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Clinical factors associated with activities of daily living and their decline in patients with severe dementia.
Tanaka, H, Nagata, Y, Ishimaru, D, Ogawa, Y, Fukuhara, K, Nishikawa, T
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society. 2020;(3):327-336
Abstract
BACKGROUND To identify the clinical factors affecting activities of daily living (ADL) at baseline and after 6 months. METHODS We conducted a single-centre observational study at two time points across 6 months (baseline and after 6 months) from April 2015 to March 2017. in a 270-bed rural recuperation hospital at Hyogo prefecture in Japan. The total number of participants was 131 (male 33, female 98; mean age: 87.0 ± 7.0; mild and moderate dementia, 38; severe dementia, 93). Measurement scales used were Personal Self-Maintenance Scale (PSMS) for assessing ADL, Mini-Mental State Examination and Cognitive Test in Severe Dementia (CTSD) for cognitive function, Neuropsychiatric Inventory-Nursing Home version and Cornell Scale for Depression in Dementia (CSDD) for behavioural/psychological symptoms of dementia, Mini Nutritional Assessment Short form (MNA-SF) for nutritional status, Pain Assessment in Advanced Dementia for pain, and Charlson comorbidity index (CCI) and the number of illness categories based on Cumulative Illness Rating Scale Geriatrics for comorbidities. Multiple regression analyses identified the association between PSMS score as the dependent variable and other variables as independent variables. RESULTS In participants with severe dementia, the PSMS scores at baseline were significantly associated with CTSD, CCI, MNA-SF, and CSDD scores. In the longitudinal analysis, only CTSD score was significantly associated with PSMS score after 6 months. It is noteworthy that for participants with severe dementia, the only factor associated with ADL after 6 months was cognitive function, as assessed by CTSD score. CONCLUSIONS The most important factor predicting functional decline is cognitive function, even at the severe and profound stage.
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Predictors of Readiness for Mobility Transition in Older Drivers.
Kandasamy, D, Harmon, AC, Meuser, TM, Carr, DB, Betz, ME
Journal of gerontological social work. 2018;(2):193-202
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Abstract
We administered the Assessment of Readiness for Mobility Transition (ARMT) to 301 older drivers and compared total scores with participant characteristics. Overall, 18% of participants were not attitudinally ready for mobility transition, while 19% were very ready. Notably, participants with hospitalizations in the past year were either very ready for mobility transition (20% vs 14% without hospitalizations) or not ready at all (30% vs 17%). Significant health events may polarize reactions towards mobility transition. Individualizing communication about driving cessation readiness could help address such differing views. To further consider its effectiveness, ARMT could be utilized in mobility transition counseling interventions.
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Unfavorable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study.
Naito, T, Okayama, T, Aoyama, T, Ohashi, T, Masuda, Y, Kimura, M, Shiozaki, H, Murakami, H, Kenmotsu, H, Taira, T, et al
BMC cancer. 2017;(1):800
Abstract
BACKGROUND Cancer cachexia in elderly patients may substantially impact physical function and medical dependency. The aim of this study was to estimate the impact of cachexia on activity of daily living (ADL), length of hospital stay, and inpatient medical costs among elderly patients with advanced non-small-cell lung cancer (NSCLC) receiving chemotherapy. METHODS Thirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to receive first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. ADL was assessed using the Barthel index. The disability-free survival time (DFS) was calculated as the time between the date of study entry and the date of onset of a disabling event, which was defined as a 10-point decrease in the Barthel index from that at baseline. The mean cumulative function of the length of hospital stay and inpatient medical costs (¥, Japanese yen) was calculated. RESULTS The study patients comprised 11 women and 19 men, with a median age of 74 (range, 70-82) years. Cachexia was diagnosed in 19 (63%) patients. Cachectic patients had a shorter DFS (7.5 vs. 17.1 months, p < 0.05). During the first year from study entry, cachectic patients had longer cumulative lengths of hospital stay (80.7 vs. 38.5 days/person, p < 0.05), more frequent unplanned hospital visits or hospitalizations (4.2 vs. 1.7 times/person, p < 0.05), and higher inpatient medical costs (¥3.5 vs. ¥2.1 million/person, p < 0.05) than non-cachectic patients. CONCLUSIONS Elderly NSCLC patients with cachexia showed higher risks for disability, prolonged hospitalizations, and higher inpatient medical costs while receiving chemotherapy than patients without cachexia. Our results might indicate that there is a potential need for an early intervention to minimize progression to or development of cachexia, improve functional prognosis, and reduce healthcare resource burden in this population. TRIAL REGISTRATION Trial registration number: UMIN000009768 . Name of registry: UMIN (University hospital Medical Information Network). Date of registration: 14 January 2013. Date of enrolment of the first participant to the trial: 23 January 2013.
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Activity Profile and Energy Expenditure Among Active Older Adults, British Columbia, 2011-2012.
Madden, KM, Ashe, MC, Chase, JM
Preventing chronic disease. 2015;:E112
Abstract
INTRODUCTION Time spent by young adults in moderate to vigorous activity predicts daily caloric expenditure. In contrast, caloric expenditure among older adults is best predicted by time spent in light activity. We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. METHODS Fifty-four community-dwelling men and women aged 65 years or older (mean, 71.4 y) were enrolled in this cross-sectional observational study. All were members of the Whistler Senior Ski Team, and all met current American guidelines for physical activity. Activity levels (sedentary, light, and moderate to vigorous) were recorded by accelerometers worn continuously for 7 days. Caloric expenditure was measured using accelerometry, galvanic skin response, skin temperature, and heat flux. Significant variables were entered into a stepwise multivariate linear model consisting of activity level, age, and sex. RESULTS The average (standard deviation [SD]) daily nonlying sedentary time was 564 (92) minutes (9.4 [1.5] h) per day. The main predictors of higher caloric expenditure were time spent in moderate to vigorous activity (standardized β = 0.42 [SE, 0.08]; P < .001) and male sex (standardized β = 1.34 [SE, 0.16]; P < .001). A model consisting of only moderate to vigorous physical activity and sex explained 68% of the variation in caloric expenditure. An increase in moderate to vigorous physical activity by 1 minute per day was associated with an additional 16 kcal expended in physical activity. CONCLUSION The relationship between activity intensity and caloric expenditure in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviors.
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Patterns of physical activity and sedentary behavior after bariatric surgery: an observational study.
Chapman, N, Hill, K, Taylor, S, Hassanali, M, Straker, L, Hamdorf, J
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2014;(3):524-30
Abstract
BACKGROUND Engaging in low levels of physical activity (PA) and accumulating prolonged periods of sedentary behavior (SB) during daily life have been associated with deleterious health outcomes. The objective of this study was to undertake an analysis of the way in which PA and SB were accumulated after bariatric surgery. METHODS Adults 12 to 18 months after laparoscopic adjustable gastric banding or 6 to 18 months after laparoscopic sleeve gastrectomy wore 2 activity monitors during the waking hours for 7 days. Anthropometric and demographic data were recorded. RESULTS Data were available on 40 participants (30 females; median ± interquartile range: age 46 ± 16 years, time since surgery 14 ± 8 months, body mass index 36 ± 9 kg/m(2)). The proportion of waking hours spent in SB, light PA, moderate PA, and vigorous PA was 72% ± 12%, 22% ± 9%, 5% ± 3% and 0% ± 0%, respectively. Half of the time in SB was accumulated in uninterrupted bouts ≥ 30 minutes. Almost all PA was accumulated in bouts<10 minutes in duration. The median daily step count was 9108 ± 4360. The proportion of people who completed an average of ≥ 10,000 steps/d was similar to that reported in Western Australian adults (39% versus 32%; P = .35). CONCLUSION Our sample spent>70% of time in SB, half of which was accumulated in uninterrupted bouts ≥ 30 minutes. Very little time was spent in moderate or vigorous PA (5%), and this was accumulated in short bouts (<10 minutes). Healthcare professionals should target not just overall time in SB and PA, but also aim to reduce prolonged periods of SB and increase sustained periods of PA.