Daily life patterns associated with 18-months changes of disability among frail elderly living at home

The purpose of this study was to investigate daily life patterns associated with changes of disability over 18-months among frail elderly living at home. Subjects were 50 frail elderly living at home who were interviewed at baseline, in July-September 1995. By detailed time budgets among them, five life patterns were classified. Lying-rest life pattern, Sitting-rest life pattern, Hobby life pattern, Walking life pattern, and Houseworking life pattern. Activities of daily living (ADL) measured by Extended ADL Index consisted of 8 items of Barthel Index and 4 items of TMIG Index of Competence. Information for follow-up were obtained from home health nurses or mail-questionnaires February-March in 1997. The results were as follows: All samples were able to be followed. Seven people died within the 18 months follow-up. Overall change of score on ADL was not seen between baseline and follow-up study. ADL improvement was seen in 45.0% and 43.7% had declines. Daily life patterns were not correlated with changes in ADL score. However, analysis of decline in ability to perform each activities, relative associations (not statistically significant) were found for changes in function and daily life patterns. Lying-rest life pattern and Sitting-rest life pattern elderly were more likely to decline in ADL than Walking life pattern and HouseworKing life pattern elderly. Hobby life pattern elderly only declined in walking. These findings support previous studies showing that disability of home frail elderly could be improved. Daily life pattern among them would be a helpful predictor of changes in specific physical performance over years.     

Functional outcome after brain tumor and acute stroke: a comparative analysis

OBJECTIVE: To compare the functional outcome, length of stay, and discharge disposition of patients with brain tumors and those with acute stroke. DESIGN: Case-controlled, retrospective study at a tertiary care medical center inpatient rehabilitation unit. SUBJECTS: Sixty-three brain tumor patients matched with 63 acute stroke patients according to age, sex, and location of lesion. MAIN OUTCOME MEASURES: The functional independence measure (FIM) was measured on admission and discharge. The FIM change and FIM efficiency were also calculated. The FIM was analyzed in three subsets: activities of daily living (ADL), mobility (MOB), and cognition (COG). Discharge disposition and rehabilitation length of stay were compared. RESULTS: Demographic variables of race, marital status, and payer source were comparable for the two groups. No significant difference was found between the brain tumor and stroke populations with respect to total admission FIM, total discharge FIM, change in total FIM, or FIM efficiency. The admission MOB-FIM was found to be higher in the brain tumor group (13.6 vs 11.1, p = .04), whereas the stroke group had a greater change in ADL-FIM score (10.8 vs 8.3, p = .03). The two groups had similar rates of discharge to community at greater than 85%. The tumor group had a significantly shorter rehabilitation length of stay than the stroke group (25 vs 34 days, p < .01). CONCLUSION: Brain tumor patients can achieve comparable functional outcome and rates of discharge to community and have a shorter rehabilitation length of stay than stroke patients.     

The Barthel activities of daily living index: self-reporting versus actual performance in the old-old (> or = 75 years)

BACKGROUND AND PURPOSE: The Barthel Index for assessing activities of daily living (ADL) was developed particularly for young stroke patients, but it now has a wider application in the geriatric assessment profile. This study tests the validity of the Barthel Index by self-report in the old-old (> or = 75 years). If more than 10% of the studied population assessed themselves incorrectly (> or = 15-point discrepancy), the test may have limitations. We set out to try to quantify and explain this discrepancy. METHODS: During a 3-month period, we tested 126 old-old patients, both geriatric medical inpatients and subjects from the community, in a cross-sectional study. Using the Barthel Index, their functional status was assessed by self-report and by observation of performance. A measure of the magnitude of discrepancy between the two methods (discrepancy score) was calculated as the difference between the self-report and performance total scores. RESULTS: Comparing the self-report with actual ADL performance scores, the mean score for self-report was higher (90 vs 88). There was a low Kappa score in all areas of the scale (range 0.103-0.398). Twenty of the 126 patients (15.9%) scored 15 or more points in the discrepancy score. By running a multiple linear regression, we were able to explain only 21% of the variance in the discrepancy score (R2 = .21). Significant explanatory variables were the presence of cognitive impairment, source of patients from acute geriatric ward, and age (very old > or = 85 years). CONCLUSION: For the purpose of this study, use of the Barthel Index by self-reporting was found to have its limitations in the old-old (> or = 75 years), particularly with regard to the very old (> or = 85 years) medical geriatric inpatients. Therefore, we suggest that the older people may have to be assessed by the rehabilitation services using a performance-based measure or a different self-report test for documenting their activities of daily living, bearing in mind that self-reported and performance-based measures capture physical abilities differently.     

Sonographically guided placement of peripherally inserted central venous catheters: review of 355 procedures

OBJECTIVE: To test whether Wallerian degeneration (WD) of the pyramidal tract as signaled by MRI affects rehabilitation outcome in patients with subcortical infarction (internal capsule or corona radiata). BACKGROUND: Recent radiologic evidence suggests that WD occurs no earlier than 3 months after a subcortical infarction. METHODS: A total of 77 consecutive patients with pure motor hemiparesis due to an initial subcortical infarction were assessed on admission and discharge with the Functional Independence Measure (FIM) for disability and Stroke Impairment Assessment Set (SIAS, full = 25) for impairment. WD was defined by a high-intensity area detected along the pyramidal tract below the level of lesion on T2-weighted MR image (WD+). RESULTS: Age, sex, side of stroke, Mini-Mental State Examination score, and volume of lesion were comparable for each group. Length of stay (LOS) was significantly longer (p < 0.05) in WD+ (130 days) than in WD- (105 days). There was no difference in the change of FIM (WD+, 99 to 111; WD-, 95 to 107) or SIAS measures (WD+, 12 to 16; WD-, 13 to 16) made on admission and discharge, nor was there any effect of the timing of the rehabilitation experience (< or = 90 days or >90 days after stroke). CONCLUSIONS: After stroke, apparent WD of the pyramidal tract may slow functional recovery but does not limit final rehabilitation outcome of pure motor hemiparesis. Study of the mechanisms of compensation for this delayed pyramidal tract degeneration will enhance the scientific basis for rehabilitation.     

Functionalization of nucleoside analogs: regiospecific conversion of 4"-hydroxyl groups to thioesters and deoxygenation of 3''-hydroxyl groups

BACKGROUND AND PURPOSE: We have previously shown that treatment of acute stroke patients in the combined acute and rehabilitation stroke unit in our hospital improves survival and functional outcome compared with treatment in general wards. The primary aim of the present trial was to examine whether the treatment in our stroke unit had an effect on different aspects of quality of life (QoL) for stroke patients 5 years after the onset of stroke. METHODS: In a randomized controlled trial, 110 patients with symptoms and signs of an acute stroke were allocated to the stroke unit and 110 to general wards. No significant differences existed in baseline characteristics between the two groups. The patients alive after 5 years were assessed by the Nottingham Health Profile (NHP) and the Frenchay Activities Index (FAI), which were the scales used as primary outcome measures for QoL. As secondary outcome measures we used a global score for the NHP and a simple visual analogue scale (VAS). RESULTS: After 5 years, 45 of the patients treated in the stroke unit and 32 of those treated in general wards were alive. All surviving patients were assessed by the FAI. Thirty-seven (82.2%) of the stroke unit patients and 25 (78.1%) of the general wards patients were assessed by the NHP; 38 (84.4%) and 28 (87.5%), respectively, were assessed by the VAS. Patients treated in the stroke unit had a higher score on the FAI (P=0.0142). Assessment with the NHP showed better results in the stroke unit group for the dimensions of energy (P=0.0323), physical mobility (P=0.0415), emotional reactions (P=0.0290), social isolation (P=0.0089), and sleep (P=0.0436), although there was no difference in pain (P=0.3186). The global NHP score and VAS score also showed significantly better results in the stroke unit group (NHP, P<0.01; VAS, P<0.001). Patients who were independent in activities of daily living had significantly better QoL assessed by these scales than patients who were dependent. CONCLUSIONS: Our study shows for the first time that stroke unit care improves different aspects of long-term QoL for stroke patients.     

Lipid peroxidation in thyroid tissue of people with diffuse toxic goiter

BACKGROUND: A growing number of dependent elderly people is cared for at home by family members. However, long-term caregiving may become an intolerable strain for some families and lead to failure of family care. The aim of the study was to examine if level of physical and mental disability of the patient influences the extent of perceived caregiver burden representing risk factor for negative outcome. METHODS AND RESULTS: 128 elderly patients with disability and dependency (37 men, 91 women, average age 79.9 +/- 6.9 yrs) and 128 their primary caregivers, mostly family members (28.9% men, 71.1% women) were evaluated. Functional status of care recipient was assessed by means of Barthel ADL Index (mean = 70.9 +/- 26.5), IADL Test (mean = 31.4 +/- 23.5) and Mini-Mental State Exam, MMSE (mean = 20.4 +/- 6.5). Average score of Caregiver Burden Interview (CBI) was 34.7 +/- 18.8. According to CBI, 40.6% of caregivers were found under high or even extremely hig level of stress. Level of perceived burden correlated significantly with physical and mental disability level, in decreasing order for IADL, ADL and MMSE (rs = 0.582-0.708, p < 0.001). CONCLUSIONS: Caregiver burden of family caregivers is significantly related to the level of functioning and cognitive impairment of care recipient, particularly to his/her ability to perform instrumental activities. Functional decline of elderly patient represents a risk factor which contributes to negative caregiving outcome and institutional placement.     

Association of stroke with dementia, cognitive impairment, and functional disability in the very old: a population-based study

BACKGROUND and PURPOSE: Stroke is a major cause of disability in the elderly and is also related to the development of dementia, which is another important source of disability in old age. The aim of the present study was to examine the potential impact of stroke on cognitive and functional status in a community-based cohort of individuals aged 75 years and older. METHODS: The data were derived from a cross-sectional survey on aging and dementia that included all inhabitants of the Kungsholmen district in central Stockholm who were aged >/=75 years. Cases of stroke were identified through the computerized inpatient register system that has been widely used to study stroke in Sweden. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Dementia onset was considered the appearance, according to an informant, of the first symptom. Cognitive impairment without dementia was defined as the presence of a Mini-Mental State Examination score of <24 and the absence of dementia. Functional disability was assessed according to Katz Index of independence in activities of daily living. RESULTS: The prevalence of stroke was 10. 0% in men and 8.0% in women. One third of stroke survivors were diagnosed as demented, which was 3 times higher than those without stroke: adjusted odds ratio (OR) was 3.6 (95% confidence interval, 2. 5 to 5.8). Stroke was also significantly related to cognitive impairment without dementia (adjusted OR, 2.4 [95% confidence interval, 1.3 to 4.6]). The population-attributable risks of dementia and cognitive impairment in relation to stroke were 18.4% and 8.5%, respectively. Among the 49 stroke patients with dementia, 15 cases (30.6%) had missing information on dementia onset, 22 (44. 9%) had been reported by the informant to have dementia-related symptoms after or close to the occurrence of stroke, and 12 (24.5%) had symptoms before stroke occurrence. The prevalence rates of disability in activities of daily living were much higher among stroke patients than among stroke-free subjects, even after adjustment for age, sex, heart disease, hip fracture, and dementia: the corresponding adjusted ORs for bathing, dressing, toileting, transfer, and continence were 3.5 (2.4 to 5.3), 2.2 (1.4 to 3.3), 3. 0 (2.0 to 4.5), 3.3 (1.9 to 5.7), and 2.1 (1.3 to 3.3), respectively. After dementia and hip fracture, stroke was the third largest contributor to disability in bathing, dressing, and transfer. Stroke was the second contributor to disability in toileting. CONCLUSIONS: Stroke is strongly associated with dementia, although it may relate to dementia in different ways: it can be the main cause or a precipitating factor of dementia, or they may share common etiological bases. Together with dementia and hip fracture, stroke is a major contributor to disability in most aspects of activities of daily living in very old people.     

Cognitive impairment among elderly coronary heart disease patients

BACKGROUND: Coronary heart disease (CHD) and decline in cognitive functioning and dementia are common problems in the elderly. Cardiovascular diseases (CVDs) are connected with vascular dementia, but less is known about cognitive functioning among elderly patients with CHD based on population studies. OBJECTIVE: To describe the associations between CHD and cognitive impairment among the elderly. POPULATION AND METHODS: Of the total population of the Lieto study (488 community-dwelling men and 708 women, >/=64 years old), the ambulatory patients with CHD (89 men and 73 women) and sex- and age-matched controls without any sign of CHD (178 men and 146 women) were selected to make up the study population. CHD was defined as the presence of angina pectoris or a past myocardial infarction. Cognitive assessment was based on the Mini-Mental State Examination (MMSE). RESULTS: The total MMSE scores, the MMSE subtest scores and the overall test-based cognitive functioning did not differ between patients and controls. Among men, higher MMSE subscores in orientation and language were related to more severe chest pain. According to logistic regression analyses, the cognitive impairment of men was associated with high age, the use of cardiac glycosides and physical disability. Among women, cognitive impairment was associated with high age and the use of antipsychotics. CONCLUSION: In general, CHD has no independent association with cognitive impairment among the non-institutionalized community-living elderly. Among men, however, a complicated CHD may negatively affect cognitive functioning.     

Quality of life in elderly patients with COPD: measurement and predictive factors

OBJECTIVE: To examine the interrater reliability and completion time of the Functional Assessment Measure, which is the Functional Independence Measure (FIM) plus additional items (FIM+FAM). DESIGN: Interrater reliability study. SETTING: Inpatient rehabilitation units of a postacute care brain injury rehabilitation program. PATIENTS: A convenience sample of 53 extremely severely impaired adult survivors of traumatic brain injuries (40 men, 13 women, mean age 38yrs). MAIN OUTCOME MEASURES: Treatment team members' ratings of the 30 FIM +FAM items, and time taken to complete the FIM+FAM. RESULTS: Intraclass Correlation Coefficients (ICCs) were within the good to excellent range (ICC > .60) for 29 of 30 items and for all subscales except psychosocial adjustment. Higher mean ICC values were obtained for motor domain items than for cognitive/psychosocial domain items. Treatment teams became progressively faster over a 12-week period in completing the FIM+FAM. The generally good to excellent range interrater reliability found in this study helps support the use of the FIM+FAM in rehabilitation settings. Further support was obtained for the finding that motor items are more reliable than cognitive and psychosocial items. Administration of the FIM+FAM can be done in a timely manner in a rehabilitation setting.     

The dimensionality and validity of the Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) Scale

The psychometric properties of the OARS ADL scale, comprised of seven physical activities of daily living (PADL) and seven instrumental activities of daily living (IADL) items, were examined using a Rasch measurement approach. Two of the PADL items failed to demonstrate acceptable goodness-of-fit with the measurement model but the remaining 12 items could be combined into a single measure of ADL ability. Although the OARS ADL scale was designed to identify those community-dwelling elderly who need supports and services to continue to live in the community, the scale items were found to be poorly targeted to community-dwelling elderly since almost half of our sample received maximal scores. Rasch analysis identified how we might improve the sensitivity of the OARS ADL scale but its utility in outcome and longitudinal studies remains questionable.     

Outcomes of stroke survivors in Yamagata Prefecture

PURPOSE: To clarify the long-term outcomes of Stroke survivors registered for the first onset of Stroke in Yamagata Prefecture and to find out problems in community-based-rehabilitation (CBR). SUBJECTS AND METHODS: The present study was performed using stroke survivors as of September 1, 1991 as subjects from residents registered for the onset of Stroke in 1985 and 1989. The subjects were composed of 1,013 residents registered in 1989 (2 years after onset) and 626 registered in 1985 (6 years after onset). RESULTS: The percent of functionally-independent Stroke survivors at 2 and 6 years (indicated in parentheses) after onset is shown by ADL items as follows: 82% (81%) for urination, 78% (78%) for eating, 78% (78%) for walking, 76% (78%) for dressing, and 66% (64%) for bathing. The lowest percent was seen in Bathing. Percentage of cases maintaining the ability to have functionally-independent ADL for all items examined (expressed as persons independent for personal care) were 62% (60%). Of the the cases 91% (91%) resided at home (their own houses or relatives' houses). With regard to overall locomotion, an item used to evaluation the range of going out doors, 45% (44%) could go out alone to visit neighbors or use public transportation. Among persons independent for personal care, 99% (98%) were living at homo, 70% (69%) used public transportation, 23% (23%) went out alone to visit neighbors and 7% (8%) did not go out. CONCLUSION: The results of the present research indicate a great in CBR for that bothpsychological and social health approaches in cooperation with public health centers, medical centers, and welfare agencies not only for persons with decreased ADL, but also for those maintaining high activity potential.     

Current functional assessment tools

In last month's issue of Home Healthcare Nurse, the article "Functional Assessment of the Home Health Client" described the value of performing functional assessment in relation to OASIS and methods to use in assessing a client's ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL). Although many different instruments are used to measure functional ability, this article will describe three of the commonly used instruments for measuring functional ability: the Barthel Index, the Functional Independence Measure (FIM), and PULSES have been tested for reliability and validity. The WeeFIM will also be discussed.     

Assessment of functional ability with the bed rise difficulty scale in a group of elderly patients

The aim of the study (part of the Progetto Longitudinale Gussago) was to evaluate the variables related to the difficulty in rising from a bed in 2 groups of elderly patients: nursing home residents, and patients admitted to a geriatric evaluation and management unit. Functional ability was tested through the bed rise difficulty scale (BRD). The version used in this study considered only those 7 items (out of 12) found to be of value. Only those patients who were able to rise from bed without help were selected in order to achieve the aim of the study (33 males, 113 females; mean age 79.6 +/- 7.3 years). Although the 146 patients assessed were considered as having a good functional level (Tinetti score 18.8 +/- 6.9, ADL Katz score 1.6 +/- 1.4), most of them had high scores on the BRD scale, indicating the ability of this scale to detect early, mild disability. The total score of the BRD scale was significantly related to the ADL Katz (r = 0.29, p = 0.000), Tinetti scale (r = -0.39, p = 0.000) and physical performance test (PTT; r = -0.47, p = 0.000). Similar results were obtained for the correlation between BRD time and ADL Katz (r = 0.033, p = 0.000), Tinetti scale (r = -0.30, p = 0.000) and PPT-(r = -0.46, p = 0.000). In a logistic regression analysis the items of the PPT scale considering upper extremity function and Tinetti balance score were significantly associated with the total bed rise time and score.     

Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years

BACKGROUND AND PURPOSE: This study compared stroke features and poststroke disability in two age groups of patients with ischemic stroke: younger (55 to 70 years) and older (71 to 85 years). Stroke has an impact on daily living in many areas, but whether risk factors, stroke features, and poststroke disability differ between young and old patients with stroke is not so well established. METHODS: A cohort of 486 ischemic stroke patients aged 55 to 85 years admitted consecutively to the Helsinki University Central Hospital (Finland) between December 1, 1993, and March 31, 1995, were examined 3 months after the index stroke. Structured medical, neurological, and radiological (MRI or CT) examinations, mental status, and emotional examination and interview of a close informant were done. Prestroke and poststroke activities of daily living were assessed with five scales: the Index of ADL, Instrumental Activities of Daily Living Scale, Functional Activities Questionnaire, Blessed Functional Activities Scale, and Barthel Index. RESULTS: History of cardiac failure (P < .001), atrial fibrillation (P < .001), and cardioembolic stroke (P = .011) was more frequent in the older age group, whereas stroke due to large-artery atherosclerosis (P = .048) was more common in the younger age group. The older patients more often had major dominant stroke syndrome (P = .018). Comparison of activities of daily living before and after stroke showed that the older age group deteriorated significantly more than the younger age group after adjustment for sex, education, and living conditions (Barthel Index, P = .005; other scales, P < .0001). CONCLUSIONS: The stroke patients in young and old age groups had different risk profiles and stroke features. The older stroke patients were more dependent and disabled beforehand, and after stroke they were relatively even more dependent than the patients in the younger age group. Because older patients already constitute the majority of stroke victims, the importance of early active diagnosis, treatment, rehabilitation, and guidance is stressed.     

The study of senile symptoms and home care on the elderly living in Korea

The purpose of this study is to investigate the daily life and care condition of elderly people living in Korea, and to observe the symptom of senile dementia among them. In the first survey, 713 subjects were screened and 42 subjects were diagnosed as suffering from senile dementia. In the second survey, 26 elderly and their caregivers who agreed to participate in this program, were interviewed. The results were as follows. 1. About 25% of the 713 subjects needed some kind of help in their daily life. 2. 85% of the subjects could go out and about their houses without help. Only 5% of them had a complete or a partial loss of activity. 3. Of all the subjects, 42 were diagnosed as suffering from senile dementia. The prevalence of this disease was calculated at 5.6% in the survey. 4. Each demented elderly person had 5.3 mental symptoms on the average. Depression was observed more among women and violence was observed more among men. 5. The elderly who had a lower CPR score (Caretaker-Patient Relationship Score), indicating a poor relationship between the patient and caretaker, had a higher prevalence of mental symptoms than those who had a higher CPR score.     

Life satisfaction and its related factors among institutionalized patients at a Hansen's disease sanatorium

We conducted a questionnaire survey on life styles and health status for 293 patients with Hansen's disease. They were admitted to the wards for disabled and physically able patients of Ohshima Seishoen, in Kagawa prefecture, in 1991. This institution is one of Japan's national leprosy sanitarians. We measured patients' life satisfaction with the Delighted-Terrible Scale. In this report, the distribution of life satisfaction and its associated factors were examined for 210(71.7%) respondents. Factors examined were length of treatment, physical health, and social aspects of life at the sanatorium. The major findings were as follows; 1. The patients aged under 60 had lower proportions of being satisfied with life than those aged 60 or older. The proportions of life satisfaction of the 40-59 age group were 17% for men and 22% for women, while for the 60 or older age groups were 33-44% for men and 41-45% for women. The proportions of life satisfaction in the 60 or older age groups were lower than those of community dwelling elderly persons. 2. We examined factors associated with life satisfaction for the respondents aged 60 or older. Dependence on activities of daily living (ADL) was associated with life satisfaction in some ADL items. Care and aid provided by the staff of the sanatorium may modify the relationship between ADL impairment and life satisfaction. For social aspects of life at the sanatorium, both having networks with family members and having resources other than family were associated with life satisfaction. Going out and positively spending their daily lives were associated with life satisfaction, too. These associations were significant for men. Similar patterns of association were observed for women, but were insignificant. This finding suggests that it is important for the health and medical care staff to pay attention to the social aspects of the life of elderly patients with Hansen's disease.     

Negative symptoms in stroke patients and length of hospital stay

The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.     

Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study

BACKGROUND: There are no earlier cross-national comparative studies analyzing the functions of the posture control mechanisms and its sensory-motor correlates in elderly subjects. We investigated whether there are differences in balance between elderly subjects living in different geographical areas, and analyzed the sensory-motor associates of balance in men and women separately. METHOD: Using a force platform method, the functioning of the posture control system under three standardized conditions (normal standing, eyes open; normal standing, eyes closed; and tandem standing, eyes open) was studied among samples of 75-year-old residents in three Nordic localities, namely Glostrup in Denmark, G?teborg in Sweden, and Jyv?skyl? in Finland. The associations of the variables describing performance in each test with other sensory and motor functions were studied using correlation analyses and multivariate regression models. RESULTS: Differences between the populations were observed in both tests with visual control, favoring the participants from Glostrup and Jyv?skyl? compared with those from G?teborg. However, only minor differences between the subjects from different localities were observed in the test performed with the eyes closed. In all localities there was a primary sex difference in favor of the women which, however, mainly disappeared when body height was taken into the analyses as a covariate. A good performance in the balance tests (body height-adjusted values) was associated with good visual acuity, low vibrotactile thresholds, and high psychomotor speed. Also, isometric muscle strength, especially hand grip and body extension, was positively associated with good performance in the balance tests. Among the women, a poorer balance was observed in women with a smaller body mass. The results of the multivariate analyses showed that among the men, the most important predictors of good performance in the balance tests were low vibrotactile threshold on the foot, high isometric hand grip strength, and low body stature. Among the women, the most important predictors were low body stature, high body mass, high isometric body extension strength, and high psychomotor speed. However, only a small proportion of the variance in balance (about 13% in the men and 11% in the women) could be explained by the help of these factors. CONCLUSIONS: As the same procedure was applied to the analysis of postural balance, some differences between the populations living in different localities could be detected in some of the tests. The better performance of the women in the balance tests may partly be explained by anthropometric factors, especially differences in body height. There may also be differences in sensory-motor associates of balance in elderly men and women. On the basis of the associations observed, it is difficult to explain the differences in balance between the sexes or subjects living in different localities. Within the sexes, only a small proportion (10-13%) of the variation in balance during normal standing with eyes open could be explained by the factors included in the study.     

The role of cognition in predicting activities of daily living and ambulation functioning in the oldest old rehabilitation patients.

Examined what demographic, medical, cognitive, and affective measures predicted activities of daily living (ADL) and ambulation for 60 geriatric rehabilitation inpatients (aged 85 yrs or older) at discharge. Ss completed the Geriatric Depression Scale, Dementia Rating Scale (DRS), and Functional Independence Measure. Cognition, as measured by the DRS, was the only significant predictor of both ADL and ambulation scores. Gender was correlated with ADL skills, indicating that women attained higher ADL scores, while men did better on ambulation skills. DRS scores accounted for 8% of ADL variance and 16% of ambulation variance, above and beyond demographic and medical variables. Depression was a poor predictor of functional skills among this sample, few of whom were depressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology of falls among the elderly community dwellers in Singapore

AIM: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore. METHOD: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience. RESULTS: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93). CONCLUSION: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.