Activities of daily living trajectories among institutionalised older adults: A prospective study.

AIMS AND OBJECTIVES: To examine activities of daily living trajectory groups among older residents in Taiwan, and to determine the relative risks of demographic characteristics and health status in explaining the trajectory group of activities of daily living. BACKGROUND: Activity of daily living is a crucial indicator of health status for institutionalised older adults. activities of daily living is a dynamic process and has differences in trajectory groups. DESIGN: This study was a 3-year longitudinal analysis of long-term care facility residents in Taiwan. METHODS: A total of 364 older residents completed the entire research process. We used group-based trajectory modelling and multinomial logistic models for statistical analysis. RESULTS: The result of this study revealed that three activities of daily living trajectory groups among older residents exhibited high dependency with gradually declining function (Group 1, 22.53%), low dependency with gradually declining function (Group 2, 43.13%) and persistent independent function (Group 3, 34.34%). Compared with Group 3, Group 1 was related to the following potential risk factors: older age, female, nonmainland China born and a married status. After considering resident health status in the analysis, three significant factors emerged for Group 1: the number of chronic diseases (odds ratio = 2.45), depressive symptoms (odds ratio = 1.71) and cognitive status (odds ratio = 83.11). Compared with Group 3, Group 2 was related to older age. After adding resident health status to the analysis, two significant factors of Group 2 emerged: the number of chronic diseases (odds ratio = 1.68) and depressive symptoms (odds ratio = 1.74). CONCLUSION: The findings of this study indicated that health factors, including the number of chronic diseases, cognitive status and depressive symptoms, were more likely to contribute to the development of a decline pattern of activities of daily living. RELEVANCE TO CLINICAL PRACTICE: Appropriate exercise programmes and physical activities, according to residents' personal characteristics and activities of daily living status, is crucial for improving physical functioning, alleviating depression and cognitive defects in institutionalised older adults.

Use of a mobile device by nursing home residents for long-term care comprehensive geriatric self-assessment: a feasibility study.

Long-term-care comprehensive geriatric assessments, such as the Minimum Data Set 3.0, are used to evaluate the clinical, psychological, and personal status of residents in long-term-care nursing facilities. Nursing staff conducts assessment interviews, thereby increasing the workload of nurses and the cost of patient care. This study explored the ability of nursing home residents to use two different mobile devices for a geriatric self-assessment. Study participants were residents of long-term-care nursing homes. A modified Minimum Data Set 3.0 was converted to a format for use with a 6-inch mobile pad and a 3.7-inch mobile smartphone. The survey completion rate and the response time were measured. A Technology Assessment Model questionnaire analyzed the participants' experience. All participants were able to use a 6-inch pad, with an average completion rate of 92.9% and an average time for completion of 21 minutes. Only 20% of the participants could complete the assessment with the 3.7-inch smartphone. The participants found the 6-inch pad easier to use than the 3.7-inch smartphone. This exploratory study suggests that nursing home residents are able to use a mobile device to perform a geriatric self-assessment and delineates the importance of the ergonomics of the device.

Factors related to the time to cryptorchidism surgery--a nationwide, population-based study in Taiwan.

BACKGROUND/PURPOSE: Current guidelines recommend that the optimal timing for cryptorchidism surgery is by the age of 12 months. This study investigated the trend of surgical timing and examined the factors associated with time to surgery for cryptorchidism in Taiwan by using a nationwide, population-based database. METHODS: The present study utilized the Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, which contains data on all paid medical benefit claims over the period 1997-2007 for a subset of 1 million beneficiaries randomly drawn from 22.72 million individuals enrolled in the National Health Insurance program in 2005. We analyzed the timing of surgery in boys younger than 18 years with diagnosis of cryptorchidism. RESULTS: We identified 547 boys who underwent surgery under 18 years of age. Approximately 79.2% of study participants received surgery after the age of 12 months. A multivariate analysis showed that several factors were significantly associated with time to surgery: age of the physician making the diagnosis, age of the surgeon performing the surgery, age of the patient at the first diagnosis of cryptorchidism, and number of previous clinic visits with the diagnosis of cryptorchidism and urbanization level of the patient's residence. CONCLUSION: A surprisingly high rate (79.2%) of all study participants underwent surgery beyond the optimal timing. Certain doctor and patient factors were associated with time to cryptorchidism surgery. Improving the alertness and education of parents and specialists may lead to earlier surgeries.

Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study.

PURPOSE: We investigated the epidemiology of upper urinary tract stone disease in Taiwan using a nationwide, population based database. MATERIALS AND METHODS: This study was based on the National Health Insurance Research Database of Taiwan, which contains data on all medical beneficiary claims from 22.72 million enrollees, accounting for almost 99% of the Taiwanese population. The Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, contains data on all medical benefit claims from 1997 through 2010 for a subset of 1 million beneficiaries randomly sampled from the 2005 enrollment file. For epidemiological analysis we selected subjects whose claims records included the diagnosis of upper urinary tract urolithiasis. RESULTS: The age adjusted rate of medical care visits for upper urinary tract urolithiasis decreased by 6.5% from 1,367/100,000 subjects in 1998 to 1,278/100,000 in 2010. There was a significantly decreasing trend during the 13-year period in visits from female and all subjects (r(2) = 0.86, p = 0.001 and r(2) = 0.52, p = 0.005, respectively). In contrast, an increasing trend was noted for male subjects (r(2) = 0.45, p = 0.012). The age adjusted prevalence in 2010 was 9.01%, 5.79% and 7.38% in male, female and all subjects, respectively. The overall recurrence rate at 1 and 5 years was 6.12% and 34.71%, respectively. Male subjects had a higher recurrence rate than female subjects. CONCLUSIONS: Our study provides important information on the epidemiology of upper urinary tract stone disease in Taiwan, helping to quantify the burden of urolithiasis and establish strategies to decrease the risk of urolithiasis.

Sphincter-preserving surgery for rectal cancer: a population-based study in Taiwan.

BACKGROUND/AIMS: Sphincter-preserving surgery (SPS) has been considered a surrogate for surgical quality for rectal cancer. This study aims to assess its rate for rectal cancer between centers and over time in Taiwan. METHODOLOGY: Data from 1997 to 2006 on patients undergoing sphincter-preserving surgery (anterior resection or AR) and proctectomy with colostomy (abdominoperineal resection or APR) were extracted from a national health insurance database. Hierarchical logistic regression was used to identify independent factors associated with SPS. RESULTS: Data on 19,919 patients were analyzed. Among them, 12,164 (61%) received AR and 7,755 (39%) underwent APR at total of 115 centers. Multifactorial analysis revealed higher SPS rates with female gender (p<0.001) and patients paying higher insurance premiums (p=0.005). Higher APR rates were seen in those receiving surgery at metropolitan hospitals (p=0.001) and hospitals outside higher volume regions (Taipei City and North, p≦0.005). For hospitals with initial low surgical volumes, significant improvement of SPS rate was found (p<0.001) with increasing volume over the study period. CONCLUSIONS: The disparity due to sphincter loss in rectal cancer between hospitals of various regions and levels narrowed in Taiwan. Characteristics of hospital (level, region, volume) and patient (gender, premium level) influenced SPS rate.

Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis.

BACKGROUND/PURPOSE: Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery. METHODS: The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias. RESULTS: Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits. CONCLUSION: This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.

Screening depression among institutionalized older Chinese men by minimum data set: we need a new instrument.

OBJECTIVE: To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. METHOD: MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. RESULTS: The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. CONCLUSIONS: The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

Design and development of interface design principles for complex documentation using PDAs.

The screen interface has been believed to be the major barrier for the adoption of PDAs in healthcare. The study objectives were to design a set of screen interface design principles for complex documentation using PDAs and to examine nurses' perception of the ease of use and usefulness of the application. A 21-page Chinese version of the interRAI MDS-HC home-care assessment tool composed of more than 250 assessment questions was used for the application. A WiFi Palm-based PDA was used. A convenience sample of 60 subjects, primarily nurses newly trained to use the MDS-HC assessment tool, were invited to evaluate the PDA system in terms of Davis' Technology Acceptance Model. The final information structure of the PDA application consisted of 18 categories composed of 262 questions over 63 screens. Subjects could move to any assessment question in less than two taps without a memory burden and finish the question in one tap. Respectively, close to 95% and 93% of the subjects agreed that, overall, the system was easy to use and useful for their work. We conclude the screen interface challenge for complex documentation using PDAs can be improved and managed to achieve to a very high usability.

Validation of EQ-5D in patients with cervical cancer in Taiwan.

PURPOSE: The survival rate of cervical cancer is increasing due to early diagnosis and timely treatment. As a result, the availability of a valid and reliable general HRQoL is important. The purpose of this study was to evaluate the psychometric properties of the EuroQol questionnaire (EQ-5D) in patients with cervical cancer in Taiwan. METHOD: Outpatients with cervical cancer were recruited from three medical centers across Taiwan. Test-retest reliability and ceiling effect were evaluated. Construct validity including convergent and discriminate validities were examined using the EORTC QLQ C-30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and the clinical indicators of the functional performance assessment using the Karnofsky Performance Scale (KPS) and disease status. RESULTS: A total of 530 patients completed the questionnaire. The intraclass correlation coefficient for the EQ-5D index was 0.83, and the Cohen's kappa values for the EQ-5D dimensions ranged from 0.54 to 0.73. The EQ-5D index and VAS scores were higher for patients with a higher KPS score and disease-free status. The EQ-5D index was strongly correlated with all EORTC QLQ-C30 functioning scales. CONCLUSION: The EQ-5D questionnaire is reliable and valid for the assessment of health-related quality of life in patients with cervical cancer in Taiwan.

Urinary incontinence among institutionalized oldest old Chinese men in Taiwan.

AIMS: To explore prevalence and related factors for urinary incontinence (UI) among the oldest old institutionalized Chinese men in Taiwan. METHODS: All residents living in Banciao Veterans Care Home were invited for study. UI was defined as urinary leakage at least once weekly. Additional data items from the Minimum Data Set (MDS Nursing Home Chinese Version 2.1) were used to explore impact associated with physical function, cognitive status and quality of life (social engagement, SocE). Depressive symptoms were screened by the Short Form Geriatric Depression Scale. RESULTS: Data from 594 male residents (mean age: 80.9 +/- 5.3 years) were analyzed. Among all study subjects, 92.8% were functionally independent, 20.4% had certain cognitive impairment and 8.2% had depressive symptoms. The prevalence of UI in the Banciao Veterans Care Home was 10.1%. Compared with residents without UI, subjects with UI had poorer physical function, cognitive status, and more depressive symptoms. The mean SocE score was 1.5 +/- 1.3, and was similar between UI (+) and UI (-) subjects (1.4 +/- 1.2 vs. 1.6 +/- 1.3, P = 0.411). By multivariate logistic regression, poorer physical functional status, cognitive impairment and depressive symptoms were independent risk factors for UI (P < 0.05). CONCLUSIONS: Poorer physical function, poorer cognitive status and depressive symptoms were all statistically significant independent risk factors for UI. However, SocE score (proxy indicator of quality of life) did not differ between subjects with and without UI. Further investigations are needed to evaluate the impact of UI on quality of life among oldest old institutionalized Chinese men in Taiwan.

Is PDA good for complex documentation in healthcare?

The screen interface has been believed to be the major barrier for the adoption of mobile devices with small display in healthcare. The study objective was to evaluate nurses' perception of the ease of use and usefulness of PDA application, designed with customerized design principles. The PDA application consisted of 18 categories composed of 262 questions over 63 screens, which was designed based on a 21-page Chinese version of the interRAI MDS-HC homecare assessment tool. A WiFi Palm(c)-based PDA was used. A convenience sample of 60 subjects was invited for evaluation in terms of Davis' Technology Acceptance Model. Results show that close to 95% and 93% of the subjects agreed, overall, the system was easy to use and useful for their work. We conclude that PDAs can be improved and managed to achieve to a very high usability with right interface design principles.

The crowding-out effects of tobacco and alcohol where expenditure shares are low: analyzing expenditure data for Taiwan.

In this paper, we used data from the 2004 Survey of Family Income & Expenditure of Taiwan to show that the problem of the crowding-out effects of tobacco and alcohol in a country with low expenditure can still be serious. Most studies that have investigated this issue have focused on developing countries with a high expenditure share on tobacco or alcohol, and have often overlooked the effects in countries with a low expenditure on such goods. After controlling for the endogeneity of tobacco and alcohol expenditure, and the possibility that households with a zero expenditure on tobacco and alcohol may result from a corner solution rather than abstention, we found that the lowest income households are still most vulnerable to tobacco and alcohol expenditures despite an overall low expenditure in Taiwan. Even higher income households may suffer a lower standard of living due to such expenditure. In addition, some goods and services may be perceived differently by households with different levels of income and this may be caused by the difference in composition across broad expenditure categories. Our results suggest that the government ought to tackle the problem of smoking and drinking outside the realm of health, since these expenditures may harm the country's standard of living even when there is high income.

Predictors of female worker attitudes towards menstruation and the provision of help to institutionalized women with intellectual disabilities in Taiwan.

No previous research has examined the importance of both individual and environmental factors for predicting caregivers' menstrual attitudes. To explore the predictors of female caregivers' attitudes towards menstruation and the help they give to women with intellectual disabilities, we conducted a cross-sectional questionnaire survey which was completed by 725 female workers from 12 institutions in Taiwan. The Menstrual Attitudes Questionnaire (MAQ) and a structured questionnaire were used. Logistic regression analysis revealed that individual characteristics such as age and education were significantly associated with menstrual attitudes of female caregivers working with institutionalized women with intellectual disabilities. Furthermore, the environmental context, such as the frequency of discussions with colleagues, training in menstrual management care and the level of difficulty when giving help in menstruation management, was important for improving caregivers' menstrual attitudes. This study contributes to the existing literature by determining both individual and environmental predictors of caregivers' menstrual attitudes.

The lifetime cost of hepatocellular carcinoma : a claims data analysis from a medical centre in Taiwan.

BACKGROUND: Hepatocellular carcinoma (HCC) is the second most common cancer in Taiwan. For males in Taiwan, it is the most dangerous cancer, with both the highest incidence and mortality rate. OBJECTIVE: To determine cancer-related medical care costs for long-term survivors of HCC. METHODS: The estimation of the lifetime cost was based on the insurer perspective and adopted an incidence-based approach. Data was sourced from the 1999-2002 cancer registry statistics of patients with HCC and the claims data of Taipei Veterans General Hospital (TVGH). In total there were 2873 HCC patients at TVGH. In addition to this data, the research used population National Health Insurance claims data from the National Health Research Institutes (1996-2002) as the comparison group. The probabilities of survival, dying of cancer or dying of other causes were estimated using cancer registry statistics. To estimate lifetime (10-year) cost, we divided the disease process into three phases: initial, continuing and terminal. The cost of HCC was calculated as the sum of the average cost of each phase. The expected lifetime cost for treatment of an HCC patient was estimated by incorporating the phase-specific costs with the survival and mortality rates. RESULTS: The results showed that 895 patients survived <1 year, and treatment for each of these patients cost on average New Taiwan dollars ($NT) 206 573 ($US 1 = $NT 33, year 2002 value) over this period. For those who survived > or =1 year, the terminal phase of treatment resulted in the highest costs, $NT 237 032. On average, for each patient, the initial phase cost was $NT 140 403 and the monthly cost for the continuing phase was $NT 8687. For the average HCC patient, the 10-year lifetime cost was $NT 418 554 (in nominal $NT). CONCLUSION: Our study showed that the terminal phase cost the most out of the three treatment phases. The aggregate lifetime cost of HCC is useful for health policy making and clinical decision making.

Risk factors for falls among elderly men in a veterans home.

BACKGROUND: Falls are major causes of mortality and morbidity in the elderly. Cognitive dysfunction, poor physical function and medical comorbidities are associated with many factors contributing to falls. The main purpose of this study was to explore the risk factors of falls among older institutionalized Chinese men in Taiwan. METHODS: Residents aged over 65 in a veterans care home in northern Taiwan were enrolled for study after they gave their full consent. Falling was defined as a fall within the past 180 days as defined by the Minimum Data Set (MDS). Physical function was determined by MDS resource utilization group activity of daily living score (RUG ADL score). Cognitive status was measured by MDS cognition scale (MDS COGS). RESULTS: In total, 585 residents (mean age, 80.9 +/- 5.4 years) were enrolled. Among all study subjects, 92.8% were physically independent and 20.2% were moderately cognitive impaired according to MDS COGS. By definition, 48 subjects (8.2%) had a past history of fall. Compared with non-fallers, fallers were significantly older (82.4 +/- 5.5 years vs. 80.7 +/- 5.4 years; p = 0.047) and had poorer functional status according to the MDS RUG ADL score (5.0 +/- 2.3 vs. 4.3 +/- 1.6; p = 0.044). Subjects with past history of anxiety disorder and cardiovascular disease were more prone to fall, and subjects who took hypnotics were also at a higher risk of falling. By using multivariate logistic regression, we found that higher RUG ADL score (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.37; p = 0.017) and hypnotic use (OR, 2.0; 95% CI, 1.0-4.1; p = 0.048) were both independent risk factors for falls. CONCLUSION: The prevalence of fall in the past 180 days was 8.2% among elderly residents in a veterans care home in northern Taiwan. The independent risk factors for falls in this setting included poorer functional status and hypnotic use.

Factors associated with prolonged hospital stay for acute stroke in Taiwan.

BACKGROUND AND PURPOSE: Stroke is one of the causes of prolonged hospital stay (PHS) in Taiwan. This study aimed to examine the magnitude and associated factors for such prolonged stays. METHODS: Patients admitted between 1997 and 2002 with the principal diagnosis of acute cerebrovascular diseases were identified from the claims data of a nationally representative cohort of 200,000 National Health Insurance enrollees. There were 2,358 subjects eligible for analysis. PHS was defined as length of stay > or = 23 days. Patient and hospital factors related to PHS were explored. RESULTS: A total of 245 subjects (10.4%) had PHS, but they accounted for 38.9% of the total person-hospital days and 47.8% of the total in-hospital medical expenses. PHS was statistically associated to surgical operation, physical/ADL dependency, infections or aspiration pneumonia, speech/swallowing disorders, female, stroke types, increased number of comorbidities, and increased age. PHS was inversely related to in-hospital mortality. CONCLUSIONS: An organized, multidisciplinary team approach should be initiated early after the onset of acute stroke to minimize functional disability, prevent complications and hence decrease the likelihood of PHS. Establishment of an integrated and affordable post-acute system should be a policy priority to effectively reduce unnecessary acute hospital use and to ensure a seamless stroke care.

Involuntary unemployment and mortality in Taiwan.

BACKGROUND AND PURPOSE: Unemployment is known to be associated with increased mortality, but little data is available from Taiwan, where dramatic structural changes in the economy have increased unemployment in recent years. The aim of this study was to investigate the effect of unemployment on mortality in Taiwan. METHODS: The study design was a cohort study with a control group. The unemployed group included 92,563 involuntarily unemployed individuals in 2001. Those in the control group (n = 92,599) were randomly selected from 1,230,000 employees, and matched with those in the unemployed group, by age, gender, income, firm size and urbanization, using a frequency matching mechanism. All subjects were followed during the period from January 2001 to December 2002. The adjusted hazard ratio was estimated using the Cox proportional hazards model. RESULTS: After adjusting for other factors, unemployment was associated with a higher risk of mortality (hazard ratio, 1.99; 95% confidence interval [CI], 1.60-2.48). The gender-specific adjusted hazard ratios for unemployment were 2.07 (95% CI, 1.59-2.70) for men and 1.82 (95% CI, 1.22-2.69) for women. Unemployed men had a significantly higher mortality risk for cardiovascular disease, digestive system diseases, all other diseases (except for cancer, digestive system and cardiovascular diseases), and other external causes (not including suicide) than men who were employed. In contrast, unemployed women had a significantly higher mortality risk only for other diseases, compared women who were employed. CONCLUSION: Unemployment is an important risk factor for mortality in Taiwan. The long-term impact of unemployment on mortality in Taiwan remains to be explored.

Surgeon volume for percutaneous nephrolithotomy is associated with medical costs and length of hospital stay: a nationwide population-based study in Taiwan.

BACKGROUND AND PURPOSE: To investigate the factors associated with outcomes and medical costs for percutaneous nephrolithotomy (PCNL). METHODS: The present study uses a subset of the National Health Insurance Research Database (NHIRD), known as the Longitudinal Health Insurance Database 2005 (LHID 2005), which contains the data of all medical benefit claims from 1997 to 2010 for a subset of 1 million enrollees randomly drawn from the population of 22.72 million persons who were enrolled in 2005. The claims data for all subjects with a diagnosis of urolithiasis who underwent PCNL were analyzed. Hospital and surgeon case volume were classified by quartile. The correlations of all patient, surgeon, and hospital variables with the outcomes and medical costs of PCNL were analyzed by generalized estimating equations. RESULTS: A total of 995 subjects received PCNL. In univariate analysis, PCNL performed by high-volume surgeons (≥12) cost 26% less ($2684 vs $1986) and resulted in a 34.3% shorter hospital stay (6.5 vs 9.9 days) compared with low-volume surgeons (≤3). In multivariate analysis, surgeon volume was a significant predictor for medical cost, length of stay, and intensive care unit transfer but not complications and mortality. CONCLUSIONS: Surgeon volume was associated with lower medical costs and shorter length of stay after PCNL. Surgeon volume, however, was not an independent predictor of complications and mortality. Our findings have important implications for urologists and policymakers with regard to the cost and effectiveness of PCNL.

Predicting functional decline of older men living in veteran homes by minimum data set: implications for disability prevention programs in long term care settings.

OBJECTIVE: To evaluate the risk and protective factors for functional decline of veteran home residents in Taiwan to develop disability prevention programs in long term care settings. DESIGN: A prospective cohort study. SETTING: Two veteran homes in Taiwan. PARTICIPANTS: A total of 1045 residents of veteran homes. INTERVENTION: None. MEASUREMENTS: Minimum data set (MDS), resident assessment protocols (RAP), MDS-COGS, Resource Utilization Group-III Activities of Daily Living scale, MDS Social engagement scale, MDS Pain scale. RESULTS: A total of 1045 (83.0 ± 5.1 years, all men) residents completed the study, and 11.3% of them developed significant functional decline during the study period. Participants with long-term institutionalization history (odds ratio [OR] 2.966, confidence interval [CI] 1.270-6.927), underlying cerebrovascular disease (OR 4.432, CI 1.994-9.852) and dementia (OR 2.150, CI 1.029-4.504), and higher sum of RAP triggers (OR 1.366, CI 1.230-1.517) were more likely to develop functional decline, whereas those who had better social engagement were significantly protective from functional decline (OR 0.528, CI 0.399-0.697). CONCLUSIONS: Cerebrovascular disease, dementia, higher sum of RAP triggers, and long-term institutionalization were independent risk factors for functional decline, whereas better social engagement had a protective effect on functional dependence. Further study is needed to develop an integrated disability prevention program based on the discoveries of this study.

How complex documentation with Personal Digital Assistants could be?

The researchers have demonstrated that the PDA could be used for complex documentation and well accepted by users. This study examined whether the researchers could make the PDA system still keep great usability when the contents of information were requested to increase from 262 to 513 questions. Two independent convenience samples from the Veterans Medical Care system in Taiwan and the questionnaire designed based on Technology Acceptance Model were used in this study. Results showed that mobile device such as PDA could still be used for complex documentation with 513 assessment questions, designed with a set of effective screen interface design principles. This is encouraging for the mobile health because its success depends on the use of mobile devices.