Understanding whether there is an agreement between older persons who provide information on their functional status and clinicians who assess their function is an important step in the process of creating sound outcome instruments.
To examine whether there is agreement between self-reported and clinician assessment of similar performance items in older adults.
Fifty independent older adults aged 70-91 years (mean age 80.3?±?5.2 years) who live in the community were examined separately and blindly in two data collection sessions. Self-reported and observed lower and upper extremity physical tasks were compared. Life Function and Disability Instrument (LLFDI) was used in both sessions. We performed intra-class correlation coefficients (ICC) as indices of agreement and "mountain plots" that were based on a cumulative distribution curve. Associations between self-reported and observed function with Fear of Fall Scale (FES) and Geriatric Depression Scale (GDS) were also assessed.
ICCs were high between self-reported lower extremity function and observed lower extremity function (ICC?=?0.83), and were poorer for self-reported and observed upper extremity function (ICC?=?0.31). In both comparisons, mountain plots revealed a right shift that was larger for upper than lower extremity functions, indicating systematic differences in self-reported and observed assessments. Associations with FES and GDS were higher for self-reported than observed function.
There is a systematic bias between self-reported and clinician observation. Professionals should be aware that information provided by patients and observation of activity assessed by clinicians could differ substantially, especially for upper extremity function. Implications for Rehabilitation There is a systematic bias between self-reported and clinician assessment of similar performance items in older adults. In general, older adults overestimate their physical function or clinicians underestimate older adults function. The bias between self-reported and clinician assessment for upper extremity function is larger than that for lower extremity function. The conclusions regarding agreement across upper extremity and lower extremity function scores are not different when using mountain plots graphs versus relying solely on the value of the ICCs. However, the graphs expand our understanding of the direction and magnitude of score differences. Professionals should be aware that information provided by patients and assessment by clinicians could differ substantially, especially for upper extremity function.
The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance.
Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB).
Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances.
The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.
The home environment is a key determinant of health, quality of life, and well-being. Given its relevance for such aspects, the scarcity of evaluations of housing adaptation (HA) interventions aimed at removing environmental barriers and accessibility problems in the homes of people with disabilities is surprising. This article aims to contribute to the development of strategies for economic evaluations of HA interventions, by stimulating the dissemination and application of the concepts of effectiveness, cost, and cost-effectiveness as used within health economics.
The focus is limited to three overarching questions for the evaluation of HA interventions. Considering X and Y as two hypothetical interventions for the same individual case, the article asks: (i) Will X be more effective than Y?; (ii) Will X cost more than Y?, and (iii) Will X be more cost-effective than Y? Vignette-like descriptions of fictional cases are used to exemplify the economic concepts explained in the article.
In the conclusion, the need is stressed for new experimental data regarding both costs and outcomes of HA interventions, in order to realize sound evaluations with the potential to inform policy and professionals in this field. Given the heterogeneity among national contexts, systematic approaches applied in a coherent manner could strengthen cross-national research and collaborations.
Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD.
During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up.
To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention.
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The aim of this article is to reveal how family members act, react and reason when their elderly relative considers relocation to a residential home. Since family members are usually involved in the logistics of their elderly relative's relocation, yet simultaneously expected not to influence the decision, the focus is on how family members experience participation in the relocation process in a Swedish context. 17 family members are included in 27 open, semi-structured interviews and follow-up contacts. Prominent features in the findings are firstly the family members' ambition to tone down their personal opinions, even though in their minds their personal preferences are clear, and secondly, the family members' ambivalence about continuity and change in their everyday lives. Family members are found to apply the adapting, the representing, or the avoiding strategy, indirectly also influencing their interaction with the care manager. Siblings applied the adapting strategy, spouses the representing strategy, while family members in the younger generation at times switched between the strategies.
Limited information is available about the impact of seizures on stroke outcome, health care delivery and resource utilization.
To determine whether the presence of seizures after stroke increases disability, mortality and health care utilization (length of hospital stay, ICU admission, consults, discharge to a long-term care facility).
This cohort study included consecutive patients with acute stroke between July 2003 and June 2005 from the Registry of the Canadian Stroke Network (RCSN), the largest clinical database of patients in Canada with acute stroke seen at selected acute care hospitals. We compared clinical characteristics and outcomes amongst patients experiencing stroke without and with seizures occurring during inpatient stay. Main outcome measures included: case-fatality, disability at discharge, length-of-stay, and discharge disposition. A logistic regression analysis was used to determine whether the presence of seizures was associated with poor stroke outcomes.
Amongst 5027 patients included in the study; seizures occurred in 138 (2.7%) patients with stroke. Patients with seizures had a higher mortality at 30-day (36.2% vs. 16.8%, P
Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments.
To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements.
One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined.
The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not.
Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.
The concept of "successful aging" has become widely accepted in gerontology, yet continues to have no common underlying definition. Researchers have increasingly looked to older individuals for their lay definitions of successful aging. The present analysis is based on responses to five questionnaires administered to surviving participants of the male Manitoba Follow-up Study cohort (www.mfus.ca) in 1996, 2000, 2002, 2004, and 2006 (n = 2,043 men were alive at a mean age of 78 years in 1996). One question on each survey asked: "What is YOUR definition of successful aging?" Applying content analysis to the 5,898 narratives received over the 11 years, we developed a coding system encompassing 21 main themes and 86 sub-themes defining successful aging. We quantitatively analyzed trends in prevalence of themes of successful aging prospectively over time. Our findings empirically support colleagues' past suggestions to shift from defining successful aging in primarily biomedical terms, by taking lay views into account.
To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture.
Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables.
Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.
Current Controlled Trials ISRCTN53680197.
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To examine the test-retest reliability, standard error of measurement, minimal detectable change, construct validity, and ceiling and floor effects in the French-Canadian Late Life Function and Disability Instrument (LLFDI-F).
The LLFDI-F is a measure of activity (i.e. physical functioning of upper and lower extremities), and participation (i.e. frequency of and limitations with). The measure was administered over the telephone to a sample of community-living wheelchair-users, who were 50 years of age and older, in this 10-day retest methodological study. The sample (n = 40) was mostly male (70%), had a mean age of 62.2 years, and mean experience with using a wheelchair of 20.2 years. Sixty-five percent used a manual wheelchair.
The test-retest intraclass correlation coefficients (ICC2,1) for the participation component ranged from 0.68 to 0.90 and from 0.74 to 0.97 for the activity component. Minimal detectable changes ranged from 7.18 to 22.56 in the participation component and from 4.71 to 16.19 in the activity component. Mann-Whitney U-tests revealed significant differences between manual and power wheelchair-users in the personal and instrumental role domains, and all areas in the activity component.
There is support for the test-retest reliability and construct validity of the LLFDI-F in community-living wheelchair-users, 50 years of age and older. However, because the majority of items in the lower-extremity domains of the activity component do not account for assistive device use, they are not recommended for use with individuals who have little or no use of their lower-extremities.
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