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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Dissertation•
01 Jan 2013
TL;DR: The number of CM in elderly nursing home residents may be an indicator to prioritize the medication review, and both polypharmacy and comorbidity were associated with a high number of medication changes in four months, regardless of other variables.
Abstract: Objective: To identify factors associated with the number of medication changes (MC) in elderly nursing home residents. Method: Prospective study for 4 months. The number of MC was recorded weekly. We analyzed the factors associated with having a large number of changes (4 or more), calculating the odds ratio as a measure of association through multivariate logistic regression and a confidence interval of 95% (OR, 95% CI) Results: There were 997 CM in 234 residents. A 80.0% of patients had any medication change, while 42.7% of patients had four or more CM. The largest number of MC was associated with nervous system medicines, digestive and metabolism system medicines and cardiovascular system medicines. Factors associated with a large number of CM were having chronic renal failure, immobility, heart failure, loss of visual acuity, dysphagia, edema, comorbidity and polypharmacy. Both polypharmacy and comorbidity (measured by the Charlson index) were associated with a high number of medication changes (iÝ 4) in four months, regardless of other variables. The risk of having a large number of medication changes in patients with polypharmacy is three times higher, while in patients with comorbidity is twice as high. On the other hand, patients suffering from the above diseases had approximately twice the risk of having 4 or more medication changes in four months. Conclusions: A large number of CM is associated with risk factors as indicators of drug-related problems. The number of CM in elderly nursing home residents may be an indicator to prioritize the medication review.
3 citations
Cites background from "Instrumental Activities of Daily Li..."
...Algunos autores han sugerido que esta escala puede ser un indicador de fragilidad (Nourhashemi et al., 2001)....
[...]
TL;DR: Comprehensive geriatric assessment can be used to detect frailty and its associated impairment and comorbidities in elderly patients, and there was higher percentage of ADL, IADL dependence among frail cases.
Abstract: Background and Aim of the Work: Frailty is a
state of reduced physiological reserve associated with increased susceptibility
to disability. It is associated with a high morbidity and mortality. This work
assessed the ability of comprehensive geriatric assessment to detect frailty in
elderly patients. Subjects and Methods: A total number of 104 elderly patients
(above 60 years old) were included in this study and they were subjected to a comprehensive
geriatric assessment (CGA) including: (history
and full clinical examination, Mini mental status examination (MMSE), Geriatric
depression scale (GDS), Activities of daily living (ADL), Instrumental
activities of daily living (IADL). The patients were divided into frail and
non-frail groups using Fried’s criteria as applied by Avila-Funes et al.,
2008, each group included 52 patients. Results: There were no significant
differences between the two groups regarding age gender or smoking habits. But
there was higher percentage of ADL, IADL dependence in addition to higher
incidence of depression and cognitive impairment among frail cases. Conclusion:
Comprehensive geriatric assessment can be used to detect frailty and its
associated impairment and comorbidities.
3 citations
Cites background from "Instrumental Activities of Daily Li..."
...Frail elderly people had a higher number of associated comorbidities more ADL and IADL dependence and also higher rates of depression and cognitive impairment....
[...]
...Nearly all studies published in the field of frailty report deterioration in ADL & IADL In the Women’s Health and Aging Study, Bandeen-Roche et al. 2006 described a cohort of frail adults (aged 70 - 79 years) through 3 years of follow-up, and reported significant outcomes [21]....
[...]
...2001 (used IADL) [22] Ottenbacher et al....
[...]
...Our study showed that cases had higher percentage of ADL & IADL affection than controls and the difference was statistically significant....
[...]
...El-Sherpiny et al. [11]. f) Instrumental activities of daily living (IADL) [12]....
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TL;DR: Assessing both perceived and physiological fall risks is clinically relevant, given it may inform targeted interventions for different at-risk Medicare beneficiaries among clinicians and other stakeholders.
Abstract: This study examined the associations of discrepancies between perceived and physiological fall risks with repeated falls. We analyzed the 2016 Medicare Current Beneficiary Survey of 2,487 Medicare ...
3 citations
Dissertation•
01 Jan 2015
TL;DR: In this article, the associations between late-life depression and frailty were investigated and it was found that physical frailty predicts higher severity of depressive symptoms and a chronic course of depression.
Abstract: Depression is the most common psychiatric disease worldwide. With demographic balance shifting towards an older population, the number of older adults with a lifetime history of depression or subthreshold depression will be significant over the next decades. Depression is a serious psychiatric disease that affects not only the person suffering from depression, but also the social environment oft he person. The course of late-life depression is characterized by high recurrence and relapse rates. Little is known about the causes of this adverse course of depression in older persons.
During the last half of the 20th century, life expectancy rapidly increased and marked the appearance and growth of a vulnerable group of older persons. This shift in age distribution resulted in the introduction of the term frailty. Frailty is a condition conferring vulnerability to poor physical health outcomes, due to a loss of reserve capacity oft he aging body.
The associations between late-life depression and frailty are investigated in this thesis.
We found that frailty prevalence is much higher in depressed older persons, than in non-depressed older persons and that physical frailty predicts higher severity of depressive symptoms and a chronic course of depression.
Frailty can be a useful construct to detect a particularly vulnerable group within depressed older persons that are at risk of a more chronic course of late-life depression. Since frailty is a potentially reversible condition that can be targeted with specific interventions such as exercise, vitamin D supplementation and reduction of polypharmacy, it can guide treatment. Therefore screening for frailty deserves a prominent place in the treatment of late-life depression.
3 citations
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