-13.611]), vision impairment (OR 2.71 [95% CI, 1.050-07.011]), fear of falling (OR 3.17 [95% CI, 1.167-08.629]), instrumental activity of daily living (IADL) impairment (OR 3.41 [95% CI, 1.251-09.301]), anti-anginal medications (OR 8.90 [95% CI, 0.997-79.564]) and self-employment (OR 5.37 [95% CI, 1.058-27.329]) were associated with falls. Adequate nutrition (OR 0.82 [95% CI, 0.688-00.976]) and caregiver support (OR 0.46 [95% CI, 0.275-00.801]) were protective of falls. Conclusion We identified the multi-factorial etiology of falls. Patients having any of the above risk factors should undergo detailed fall risk assessment and preventive measures afterwards.

6 citations

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