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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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Journal ArticleDOI
TL;DR: Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition; the best indicator to discriminate fit versus frail was exhaustion.
Abstract: PURPOSE: The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS: After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS: Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION: Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression. Language: de

5 citations

Journal ArticleDOI
TL;DR: In this paper, a semi-automated acquisition and analysis of health data to assess and predict the dependence in older adults while executing one instrumental activity of daily living (IADL) is presented.

5 citations

Dissertation
26 Sep 2005
TL;DR: In this article, the authors compare the modeles logistiques ordonnes mixtes and modeles a effets aleatoires en prenant comme reponse l'incapacite consideree comme variable binaire afin d'illustrer les aspects suivants : choix de la structure de covariance, importance de donnees manquantes and des covariables dependantes du temps, interpretation des resultats.
Abstract: La modelisation de reponses binaires ou ordinales correlees est un domaine de developpement important en epidemiologie. L'etude longitudinale de l'incapacite des personnes âgees et la recherche des facteurs de risque de la vie en incapacite represente un enjeu crucial de sante publique. Dans ce contexte nous comparons les modeles logistiques marginaux et les modeles a effets aleatoires en prenant comme reponse l'incapacite consideree comme variable binaire afin d'illustrer les aspects suivants : choix de la structure de covariance, importance de donnees manquantes et des covariables dependantes du temps, interpretation des resultats. Le modele a effets aleatoires est utilise pour construire un score predictif de l'incapacite issu d'une large analyse des facteurs de risque disponibles dans la cohorte Epidos. Les modeles logistiques ordonnes mixtes sont ensuite decrits et compares et nous montrons comment ils permettent la recherche d'effets differencies des facteurs sur les stades d'incapacite.

5 citations

Journal ArticleDOI
TL;DR: In this paper , the authors proposed a semi-automated approach to assess and predict the dependence in older adults while executing one instrumental activity of daily living (IADL).

5 citations

13 Oct 2017
TL;DR: In this paper, the authors evaluate the performance of l'outil ''ABCDEF'' for prevenir les complications of a morbi-mortalite a 6-month period, including chutes, fractures osteoporotiques, hospitalisations non-programes, and dependance.
Abstract: La fragilite responsable d’une morbi-mortalite, doit etre depistee pour prevenir les complications de celle-ci. « ABCDEF », outil de depistage de la fragilite a ete valide en medecine generale. Objectif : Evaluer la performance de l’outil « ABCDEF » pour predire a 6 mois la survenue du critere composite « chutes, fractures osteoporotiques, hospitalisations non programmees y compris consultations aux urgences, dependance, institutionnalisation et mortalite » chez des sujets âges et comparer cet outil aux criteres de Fried pour predire la morbi-mortalite a 6 mois. Methodes : Une etude prospective non-interventionnelle a ete menee en consultation de medecine generale, incluant sur 6 mois, des patients de 70 ans et plus. Ils ont ete evalues par les outils « ABCDEF » et Fried. Le critere composite etait recherche a 3 et 6 mois. Resultats : L’etude a ete realisee sur 295 patients. Pour predire le critere composite a 6 mois, l’outil « ABCDEF » avait une sensibilite de 24,7 %, une specificite de 88,6 %, une valeur predictive negative de 74,4 % et une valeur predictive positive de 46,7 %. Il etait significativement associe a la survenue a 6 mois du critere composite (OR = 2,5 ; p = 0,0071), de la dependance (OR = 4,5 ; p = 0,0002) et d’hospitalisations (OR = 2,7 ; p = 0,021). Aucun de ces 2 outils n’etait plus performant pour predire la morbi-mortalite a 6 mois. Conclusion : « ABCDEF » predit la morbi-mortalite a 6 mois. Il est aussi performant que Fried mais s’affranchit d’un materiel specifique. Lorsqu’il est anormal (score ≥3/6), une evaluation geriatrique standardisee est necessaire pour la mise en place d’un plan personnalise de soins.

4 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