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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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01 Jan 2012
TL;DR: Dans les annees 1970, l’hospitalisation dans les departements des urgences de nombreux sujets âges polypathologiques, avec un declin cognitif et des incapacites severes, a rendu necessaire l�’emergence d’une nouvelle specialite dans de nombs pays : the geriatrie.
Abstract: Dans les annees 1970, l’hospitalisation dans les departements des urgences de nombreux sujets âges polypathologiques, avec un declin cognitif et des incapacites severes, a rendu necessaire l’emergence d’une nouvelle specialite dans de nombreux pays : la geriatrie. En realite, a cette epoque, personne ne souhaitait ou n’etait capable de prendre en charge des sujets âges tres dependants, necessitant des soins au long cours. Pour cette raison, de nombreux departements de medecine geriatrique, essentiellement des services de soins subaigus, et de long sejour, ont ete crees. Depuis, la medecine geriatrique s’est developpee dans de nombreux pays et existe de nos jours sous la forme d’unites de soins aigus, d’hopitaux de jour, d’equipes mobiles et de centres memoire a travers le monde entier. Cependant, dans la plupart des centres, les medecins geriatres accueillent des patients avec des incapacites deja severes a un stade souvent irreversible. Pres de 95 % des forces de la medecine geriatrique s’orientent donc sur des sujets âges qui sont deja dependants. Il est evidemment indispensable de continuer a prendre en charge ces patients, neanmoins, un nouvel axe de la medecine geriatrique doit se developper visant a prendre en charge les patients qui ne sont pas encore dependants mais a risque de le devenir : les sujets fragiles et prefragiles. Il s’agit d’une absolue necessite si nous voulons prevenir et anticiper l’accroissement rapide de la dependance dans notre population vieillissante et promouvoir des soins plus efficients. Les sujets âges fragiles et prefragiles sont ceux qui, selon les criteres de Fried, ont une perte de poids involontaire, une grande sedentarite, une fatigue generale, une faible force musculaire et une vitesse de marche lente [1-7]. Si ces personnes ont au moins un des criteres de Fried, les sujets sont prefragiles ; s’ils ont trois criteres ou plus, ils sont fragiles. Les sujets âges fragiles sont plus a risque de devenir dependants, pourtant aujourd’hui, ils ne sont pas reellement pris en charge par notre systeme de soins. Il s’agit donc, en collaboration avec les medecins de ville, de relever ce challenge. Dans ce but, nous devons proposer une intervention ciblee, forte, et soutenue.

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

  • ...Les sujets âgés fragiles et préfragiles sont ceux qui, selon les critères de Fried, ont une perte de poids involontaire, une grande sédentarité, une fatigue générale, une faible force musculaire et une vitesse de marche lente [1-7]....

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01 Jan 2004
TL;DR: Being physically active would seem to postpone the emergence of needing help in PADL, normal everyday activities, such as household work and walking, are physically moderate but enough to keep up the P ADL of the independent elderly people.
Abstract: Association of Physical Activity and Muscle Strength with the Need of Help in PADL Laakko Katja University of Jyvaskyla, Department of Health Science, Autumn 2004 36 pages, 2 appendices The purpose of this study was to describe the functional ability of men and women over 80 years by studying how well they perform in the physical activities of daily living (PADL). The aim was especially to clarify how physical activity and hand grip strength were connected to the need of help in the physical activities of daily living. The subjects of the study lived independently in their own homes in Tyrnava. 26 men and 47 women took part in the study. The data of this study were collected in the summer of 2002 in connection with preventive home visits in Tyrnava, by personal structured interviews in the subjects’ homes. Variables were analysed by cross-tabulation, Chi-testing, Student’s t-testing and logistic regression analysis methods. The subjects needed help the most with climbing stairs, walking outdoors and cutting toenails. Almost 70 percent of subjects exercised moderately daily. Physically active subjects were more independent in dressing and walking indoors and outdoors than physically less active subjects. The mean hand grip strength was 25,1 kg with men and 14,6 kg with women. The physically active subjects, compared to physically less active subjects, had lower risk of needing help in climbing stairs, dressing and walking outdoors. The risk of needing help in getting in and out of bed was smaller with those subjects who had stronger hand grip strength than those with weaker hand grip strength. Also comorbidity, older age and male sex increased the risk of needing help in some activities. Being physically active would seem to postpone the emergence of needing help in PADL. Normal everyday activities, such as household work and walking, are physically moderate but enough to keep up the PADL of the independent elderly people.
Journal ArticleDOI
TL;DR: In this article, a strategie de depistage de la deficience visuelle au sein de ''l’Hopital de jour d’evaluation des fragilites and de prevention de la dependance'' du CHU de Toulouse was presented.
01 Jan 2015
TL;DR: Visual impairment testing strategy is presented as part of the “Geriatric frailty clinic for assessment of frailty and prevention of disability” at Toulouse CHU and shows that abnormal vision is independently associated with age, lower educational level, lower cognitive performance and lesser degree of autonomy.
Abstract: Frailty is usually defined as a syndrome characterised by increased “latent vulnerability” to an endoor exogenous stress. In Europe, it would concern 25-50% of patients over 85 years old. This condition is associated with an increased risk of loss of autonomy, institutionalisation, dependency and death. Thus, early detection of frailty is required. After 60 years old, the prevalence of visual impairment increased with age from 60 years; it reaches 23 to 38% at 90 years. Visual impairment gained, even slight, is associated with a risk of accidents and loss of autonomy in the elderly. We present the visual impairment testing strategy as part of the “Geriatric frailty clinic for assessment of frailty and prevention of disability” at Toulouse CHU. We analyzed the available ophthalmologic data of 1425 patients evaluated between October 2011 and October 2014, our experience shows that abnormal vision is independently associated with age, lower educational level, lower cognitive performance and lesser degree of autonomy. Abnormal vision is not independently associated with frailty, defined with Fried criteria. Nevertheless, the close relationship between visual impairment and risk of falls, as well as the integration of visual impairment factor in new evaluation index of frail patients are strong arguments for integrating in each geriatric assessment a simple visual testing, that may be very useful in terms of effectiveness of intervention.
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