Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults.

BACKGROUND: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. OBJECTIVE: to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. DESIGN: population-based cross-sectional observational study. SETTING: all 19 counties in Taiwan. PARTICIPANTS: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). METHODS: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. RESULTS: we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. CONCLUSIONS: our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.

Movement pattern and upper extremity muscle activation during fast and slow continuous steering movement.

Continuous steering movement (CSM) is an essential component of the upper extremity (UE) task during vehicle driving, and could be a suitable candidate for multi-joint rehabilitation programs for patients with UE disabilities. This study aims to evaluate the UE muscle activation during CSM and how the rotating speed and direction affect CSM's kinematic and kinetic performance. Surface electromyography (EMG), hand contact information, and steering torque were measured under fast (180°/s) and slow (60°/s) constant-velocity CSM to reveal the activation of shoulder and elbow muscles, temporal characteristics, and force exertion during the stance and swing phases of a CSM cycle. Data from 24 normal young adults showed that shorter contact duration but higher force exertion occurred in the hand moving in an outward steering direction during only fast CSM in either the clockwise (CW) or counterclockwise (CCW) direction. During a steering cycle (either fast or slow speed), the triceps brachii, sternal part of the pectoralis major (PS), and posterior deltoid play major roles in generating steering torque in the CW direction of the CSM. In contrast, the PS, clavicular part of the pectoralis major (PC), and anterior deltoid (AD) largely contribute to torque generation during the CCW CSM. During the swing phase of CSM, AD, PC, and PS are the major muscles that move the hand for the next grasping of the steering wheel in all four conditions. Using the mean activation profiles of the major contributing muscles, the functional roles of these elbow and shoulder muscles were analyzed and are discussed herein. These findings help us to further understand the activation patterns of UE muscles and the kinematic and kinetic changes during two rotating directions and two speeds of CSM, and suggest important implications for future practice in clinical training.

Association between Fear of Falling and Seven Performance-Based Physical Function Measures in Older Adults: A Cross-Sectional Study.

Fear of falling (FOF), a common phenomenon among older adults, may result in adverse health consequences. The strength of the association between FOF and physical function among older adults has not been well compared in previous studies. Therefore, a cross-sectional study was performed on 105 older adults to determine and compare the strength of the association between FOF and seven common physical function measures. After controlling for age, logistic regression models were fitted for each physical function measure. According to odds ratios, the Berg Balance Scale (BBS), Short Physical Performance Battery, gait speed, and Timed Up & Go Test were associated with the identification of FOF. Based on a c-statistic value of 0.76, the BBS, a common and quick assessment of functional balance tasks, was found to be able to distinguish between fearful and non-fearful older adults. Interventions targeted to improve lower-extremity physical functions, especially functional balance ability, may help prevent or delay the adverse consequences of FOF.

Cross-cultural adaptation and validation of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0): the development of the Taiwanese version.

OBJECTIVE: To develop and validate a cross-cultural version of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) for users of assistive technology devices in Taiwan. DESIGN: A cross-sectional survey. PROCEDURES: The standard cultural adaptation procedure was used for questionnaire translation and cultural item design. A field test was then conducted for item selection and psychometric properties testing. SUBJECTS: One hundred and five volunteer assistive device users in community. MAIN OUTCOME MEASURES: A questionnaire comprising 12 items of the QUEST 2.0 and 16 culture-specific items. RESULTS: One culture-specific item, 'Cost', was selected based on eight criteria and added to the QUEST 2.0 (12 items) to formulate the Taiwanese version of QUEST 2.0 (T-QUEST). The T-QUEST consisted of 13 items which were classified into two domains: device (8 items) and service (5 items). The internal consistencies of the device, service and total T-QUEST scores were 0.87, 0.84 and 0.90, respectively. The device, services and total T-QUEST scores achieved good test-retest stability (intraclass correlation coefficient (ICC) 0.90, 0.97, 0.95). Exploratory factor analysis revealed that T-QUEST had a two-factor structure for device and service in the construct of user satisfaction (53.42% of the variance explained). CONCLUSIONS: Users of assistive device in different culture may have different concerns regarding satisfaction. T-QUEST is the first published version of QUEST with culture-specific items added to the original translated items of QUEST 2.0. T-QUEST was a valid and reliable tool for measuring user satisfaction among Mandarin-speaking individuals using various kinds of assistive devices.

An observational treatment-based gait pattern classification method for targeting interventions for older adult males with mobility problems: Validity based on movement control and biomechanical factors.

BACKGROUND: A reliable and valid observational gait assessment intended to guide clinical intervention for gait deficits in older adults has not been proposed. A quick gait classification method which tailors clinical management for different patterns of gait dysfunction may be useful for clinicians with limited access to apply computer-assisted gait analyses. RESEARCH QUESTION: This work aims to establish reliability and validity of the Treatment-Based Gait Pattern Classification (TBGPC) that can be used to quickly identify and classify mobility problems of older males, and possibly target interventions for specific gait deficits in clinical settings. METHOD: Videotapes of 116 older male veterans referred for mobility problems were analyzed in this cross-sectional study. The TBGPC defined by movement control (consistent, inconsistent) and postural biomechanical factors (usual, flexed, extended, crouched) was validated by comparing means of individual items of the Modified Gait Abnormality Rating Scale (GARS-M) across groups. RESULTS: Kappas for interrater reliability of the TBGPC movement control and biomechanical components were 0.59 and 0.75, respectively; for intrarater reliability, 0.82 and 0.72, respectively. Both movement control and biomechanical components were validated. All GARS-M items were different between older males with consistent and inconsistent gait. Within the consistent and inconsistent group, hip ROM was one of the most differentiating GARS-M item between older males with usual and flexed gait and flexed and crouched group. Total GARS-M score and guardedness were two differentiating factors between the usual and crouched group. SIGNIFICANCE: Gait patterns of older males were reliably recognized and validated by mean differences in abnormal characteristics of gait across patterns. The TBGPC may be useful to quickly identify and classify mobility problems of older males and to guide clinical intervention.

Indicators of perceived useful dementia care assistive technology: Caregivers' perspectives.

AIM: The study aims to investigate the caregivers' context-specific perceived usefulness of available assistive technology (AT) devices and the professionals' perspectives on the usefulness indicators of AT devices for home-dwelling individuals with mild-to-moderate dementia. METHODS: A total of 72 caregivers completed a questionnaire rating 82 AT devices with a high-perceived usefulness (HPU) or low-perceived usefulness (LPU). A total of 21 experts rated 10 usefulness indicators of these devices. We compared the mean of each indicator between the HPU and LPU groups. RESULTS: Most caregivers, who are generally amenable to using AT devices, thought they were useful for helping to care for home-dwelling older adults with mild-to-moderate dementia. The level of perceived usefulness from the experts' perspectives depends on specific design indicators (e.g. familiarity) and the context in which the AT is used (e.g. in everyday life or in emergencies). Indicators for HPU devices were: allows selective accident prevention, has an intuitive interface, is familiar, offers ease of use and simplifies activities. LPU devices featured client prompting. There were no significant differences between HPU and LPU devices with indicators of: is automated, informs caregiver, preserves privacy and preserves autonomy. Safety issues were considered important, and sometimes overshadowed ethical dilemmas, such as privacy and autonomy concern. CONCLUSIONS: The present study provides insight into how caregivers perceived the usefulness of AT devices, and how that varied with context. Indicators of devices perceived as useful can serve as guidelines for modifying existing devices and designing new devices. Future application could also incorporate the points of view from the persons with dementia.

Gait variability in older adults: observational rating validated by comparison with a computerized walkway gold standard.

BACKGROUND AND PURPOSE: Gait variability has been measured with computerized technology-intensive techniques, which are not practical in clinical settings. The purpose of this study was to validate an observational rating of gait variability for routine clinical practice. SUBJECTS: Community-dwelling older adults aged 65 years and older (n=46; mean age=81.2 years, SD=6.8 years, range=66-91 years) participated in this study. METHODS: The standard deviation of stance time (stance time variability) derived from gait characteristics recorded by use of a computerized walkway was used as the gold standard for gait variability. The validity of the diagnostic test evaluated in this study (an observational rating of gait variability) was determined by comparison with the quantitative measure of stance time variability. RESULTS: Six validity indexes were defined for the observational rating of gait variability: sensitivity=81%; specificity=53%; positive predictive value=65%; negative predictive value=71%; positive likelihood ratio=1.72; and negative likelihood ratio=0.36. DISCUSSION AND CONCLUSION: An observational rating of gait variability was validated by comparison with stance time variability derived from a computerized walkway. The concurrent validity of the 2 methods of determining gait variability provides support for the use of the observational rating as an alternative measure of gait variability for the purpose of identifying older adults at risk for mobility disability in clinical settings.