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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01 Jan 2019
TL;DR: This chapter will provide an overview of the current state of assessment models for frailty syndrome in the elderly and will describe a new assessment tool based on mobile technology, which takes account and advantage of the ways in which elderly people interact with a touchscreen.
Abstract: Frailty is a common clinical syndrome in older adults; it carries an increased risk of negative health events and outcomes including falls, incident disability, hospitalization, and mortality. Therefore, it is critical to identify high-risk subsets of the elderly population and explore new arenas for frailty prevention and treatment. This chapter will provide an overview of the current state of assessment models for frailty syndrome in the elderly and will describe a new assessment tool based on mobile technology, which takes account and advantage of the ways in which elderly people interact with a touchscreen. While healthcare providers and researchers in the field of aging have long been aware of the changing characteristics and needs of older people living in the community, there has not been any marked change in frailty syndrome assessment models until now. In the twenty-first century world with its technological advancements, the elderly require new, special physical skills combining perceptual, motor, and cognitive abilities for their functional daily activities and for maintaining their independence and quality of life.
2 citations
03 Feb 2012
TL;DR: This thesis aims to explore the relationship between health, aging and occupation in community-dwelling older adults in Sweden and the findings will help clarify the role of environmental factors in the development of older adults.
Abstract: LIST OF PAPERS ABBREVATIONS INTRODUCTION 7 Opening statement 7 Aging and its consequences 7 Relations between health, aging and occupation 10 Everyday life of older persons 13 Health promotion for community-dwelling older adults 15 Rationale for this thesis 17 AIMS 19 METHODS 20 Study I 20 Study II 21 Studies III and IV 22 ETHICAL CONSIDERATIONS 31 RESULTS 32 Study I 32 Study II 33 Studies III and IV 35 DISCUSSION 39 Discussion of the findings 39 Methodological considerations 46 CONCLUSIONS 53 FUTURE RESEARCH 54 SWEDISH SUMMARY 55 ACKNOWLEDGEMENTS 56 REFERENCES 58 PUBLICATIONS
2 citations
Cites result from "Instrumental Activities of Daily Li..."
...One conclusion in study I, supported by other studies [11, 97, 126, 127], was that HPDP programs should target older persons with moderate frailty instead of those with severe frailty, and that HPDP interventions are likely to be more successful if they target older persons at an early stage of frailty....
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06 Apr 2016
TL;DR: La mitad of los pacientes presentaban RD, estos presentaban mayor prevalencia of salud bucal no satisfactoria, dependencia of las ABVD, uso de farmacos with alteracion del gusto y menor uso of farmacOS para el dolor.
Abstract: Introduccion: El estado nutricional adecuado, entre otros factores, es un aspecto de importancia para la conservacion de la autonomia funcional de los adultos mayores. Objetivos: determinar los factores biopsicosociales asociados en el adulto mayor que conllevan al riesgo de desnutricion (RD). Paciente y Metodos: Estudio observacional descriptivo, corte transversal con componente analitico, incluyo a 124 adultos mayores de ambos sexos que viven en Hogares de la ciudad de Asuncion- Paraguay. Muestreo: No probabilistico por conveniencia. Variables analizadas: Riesgo de desnutricion (RD), Comorbilidad, depresion, Salud bucal, Funcion mental, Capacidad funcional, Medicacion con afeccion nutricional y para el dolor. Resultados: Se encontro RD en un 50% de los varones, y 42% de las mujeres Por orden de prevalencia, patologias asociadas: Cardiopatias 55%, HTA 45%, artrosis 40%, DM tipo 1 32%, EPOC y ACV 12% respectivamente, Parkinson 10% e IRC 2% En un 64% de las mujeres y 75% de los varones una salud bucal no satisfactoria. Presentaron en 42% depresion moderada y en 20% depresion severa,Presencia de deterioro cognitivo severo en 8%, moderado 20% y leve 6%, En un 16% con dependencia para todas las actividades y solo en 15% independencia en todas las ABVD.Farmacos 58% de antiacidos, 37% laxantes, 15% de antidepresivos triciclicos. Solo el 12% presentaba manejo farmacologico para el dolor. Conclusion: La mitad de los pacientes presentaban RD, estos presentaban mayor prevalencia de salud bucal no satisfactoria, dependencia de las ABVD, uso de farmacos con alteracion del gusto y menor uso de farmacos para el dolor.
2 citations
TL;DR: In the researched group, the level of satisfaction with life varied, with lower results among the residents of the nursing home, whereas for those living in a home environment, functional fitness was the key factor in its determination.
Abstract: Background. life satisfaction may refer to one’s life evaluation, social skills and engagement in life activities. Objectives. evaluation of life satisfaction and functional fitness of people over 60 years of age living in a nursing home and home environment. Material and methods. a survey research was conducted at the turn of 2013 and 2014 in a group of 101 subjects over 60 years of age. This group comprised of 50 residents of the “kombatant” nursing home in ciechanow and 51 subjects staying in a home environment. in the research, the satisfaction With life scale (sWls) and barthel scale were used. Results. analysis of the results shows that the mean index of satisfaction with life among all subjects reached 20.7 ± 6.21 with a median of 23, which indicated an average level of satisfaction with life. in a home environment, 50.98% of the subjects reported a high level of satisfaction with life as compared to only 20% in the nursing home. as for evaluation of functional fitness, more than half of the subjects (53.47%) scored 21 to 85 points according to the barthel scale, and their condition was determined as “moderate to severe”. a high positive correlation (r = 0.7) was also observed between the functional state described as “moderate to severe” among the subjects staying in a home environment and their satisfaction with life. Conclusions. in the researched group, the level of satisfaction with life varied, with lower results among the residents of the nursing home, whereas for those living in a home environment, functional fitness was the key factor in its determination.
2 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