Developing SSC program for disabled elderly to promote ADL independence in nursing home using MRC framework for complex interventions.

OBJECTIVE: To develop SSC program for promoting the independence of disabled elderly in Activities of Daily Living (ADL) care in nursing homes. METHODS: This intervention aligns with the Medical Research Council (MRC) Framework for complex interventions. The following three steps were undertaken: (1) identifying the evidence base; (2) identifying/developing theory; (3) modeling processes and outcomes. RESULTS: We successfully developed the complex intervention program of self-supporting care (SSC). The program comprises two integral parts: (1) self-supporting care interventions (SSC-i); (2) self-supporting care implementation interventions (SSC-ii). CONCLUSIONS: Through adherence to the MRC framework, an evidence-based SSC program for managing ADL among disabled elderly individuals in nursing homes was developed. These findings offer a detailed specification of the SSC intervention protocol, which can serve as a valuable resource for healthcare professionals and researchers in subsequent phases, particularly in pilot testing the efficacy of the intervention and promote independence among disabled elderly individuals.

Activities of Daily Living Disability Transition Patterns in Older Adults with Chronic Diseases: A Four-Year Cohort Study in China.

BACKGROUND: Older adults with chronic diseases often experience higher rates of Activities of Daily Living (ADL) disability, with research primarily examining the transition between states of ADL disability and non-disability. The current study aims to analyze the patterns and factors of mutual transitions between multiple different ADL disability states in older adults with chronic diseases. METHODS: This longitudinal study utilized data from the Shanghai Elderly Care Unified Needs Assessment (SECUNA) spanning 2014 to 2017, with 2014 being the baseline. The study included older adults aged 60 years and older with chronic diseases. Using the Markov model, individuals were classified into three states: no ADL disability, mild ADL disability, and severe ADL disability. Transition patterns were analyzed by calculating the frequency, intensity, and probability of transition, and the influencing factors of six transition scenarios were evaluated. RESULTS: Older adults with mild ADL disability were more likely to experience improvement (transition intensity: 0.4731) rather than deterioration (transition intensity: 0.2226) in their ADL disability states. However, those with severe ADL disability faced challenges in improving their states (transition intensities: 0.0068 and 0.1204). Among the six ADL disability transition scenarios, place of residence was associated with four scenarios, age and economic sources were associated with three scenarios, sex was associated with two scenarios, and other factors were associated with one scenario. CONCLUSIONS: The transition patterns and factors differ among individuals with varying ADL disability states. It is essential for relevant agencies to implement tailored preventive healthcare strategies to effectively manage the health status of older adults with chronic diseases.

Association of Loneliness with Functional and Cognitive Status in Minor and Major Neurocognitive Disorders.

BACKGROUND: Neurocognitive disorders (NCDs) have a variable decline in cognitive function, while loneliness was associated with cognitive impairment and increased dementia risk. In the present study, we examined the associations of loneliness with functional and cognitive status in patients with minor (mild cognitive impairment) and major NCDs (dementia). METHODS: We diagnosed mild NCD (n = 42) and major NCD (n = 164) through DSM-5 criteria on 206 participants aged > 65 years using the UCLA 3-Item Loneliness Scale (UCLA-3) to evaluate loneliness, the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales to measure functional status, and Mini-Mental State Examination (MMSE) to assess cognitive functions. RESULTS: In a multivariate regression model, the effect of loneliness on cognitive functions was negative in major (ß = -1.05, p < 0.0001) and minor NCD (ß = -0.06, p < 0.01). In the fully adjusted multivariate regression model (sex-age-education-multimorbidity-depressive symptoms-antidementia drug treatment), the effect of loneliness remained negative for major NCD and became positive for minor NCD (ß = 0.09, p < 0.001). The effect of loneliness on IADL (ß = -0.26, p < 0.0001) and ADL (ß = -0.24, p < 0.001) showed a negative effect for major NCD across the different models, while for minor NCD, the effect was positive (IADL: ß = 0.26, p < 0.0001; ADL: ß = 0.05, p = 0.01). Minor NCD displayed different levels of MMSE (ß = 6.68, p < 0.001) but not ADL or IADL, compared to major NCD for the same levels of loneliness. MANOVA pill test suggested a statistically significant and different interactive effect of loneliness on functional and cognitive variables between minor and major NCDs. CONCLUSIONS: We confirmed the relationships between loneliness and cognitive and functional status in major NCD, observing a novel trend in minor NCD.

The Asymmetric Spillover Effects of Retirement on Disability: Evidence From China.

Background and Objectives: Recent research has explored the spillover effects of retirement on spousal well-being, yet limited attention has been given to the short-term impact on spousal disability. This study explored the asymmetric spillover impact of retirement on spouses' disability severity among a national cohort of urban residents in China. Research Design and Methods: Utilizing 4 waves of data (2011-2018) from the China Health and Retirement Longitudinal Survey, we employ a nonparametric regression discontinuity design to estimate the short-term effect of retirement on spousal disability severity. Disability is assessed based on their ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Furthermore, we conduct heterogeneity analysis stratified by factors such as the husband's retirement status, health conditions, lifestyle behaviors, and the wife's educational level. Additionally, we explore potential mechanisms including changes in health behaviors, emotions, and disease diagnoses. Results: Our findings indicate that wives' retirement has a significant favorable short-term effect on husbands' ADL scores, with a magnitude of -0.644 points (-9.78% relative to baseline). A significant beneficial effect of wives' retirement on the prevalence of husbands' difficulty in dressing, bathing, and eating was observed with substantial magnitudes of 0.075, 0.201, and 0.051 points, respectively. Various heterogeneity analyses and sensitivity tests confirmed the robustness of our results. The positive spillover effect of wives' retirement likely results from reduced negative emotions in husbands. In contrast, husbands' retirement does not affect the prevalence of ADL/IADL disability in their wives. Discussion and Implications: Underscoring the gender asymmetry in the effects of spousal retirement on disability, this study emphasizes the need for tailored policies considering men's and women's distinct disability experiences.

The Relationships Between Activities of Daily Living, Depression, and Quality of Life in Older Adults with Multiple Chronic Conditions: A Path Analysis.

OBJECTIVES: This study was conducted to determine the relationships between activities of daily living (ADL), depression, and quality of life. Specifically, the study aimed to evaluate the potential mediating role of depression in the relationship between activities of daily living and quality of life in a sample of Iranian older adults. METHODS: This cross-sectional study recruited 118 older adult adults with multiple chronic conditions in Iran from December 2022 to September 2023. Data were collected using a demographic and health information questionnaire, the Katz Index, the Lawton scale, Old-World Health Organization Quality of Life, and the Geriatric Depression Scale. Path analysis was used to test the hypothesis. RESULTS: Participants' average age was 70.15 ± 6.91 years. BADL (B = 0.2, p = .02), and depression (B = -0.25, p = .004) were significantly related to the quality of life. The standardized indirect effect of BADL on quality of life was 0.08 (p = .006). CONCLUSIONS: According to the results of this study, functional status can directly and also, indirectly affect the quality of life of older adults with multiple chronic conditions through depression. CLINICAL IMPLICATIONS: Health care providers are advised to carefully assess older adults' mental health and functional status and consider their relationships to quality of life.

Functional disability and suicidal ideation in Korean older adults: the moderating role of socioeconomic status.

OBJECTIVES: Although the relationship between functional disability and suicidal ideation among older adults has been well documented, limited research exists regarding how socioeconomic status might moderate the relationship between functional disability and suicidal ideation. The objective of this study is to identify the relationship between functional disability and suicidal ideation and assess how SES moderates this relationship among Korean older adults. METHODS: Using data from wave 3 of the Korean Retirement and Income Study, this study has conducted a linear regression analysis with interaction terms. RESULTS: There are three main findings. First, the main effects of Activities of Daily Living, Instrumental Activities of Daily Living, and economic status on suicidal ideation were identified. Second, functional disability is identified as a serious risk factor for suicidal ideation among Korean older individuals who express dissatisfaction with their economic circumstances. Last, the moderating effect of economic condition and education on the relationship between functional disability and suicidal ideation exhibited some differences. CONCLUSION: This study suggests that the interactions of functional disability and economic status yield a significant predictive effect on suicidal ideation in South Korea.

Regional variation in prevalence of frailty in India: Evidence from longitudinal ageing study in India (LASI) wave-1.

Background & objectives Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI). Methods This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried's frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression. Results The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98-2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64-1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01-1.51) and multimorbidity (OR: 1.18, CI: 1.04-1.33) among frailty. Interpretation & conclusions The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes.

Dynapenic abdominal obesity and activities of daily living disability among older adults residing in low- and middle-income countries.

BACKGROUND: Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown. AIMS: Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs. METHODS: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted. RESULTS: Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37-3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability. CONCLUSIONS: DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

The evaluation of daily activity questionnaire for stroke survivors: cross-cultural adaptation, content validity and digitisation.

OBJECTIVE: The study's objective was to culturally adapt and digitise the Evaluation of Daily Activity Questionnaire (EDAQ), originally designed for rheumatoid arthritis and various other musculoskeletal conditions, creating a version for stroke survivors (EDAQ-SS). This adaptation also aimed to develop a comprehensive electronic Patient Reported Outcome Measure (ePROM) intended to refine stroke survivors' self-assessment of their daily activity limitations. MATERIALS AND METHODS: Cross-cultural adaptation of the EDAQ was completed by a review of expert panel, which included healthcare professionals to increase the clarity and relevancy of the items, followed by cognitive debriefing interviews with British stroke survivors to rate their understanding of the questionnaire items. After developing the paper version of the questionnaire, this was digitised (eEDAQ-SS) and disseminated online via the Stroke Survivors Hub (SSHUB). Content validity of the EDAQ-SS was evaluated using the International Classification of Functioning (ICF) Core Set for Stroke. RESULTS: The expert panel meeting (n:11) and cognitive debriefing interviews with stroke survivors (n:10) resulted in an EDAQ-SS with 160 items across 15 domains, which was understandable and relevant to stroke survivors. The SSHUB was deemed to be a user-friendly platform, providing easy access to eEDAQ-SS and aid self-assessment of daily activities of stroke survivors. Mapping the EDAQ-SS items to the ICF Core Set for Stroke demonstrated good content validity with 44/55 matching categories. CONCLUSION: The EDAQ-SS offers a comprehensive measure for self-assessment, which may serve to guide stroke survivors' self-management by overcoming limitations of existing PROMs. Further psychometric testing of the EDAQ-SS and wider testing of the digital version is recommended. CONTRIBUTION OF THE PAPER.

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

Background: The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. Methods: In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Results: Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Conclusion: Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

Implementing and Evaluating a Mobile Phone-Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0): Protocol for a Randomized Controlled Trial.

BACKGROUND: Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. OBJECTIVE: This study aims to implement F@ce 2.0, a mobile phone-supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. METHODS: A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. RESULTS: Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. CONCLUSIONS: This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60955.

Effectiveness of Horticultural Therapy in Older Patients With Dementia: A Meta-Analysis Systemic Review.

AIM: Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia. DESIGN: A systematic review and meta-analysis. METHODS: The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software. DATA SOURCES: On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. RESULTS: The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions. CONCLUSION: More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: We provide references for non-pharmacologic treatment of older patients with dementia. WHAT PROBLEM DID THE STUDY ADDRESS?: This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life. WHAT WERE THE MAIN FINDINGS?: In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will inform non-pharmacological interventions for older patients with dementia worldwide. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Influence of caregiver understanding of their capability to perform activities of daily living, disease comprehension, and attitudes on occupational low back pain: a cross-sectional study.

[Purpose] The aim in this study was to evaluate the impact of caregiver understanding of their ability to perform activities of daily living (ADLs), movement abilities, diseases, and attitudes on the prevalence of occupational low back pain. [Participants and Methods] A cross-sectional survey was conducted of caregivers of older adults living in residential care facilities. Of the 150 questionnaires distributed, 71 were valid. The survey collected data on demographics, low back pain status using a numerical rating scale, and familiarity with ten ADLs and five diseases (stroke, rheumatoid arthritis, fractures, Parkinson's disease, and dementia). [Results] In this study, 52% of the participants reported lower back pain. Significant factors included an understanding of repositioning in ADLs, familiarity with stroke and rheumatoid arthritis, and attitudes toward using patients' residual functions. Participants with limited knowledge of repositioning and stroke, a better understanding of rheumatoid arthritis, and those who did not consider residual function were more prone to lower back pain. [Conclusion] Our findings highlight the importance of enhancing caregiver education on ADL movements and disease specifics, particularly stroke and rheumatoid arthritis, and promoting the use of patients' residual capabilities. Improved training and information sharing among caregivers may reduce the risk of occupational low back pain.

Factors Influencing the Postoperative Flexion Angle in Cruciate-Sacrificing Rotating Platform of Total Knee Arthroplasty.

BACKGROUND: Various factors affect the improvement of range of motion (ROM) after total knee arthroplasty (TKA). However, there are few reports specific to cruciate-sacrificing rotating platform (CSRP) TKA. In this study, factors affecting postoperative ROM improvement of CSRP TKA were investigated. METHODS: The study included 79 patients with knee osteoarthritis who underwent unilateral CSRP TKA at our institution. The group with an improvement of 5° or more (Δflexion angle) than the preoperative was defined as the good Δflexion group (38 knees), and that with less than 5° was defined as the poor Δflexion group (41 knees). The assessments were performed one day before and one year after surgery. Factors including rest and walking pain, knee flexion and extension angle, isometric knee extension strength, the five subscales of Knee injury and Osteoarthritis Outcome Score (KOOS), α, ß, γ and δ angles, femoro-tibial angle (FTA), and condylar twist angle were assessed. Unpaired t-test, Mann-Whitney U test, and Chi-square test were used to test differences between the good and poor Δflexion groups. Multiple logistic regression examined the association between each factor and the dependent variables (good Δflexion or poor Δflexion). RESULTS: Significant differences in the preoperative knee flexion, postoperative knee flexion, preoperative knee extension, and postoperative knee extension angles, postoperative KOOS pain and activity of daily living, ß, ɤ angles were observed between the good and poor Δflexion groups. The model Chi-squared test revealed that the ɤ angle was significantly affected by the Δflexion angle. CONCLUSIONS: With the CSRP TKA, flexion insertion of the femoral component was associated with postoperative flexion ROM improvement.

Alpha transcranial alternating current stimulation as add-on to neglect training: a randomized trial.

Visuospatial neglect is a common and debilitating condition following unilateral stroke, significantly impacting cognitive functioning and daily life. There is an urgent need for effective treatments that can provide clinically relevant and sustained benefits. In addition to traditional stroke treatment, non-invasive brain stimulation, such as transcranial alternating current stimulation, shows promise as a complementary approach to enhance stroke recovery. In the current study, we aimed to evaluate the additive effects of multi-session transcranial alternating current stimulation at alpha frequency when combined with visual scanning training in chronic stroke patients with visuospatial neglect. In this double-blind randomized controlled trial, we compared the effects of active transcranial alternating current stimulation at alpha frequency to sham (placebo) transcranial alternating current stimulation, both combined with visual scanning training. Both groups received eighteen 40-minute training sessions over a 6-week period. A total of 22 chronic visuospatial neglect patients participated in the study (active group n = 12, sham group n = 10). The median age was 61.0 years, with a median time since stroke of 36.1 months. We assessed the patients at six time-points: at baseline, after the first, ninth and eighteenth training sessions, as well as 1 week and 3 months following the completion of the combined neuromodulation intervention. The primary outcome measure was the change in performance on a visual search task, specifically the star cancellation task. Secondary outcomes included performance on a visual detection task, two line bisection tasks and three tasks evaluating visuospatial neglect in daily living. We found significantly improved visual search (primary outcome) and visual detection performance in the neglected side in the active transcranial alternating current stimulation group, compared to the sham transcranial alternating current stimulation group. We did not observe stimulation effects on line bisection performance nor in daily living. Time effects were observed on all but one outcome measures. Multi-session transcranial alternating current stimulation combined with visual scanning training may be a more effective treatment for chronic visuospatial neglect than visual scanning training alone. These findings provide valuable insights into novel strategies for stroke recovery, even long after the injury, with the aim of enhancing cognitive rehabilitation outcomes and improving the overall quality of life for individuals affected by this condition. Trial registration: ClinicalTrials.gov; registration number: NCT05466487; https://clinicaltrials.gov/ct2/show/NCT05466487.

The effect of the interaction between intrinsic capacity and social support on the trajectories of activities of daily living in older adults.

OBJECTIVES: This study explored the effect of the interaction between intrinsic capacity and social support on the activities of daily living in the older adults. METHODS: A total of 3,124 older adults participated in the study. Data on the assessment of intrinsic capacity as well as activities of daily living (ADL) and social support were collected. The latent growth curve model (LGCM) was used to examine the effect of the interaction between social support and intrinsic capacity on the activities of daily living in the older adults. RESULTS: A total of 3,730 older adults were included at baseline, and 3,124 older adults completed the 4-year follow-up. The ADL score of the older adults showed a significant downward trend with time over 4 years (ß=-0.115, P<0.05). In the elderly population with high intrinsic capacity, the ADL of individuals with low levels of social participation decreased significantly over time (ß=-0.114, P=0.012). In the elderly group with low intrinsic capacity, the ADL of individuals with low levels of social participation (ß=-0.245, P=0.005) and high levels of life care (ß=-0.167, P=0.001) decreased significantly over time. CONCLUSION: This is the first longitudinal study to explore the effects of interactions among intrinsic capacity, social participation and family support on the trajectory of ADL in the older adults from the perspective of the life course. Social participation can effectively improve functional ability of older adults with low intrinsic capacity. Life care is beneficial for maintaining the functional ability of older adults with intact intrinsic capacity, but it accelerates the deterioration of the functional ability of older adults with low intrinsic capacity.

Visual activities of daily living survey for retinitis pigmentosa.

PURPOSE: To gauge the value of low-vision-specific function and activities of daily living measures (LVFAM) in the assessment of Patient Reported Outcomes (PRO) of Retinitis Pigmentosa (RP). STUDY DESIGN: Prospective observation study. METHODS: The May-July 2023 Visual activities of daily living (ADL) Survey of the low-vision-specific function and activities of daily living measure (LVFAM) was conducted on 15 RP patients attending our Ophthalmology outpatient clinic. We used the better corrected visual acuity, and the better Mean Deviation (MD) values of the central 10 degrees of Humphrey's visual field as macular sensitivity, and examined the total scores after Rasch Analysis for each of the low-vision-specific function of Daily Living (LVFDL) and the low-vision-specific activities of Daily Living (LVADL) among LVFAM, as well as the relationship between the items. RESULTS: Age 26-78 (mean 60.8), 5 men and 10 women, corrected visual acuity of 0.01-1.0 (mean 0.45) in the better eye, macular sensitivity of 3.47-40.00 (mean 18.60) dB, mean 52.2 for LVFDL and 66.4 for LVADL. The correlations were positive for visual acuity and LVFDL and LVADL, and negative for macular sensitivity, LVFDL and LVADL. In addition, four items were scored 0 by at least 5 (33%) of the LVFDL respondents, and two items were scored 1 by at least 5 (33%) of the LVADL respondents, suggesting that the results differed by question items. CONCLUSION: The LVFAM was useful not only for the total score but also for each question item in the development strategy of PROs in RP with no treatment.

Analysis of the effect of BMI on depression and anxiety among older adults in China: the mediating role of ADL and IADL.

Background: Anxiety and depression are serious psychological and public health issues among the older adults. Currently, there is a lack of understanding of the relationship between Body Mass Index (BMI) and anxiety or depression symptoms in the older adult population in China. Therefore, the purpose of this study is to investigate the impact of BMI on anxiety and depression through correlation analysis in different subgroups and to examine the potential chain mediating effects of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) between BMI and symptoms of anxiety and depression. Methods: From the CLHLS database conducted in 2017-2018, data regarding height, weight, anxiety symptoms, depression symptoms, as well as demographic, socioeconomic, behavioral, and health-related characteristics were collected. Multivariate logistic regression analysis was used to explore the impact of BMI on anxiety and depression symptoms. Finally, the SPSS macro process was utilized to test the multiple mediating effects of ADL and IADL between BMI and anxiety or depression symptoms. Results: After screening, a final sample of 9,098 Chinese older adult individuals aged 65 and above was selected. Among them, 1,074 cases (11.8%) exhibited anxiety symptoms, 1,458 cases (16.0%) exhibited depressive symptoms. Compared to normal BMI, the adjusted analysis showed that underweight in Chinese older adult individuals was significantly associated with anxiety (OR = 1.316, p = 0.004) and depression (OR = 1.232, p = 0.013). This relationship was found to be more significant in males, individuals aged 80 and above, unmarried individuals, and those residing in town. ADL and IADL played a chain-mediated role between BMI and anxiety symptoms in the older adult. BMI not only had a direct effect on anxiety symptoms in the older adult (effect = -0.0159; SE = 0.0066; 95%CI: LL = -0.0288, UL = -0.0031), but also influenced them indirectly through two pathways: the independent mediating role of IADL (effect = -0.0010; SE = 0.0005; 95%CI: LL = -0.0018, UL = -0.0003) and the chain-mediated role of ADL and IADL (effect = -0.0012; SE = 0.0004; 95%CI: LL = -0.0020, UL = -0.0006). Conclusion: In the older adult individuals in China, underweight is associated with an increased risk of anxiety and depression symptoms. Improving the underweight condition of Chinese older adult individuals can reduce their ADL and IADL limitations, thereby benefiting their mental health.

Intrinsic capacity and recent falls in adults 80 years and older living in the community: results from the ilSIRENTE Study.

BACKGROUND: Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. AIMS: To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. METHODS: The Minimum Data Set for Home Care (MDS-HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0-100). RESULTS: The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94-0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93-0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16-0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15-0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16-0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97-0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96-0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96-0.99, p < 0.001). DISCUSSION: This is the first study using an MDS-HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. CONCLUSIONS: Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians.

Effects of Social Support Provided by Disabled Older Adults to Others on Their Own Depressive Symptoms: A Moderated Mediation Model.

Purpose: While previous studies have extensively examined the impact of receiving positive social support during social support interactions on depressive symptoms among older adults, adverse effects experienced, such as being rejected or ignored, are often overlooked. Moreover, there has been limited discussion on the effects of giving social support to others. Thus, this study investigates the impacts of social support given by disabled older adults to others on their own depressive symptoms, as well as the mediating role of receiving social support (both positive and negative aspects) and the moderating effect of the activity of daily living (ADL). Patients and Methods: This cross-sectional, community-based study was conducted in Wenzhou and Jiaxing City, China, from September 2021 to September 2022, with a total of 255 disabled older adults meeting the inclusion and exclusion criteria. The data were collected face-to-face using a structured questionnaire. The participants were asked to complete the Barthel Index Scale, the Chinese version of the Positive and Negative Social Exchange Scale, the Giving Social Support questionnaire, and the Short Form Chinese Geriatric Depression Scale to measure disability, receiving positive and negative social support, giving social support, and depressive symptoms, respectively. Descriptive statistical analysis, correlation analysis, mediation effect tests, and moderation effect tests were used to analyse the questionnaire data. Results: The social support provided by disabled older adults to others primarily involved companionship and care. The positive aspect of social support received was largely emotional support, while the negative aspect was mainly characterised by failure to obtain help and unsympathetic behaviour. Providing social support was found to be associated with a potential beneficial effect on depressive symptoms, linked to lower severity, with this effect fully mediated by receiving social support. Specifically, receiving emotional support accounted for 56.63% of the effect size, while failure to obtain help and unsympathetic behaviour contributed 21.55%, and rejection and neglect collectively accounted for 21.83%. Additionally, the effect was partially moderated by ADL, with older adults exhibiting lower ADL scores showing a greater benefit from both giving and receiving social support compared to those with higher ADL scores. Conclusion: It is imperative to recognise and encourage disabled older adults to provide social support to others, especially emotional support, while reducing negative feedback, such as neglect and unnecessary blame. This could alleviate their depressive symptoms and promote psycho-social well-being.