The Validation Study of Both the Modified Barthel and Barthel Index, and Their Comparison Based on Rasch Analysis in the Hospitalized Acute Stroke Elderly.

A validation study the Iranian Modified Barthel Index (MBI) in hospitalized acute stroke elderly by classical test theory approach and investigate Rasch analysis for both Iranian version MBI and BI and compare the hierarchical item difficulty of them. Face-to-face interview with 100 geriatric stroke inpatients 60+ or their caregivers was done in a cross-sectional study. First, construct validity of MBI analyzed by the classical test theory, then Rasch analysis were done for BI and MBI. The reliability of the Iranian MBI was significant at 0.955. One factor achieved by the variance of 83.2%. In Rasch analysis for MBI, the most difficult item was stair climbing, whereas the simplest items were bowel and bladder control. In BI, the most difficult items were toilet use and ambulation. The Iranian MBI is very accurate and reliable; therefore the use of MBI to measure better outcomes in stroke elderly inpatients is recommended comparing with BI.

Role of frailty in prediction of hospitalized older adult patient's outcomes: a prospective study

Background/aim: Frailty is associated with an increased risk of negative short-term and long-term hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults. Materials and methods: This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. In total, 304 participants (65­85 years), were enrolled through the inclusion criteria from August to December 2019. The frailty index (FI) was assessed by the minimum data set-home care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient's hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes. Results: According to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the nonfrail and frail groups (OR = 1.88, 95% CI = 1.90­3.26), and also for GP visits, frail patients showed nearly significant differences (OR = 2.45, 95% CI = 0.99­6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR = 2.28, 95% CI: 1.24­4.18). The fully-adjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR = 10.77, 95% CI: 3.97­29.18). Conclusions: The findings indicated that frailty worsened negative outcomes and declined QoL. Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.

Screening for elder abuse in geriatric outpatients: reliability and validity of the Iranian version Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).

The present research seeks the notion of the appropriateness of "Hwalek-Sengstock Elder Abuse Screening Test (H-S/East)", and psychometric properties to analyses cultural aspects of elder abuse in the Iranian community dwellers referred to clinics. In this cross-sectional validation study 364 participants, 60 years and over were selected from outpatient' clinics. The SF-36, GDS-15, and AMT scores were used for concurrent validity. The Brief Abuse Screen for the Elderly (BASE) scale was examined to determine the sensitivity and specificity of the Iranian version H-S/East. The elder abuse rate in participants was 29.4% based on cutoff ≥4, while a significant correlation was found in Iranian version H-S/EAST with depression and SF-36 subscale MCS at P < .01, and four factors observed. Optimal cutoff ≥4 obtained with 82.8% sensitivity and 84.5% specificity. It seems the Iranian version of H-S/East demonstrates concurrent validity and fair reliability in elderly outpatients, while construct validity should be carried out in the Iranian elder illiterate population and other languages/cultures.

Effects of hospital-to-home transitional care on health outcomes of elderly patients in Islamic Republic of Iran.

Background: Hospitalization has a negative effect on the functional and clinical outcomes of elderly patients. Aims: To evaluate the effect of a care transition intervention on functional and clinical outcomes and quality-of-life of elderly patients in the Islamic Republic of Iran after hospital discharge during a 3-month follow-up. Methods: We conducted a randomized controlled trial of 304 elderly hospitalized patients in Tehran from December 2018 to January 2020. The intervention group (n = 152) received care transition intervention and the control group (n = 152) received routine hospital discharge. All patients were assessed during hospital stay and at 30, 60 and 90 days after hospital discharge. Participants were evaluated using the Minimum Data Set-Home Care form, which assesses daily living activity, instrumental daily living activity, cognitive performance, cognition, pain, and depression. Rehospitalization and qualityof- life were evaluated, and differences between the groups and trends in quality-of-life were assessed. Results: Only instrumental daily living activity in the functional outcomes and quality-of-life were greater in the intervention group than the controls. The intervention (odds ratio (OR): 0.11; 95% confidence intervals (CI): 0.01-0.97), age (OR: 1.16; 95% CI: 1.01-1.33), and cognition (OR: 1.24; 95% CI: 1.02-1.51) predicted instrumental daily living activity. Age (coefficient: -0.009, P = 0.001), depression (coefficient: -0.157; P < 0.001), cognition (coefficient: -0.023, P < 0.001) and pain (coefficient: -0.106, P = 0.007) predicted quality-of-life. Conclusion: Care transition interventions can help maintain the independence of older adults after hospital discharge and improve their quality-of-life.

Applicability of SPMSQ in illiterate outpatients in clinics: The validity and reliability of the Short Portable Mental Status Questionnaire.

OBJECTIVES: The Short Portable Mental Status Questionnaire is a brief cognitive tool designed to screen cognitive impairment in geriatric inpatients and outpatients. The validity and reliability of this tool have not been studied in Iran so far. Therefore, this study was conducted to assess the diagnostic properties of the SPMSQ for detection of cognitive disorders in elderly and determine an appropriate cutoff point based on respondents' level of education. METHODS: This cross-sectional study was conducted through face to face interviews on a sample of 156 patients (≥60 years) referred to neurology and geriatric clinics of Ziaiyan hospital, Tehran University of Medical Sciences. Regarding the type of cognitive impairment, Participants were divided into two groups; those with cognitive disorders (n = 96) and healthy (n = 60). The level of literacy was also considered in each of the groups. RESULTS: The Cronbach's alpha coefficient for the SPMSQ was 0.88. In terms of the concurrent validity, a correlation coefficient between SPMSQ and GDS was higher in the literate group compared to the illiterate patients, while in the illiterate group, the SPMSQ had a higher correlation with AMT compared to the other tools. Based on DSM-5, the cutoff point of SPMSQ was 4 in the illiterate elderly patients and the sensitivity and specificity of the tool were at 86.4 and 88.2%, respectively. However, in the literate patients, the cutoff point was 3 and the sensitivity and specificity were 83 and 93.7%, respectively. Also, two components, namely orientation and long-term memory/concentration were determined for the SPMSQ using the factor analysis. CONCLUSION: The Iranian version of SPMSQ has a favorable validity and reliability for diagnosing cognitive disorders and can be used for cognitive screening of illiterate older adults.

Diagnosis of frailty in geriatric patients: Is the pictorial fit frail scale an appropriate screening tool in hospital settings?

BACKGROUND: Frailty is accompanied by serious health complications in the elderly, especially during hospitalization. Visual scales have been designed for quick and easy evaluation of frailty in different cultures and settings. Therefore, this study aimed to define the accuracy of the Pictorial Fit Frail Scale (PFFS) for frailty screening in the hospitalized elderly in Iran. METHODS: This cross-sectional study was conducted on 304 hospitalized participants, aged 65-85 years old admitted at Ziaeian Hospital (Tehran) were enrolled through the inclusion criteria from August to December 2019. All participants were evaluated based on the Minimum Data Set-Home Care, the Pictorial Fit Frail Scale, and the Quality-of-Life instrument, through face-to-face interviews by a trained nurse at the admission time. Spearman's correlation coefficient, and ROC analysis were performed using SPSS at p<0.05. RESULTS: The highest correlation was obtained by Frailty Index (FI) and PFFS (0.770). FI had a negative correlation with QoL (-0.48). The optimal cut-points for PFFS according to FI ≤ 0.08 (robust vs. pre-frail) was obtained 0.10 with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00% and the best cut-point for PFFS based on FI ≥ 0.25 (pre-frail vs. frail) was obtained 0.29 with sensitivity and specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00%. CONCLUSION: It seems the Pictorial Fit-Frail Scale (PFFS) is a reliable scale with a high level of accuracy, and excellent sensitivity and specificity to measure the frailty level in hospitalized elderlies.

Validity and reliability of Bayer Activities of Daily Living (Bayer- ADL) scale in the Iranian elderly dementia population: Is there distinguish between illiterate and literate demented in functional dependency?

This validation study is discriminant and concurrent, with the Bayer-Activities of Daily Living (Bayer-ADL) tool among the Iranian elderly dementia illiterate and literate. The tools Bayer-ADL, Global Deterioration Scale (GDS), Mini Mental State Examination (MMSE), ADL-Barthel, and instrumental activities of daily living (IADL) were applied to find Bayer-ADL correlations in 311 dementia outpatients that were ≥60 years old. The Iranian version Bayer-ADL scores between illiterate and literate dementia elderly, based on GDS, observed good discrimination values (0.923 sensitivity and 0.750 specificity) in illiterate people, and excellent discrimination values were achieved (sensitivity 0.919 and 0. 986 specificity) in literate dementia elderly. The suggested cutoff points were 1.79 for illiterate and for the Iranian literate dementia elderly 1.82, based on GDS. Both forms (24 and 25 items) of Bayer-ADL were correlated to GDS, ADL, and IADL. Bayer-ADL is a valid tool to distinguish physical dysfunction between illiterate and literate of the Iranian dementia elderly; however, some revisions in the components are needed for the illiterate elderly. Generally, the findings presented in the Iranian version Bayer-ADL could be useful to both clinical purpose and international studies.

Iranian Version of Barthel Index: Validity and Reliability in Outpatients' Elderly.

BACKGROUND: Validation study of Barthel Index for elderly patients being attended in outpatient and rehabilitation clinics in Iran. METHODS: Face-to-face interview with 395 out patients geriatric 60+ years was done in a cross-sectional study. The internal consistency Barthel-ADL was used to approve reliability. Criterion validity and factor analysis were used to verify validity. RESULTS: Reliability the Iranian version BI was significant at 0.938. In criterion validity analysis, the high correlation tools included Functional Ambulation Category (FAC) and Foot and Ankle Ability Measure (FAAM-subscales ADL) at 0.947 and -0.945, respectively. In factor analyses, two domains obtained, the variance of 10 items achieved 69.79%; also, the Item Total Correlation (ITC) of each item was measured. CONCLUSIONS: The Barthel Index shows a good validity and reliability, and recommended to use in the Iranian geriatric outpatients in evaluating physical ability.