Functional independence of Taiwanese patients with mucopolysaccharidoses.

BACKGROUND: Information on functional strengths and weaknesses of mucopolysaccharidosis (MPS) patients is important for early intervention programs and enzyme replacement therapy (ERT). METHODS: We used the Functional Independence Measure for Children (WeeFIM) questionnaire to assess the functional skills of 63 Taiwanese MPS patients (median age, 13 years 3 months; range, 3-20 years) from January 2012 to December 2018. RESULTS: Mean total WeeFIM score was 75.4 of a potential score of 126. Mean total WeeFIM scores of each type (MPS I, MPS II, MPS IIIB, MPS IVA, and MPS VI) were 103.8, 76.2, 41.6, 92.2, and 113.6, respectively. Mean scores for self-care, mobility, and cognition domains were 30 (maximum 56), 23 (maximum 35), and 22 (maximum 35), respectively. MPS type IIIB patients had the lowest scores in self-care, mobility, cognition, and total domains compared to other types of MPS. All patients with ERT in MPS I, II, and IVA had higher scores in self-care and mobility domains than patients without ERT. Most patients required assistance for self-care skills, especially in grooming and bathing. CONCLUSION: MPS patients require support and supervision in self-care tasks. For cognition tasks, MPS IIIB patients also require help. This questionnaire is useful to identify the strengths and limitations of MPS patients.

Validation of the O3DY French Version (O3DY-F) for the Screening of Cognitive Impairment in Community Seniors in the Emergency Department.

BACKGROUND: It is recommended that older patients undergo systematic mental status screening when presenting to the emergency department (ED). However, the tools available are not necessarily adapted to the ED environment, therefore, quicker and easier tools are needed. OBJECTIVES: The purpose of this study is to validate the Ottawa 3DY-French (O3DY-F) Scale as a screening tool for delirium and cognitive impairment in a French-speaking cohort. METHOD: This multicenter prospective study was conducted in four hospitals across the province of Quebec. Inclusion criteria were: age ≥ 65 years, ED stay ≥ 8 h, awaiting admission to a care unit, and independent or semi-independent in their daily living activities. Cognitive status was assessed during the initial interview using the Telephone Interview for Cognitive Screening-modified (TICS-m) and the O3DY-F scale. Comparisons were made between the O3DY-F and the TICS-m and Confusion Assessment Method (CAM) to assess the sensitivity and specificity of the O3DY-F for the detection of cognitive impairment and delirium. RESULTS: A total of 313 patients were included in this study, 139 of which had a positive O3DY-F. When compared with the CAM, the O3DY-F had a sensitivity of 84.2% (95% confidence interval [CI] 60.4-96.6) and a specificity of 58.2% (95% CI 52.3-63.9) for the detection of prevalent delirium. The O3DY-F had a sensitivity of 76.2% (95% CI 66.7-84.8) and a specificity of 67.6% (95% CI 61.0-73.6) for cognitive impairment (defined as a TICS-m < 27). CONCLUSION: The O3DY-F is a useful and effective tool to screen for delirium and undetected cognitive impairment among a French-speaking cohort in the ED.

Patterns of instrumental activities of daily living and association with predictors among community-dwelling older women: A latent class analysis.

BACKGROUND: The purpose of this study was to classify patterns of instrumental activities of daily living (IADL) among community-dwelling older women, to examine difference in characteristics among the classes, and to explore predictors of class membership. METHODS: This study was a secondary analysis of nationwide data from the 2014 Actual Living Condition of the Elderly and Welfare Need Survey. A total of 10,451 individuals aged 65 years or older were interviewed for the 2014 dataset, but we only selected the female participants (n = 6095) for this study. For statistical analyses, latent class analysis was applied to identify different latent classes of IADL and then the effects of predictors on IADL patterns were analyzed by using multinomial logistic regression. RESULTS: The 5-class model was the best fit for the data. The size of class 1was the biggest (n = 5093, 83.6%), followed by class 5 (n = 401, 6.6%), class 3 (n = 308, 5.1%), class 2 (n = 181, 3.0%), and class 4 (n = 113, 1.8%). The largest class had total independency on all items of IADL. In the multinomial regression, members in the classes 2, 3, 4 and 5 were significantly more likely to have older age and decreased cognitive status compared with the class of total independency on all items of IADL (class1). CONCLUSIONS: The predictors of the classes identified in this study can be used for tailored and targeted interventions to increased old adults' independency on IADL.

Conceptualizing Everyday Mobility of Older People as Basis for the Development of a Pedestrian Assistance System.

For older persons, everyday mobility is an important aspect of living an independent and self-determined life. Especially with increasing age most of the everyday ways in urban areas are covered by foot. The more severe is the fact that older pedestrians are among the most vulnerable road users. This is the starting point of the research group FANS aiming for developing a pedestrian assistance system for older road users. Therefore, it is necessary to understand the difficulties older pedestrians encounter. In order to do so, everyday mobility of this group will be conceptualized using the Constraints Approach by Hägerstrand and the Theory of Structuration by Giddens. Currently, two focus groups have been carried out that have been analyzed according to Hägerstand's and Gidden's considerations. Hereinafter, the category system that has been derived from the theoretical considerations will be presented and an outlook will be given.

Restricting back pain and subsequent mobility disability in community-living older persons.

OBJECTIVES: To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent mobility disability in community-living older persons. DESIGN: Prospective cohort study. SETTING: Greater New Haven, Connecticut. PARTICIPANTS: Community-living men and women aged 70 and older (n = 709). MEASUREMENTS: Restricting back pain and mobility disability (defined as needing help with or unable to walk one-quarter of a mile, climb a flight of stairs, or lift and carry 10 pounds) were assessed during monthly telephone interviews for up to 159 months. The association between restricting back pain and subsequent mobility disability was evaluated using a recurrent-events Cox model. Secondary analyses evaluated the association between restricting back pain and mobility disability for two or more consecutive months (persistent mobility disability). Additional analyses were repeated in participants without baseline mobility disability. RESULTS: The event rate for mobility disability was 7.26 per 100-person months (95% confidence interval (CI) = 6.89-7.64). Mobility disability episodes lasted for a median of 2 months (interquartile range (IQR) 1-4). In a recurrent-event Cox regression analysis, after adjusting for 11 covariates, restricting back pain was strongly associated with mobility disability (hazard ratio (HR) = 3.23, 95% CI = 2.87-3.64). The association was maintained when the outcome was defined as persistent mobility disability (adjusted HR = 3.63, 95% CI = 3.15-4.20) and when participants with baseline mobility disability were omitted (adjusted HR = 3.71, 95% CI = 3.22-4.28). CONCLUSION: Restricting back pain was strongly associated with mobility disability. Interventions that prevent or ameliorate restricting back pain may be effective for reducing the burden of mobility disability in older persons.

Faster cognitive decline in elders without dementia and decreased risk of cancer mortality: NEDICES Study.

OBJECTIVE: To assess whether faster cognitive decline in elders without dementia is associated with decreased risk of cancer mortality. METHODS: In this population-based, prospective study of 2,627 people without dementia aged 65 years and older (Neurological Disorders in Central Spain), a 37-item version of the Mini-Mental State Examination (37-MMSE) was administered at 2 visits (baseline and follow-up, approximately 3 years later). We divided change in 37-MMSE into tertiles (lower tertile ≥ 2 point improvement in score, higher tertile ≥ 2 point decline in score). Community-dwelling elders were followed for a median of 12.9 years, after which the death certificates of those who died were examined. RESULTS: A total of 1,003 (38.2%) died, including 339 (33.8%) deaths among participants who were in the higher tertile of 37-MMSE change and 664 (66.2%) deaths among those in the remaining tertiles. Cancer was reported significantly less often in those in the higher tertile of MMSE change (20.6%) than in those in the remaining tertiles (28.6%): in an unadjusted Cox model, hazard ratio for cancer mortality in participants within the higher tertile = 0.75 (p = 0.04) compared with the participants within the remaining tertiles. In a Cox model that adjusted for a variety of demographic factors and comorbidities, hazard ratio for cancer mortality in participants within the higher tertile = 0.70 (p = 0.01). CONCLUSION: In this population-based, prospective study of community-dwelling elders without dementia, faster cognitive decline was associated with a decreased risk of cancer mortality. Further studies are required to elucidate this inverse association in elders without dementia.

[Clinimetrical scales in spinal cord lesion]. / Skale klinimetryczne stosowane w uszkodzeniu rdzenia kregowego.

Clinimetrics is a specific field of medical science, it is the science of measurement of clinical occurrence in a patient. The aim of clinimetrics is to construct scales to evaluate patients with clinical indicators. The inclusion of the patient's condition in the point value allows to objectified, compare and evaluate treatment and to carry out mathematical and statistical analysis in science researches. A review of clinimetrical methods used in spinal cord lesion was made in reference to both injury and functional scales. The latest tools for functional assessment of patients after spinal cord injury--Spinal Cord Independence Measure (SCIM) and Walking Index for Spinal Cord Injury (WISCI)--were described. Properly selected and used the scales let achieve a goal, which is unambiguous, repeatable and quantitative summary of clinical phenomena.

Limits of the Epworth Sleepiness Scale in older adults.

PURPOSE: Excessive daytime sleepiness (EDS) in older adults is associated with obstructive sleep apnea, falls, reduced quality of life, and mortality. The Epworth Sleepiness Scale (ESS) is widely used to assess sleepiness. However, EDS assessment with the ESS may not be accurate in older adults. We aimed to (1) describe the responsiveness of nondemented older subjects to the ESS and (2) compare the self-report ESS scores to those of close relatives (CR) proxy and identify factors influencing any discrepancies between them. METHODS: This is a cross-sectional observational study including 104 independently living nondemented older subjects with daytime sleepiness complaints and 104 nondemented CRs. Cognitive tests (Mini-Mental State Examination) and the ESS were completed separately by subjects and CRs to assess the subject's daytime sleepiness. RESULTS: Almost 60 % of subjects and CRs were not able to answer at least one question on the ESS. Despite the fact that all subjects complained of EDS, only 24 % of them had an abnormal ESS score (>10). Subjects rated their sleepiness lower (7.10 ± 4.31) than their CR proxy did (9.70 ± 5.14) (p < 0.0001). In multivariate analysis, an increase in age and a decrease in cognitive status of the subjects appeared related to the difference in ESS between subject and CR. CONCLUSIONS: The majority of older adults were not able to answer all of the ESS items. The ESS may underestimate sleepiness severity in older subjects. Despite EDS complaints in all subjects, only one quarter of them had a pathological ESS score.

[Paquid 2012: illustration and overview]. / Paquid 2012 : illustration et bilan.

Paquid (personnes âgées quid) is a population-based cohort specifically designed to study the epidemiology of brain aging and dependency in activities of daily living in elderly people. At baseline screening, 3.777 subjects older than 65 were randomly selected in 75 different parishes from Gironde and Dordogne, and two administrative districts around Bordeaux in South-Western France. The participation rate was 68%. Subjects were followed up every two to three years with repeated measures of cognition, instrumental and basic activities of daily living collected by a trained psychologist, and a systematic detection of incident cases of dementia. The participation rate of each follow-up screening was around 75%. The detection of dementia was conducted with a two-stage design, with a first stage conducted by the psychologist and the confirmation of the diagnosis made at home by a physician, specialist in Alzheimer disease and related disorders (ADRD). Over 20 years of follow-up more than 800 subjects developed incident dementia and more than 2.500 died. Paquid remains the only representative cohort of elderly people living at home in France, giving estimations of prevalence, incidence and duration of ADRD and dependency. Thirty six risk factors of dementia and/or AD have been studied. On the basis of the Paquid data, we have shown that the prodromal phase of AD was longer than ten years and that dementia represented the major cause of dependency in the elderly.

Design, measures and sample characteristics of the CadeViMa-Spain survey on quality of life in community-dwelling older adults.

BACKGROUND: The survey "Quality of life in older adults-Spain" (CadeViMa-Spain) was designed to obtain information about objective and subjective determinants of Quality of Life (QoL) in old age, from a multidimensional perspective. This paper presents the overall description, methodology, sample characteristics and reliability of the measures used. METHODS: A cross-sectional survey was carried out in a representative sample of 1106 community-dwelling adults aged 60 years and over in Spain. The sample was obtained by a geodemographically-based proportional multistage stratified sampling. A home-based questionnaire included validated scales and questions about sociodemographic characteristics, global QoL, health, family and social networks, financial means and retirement, leisure and social participation, residential environment, and satisfaction with those issues. Face-to-face semi-structured interviews were conducted. Cronbach's α coefficients were used to assess internal consistency of the scales. RESULTS: This nationally representative survey furnishes information about global QoL, health-related QoL, resources availability, living conditions, and satisfaction with the assessed aspects, including life domains most valued by this group. In general, community-dwelling older adults reported positive assessments of health, living conditions, and high levels of satisfaction with the different aspects of QoL. The reliability of the measures in this population was good. CONCLUSIONS: This survey provides comprehensive and useful information, based on the view of older people themselves, with potential to contribute to health and social policies towards promoting active aging. The database is available for in-depth comparisons.

Cross-cultural adaptation, reliability and validity of the DAFS-R in a sample of Brazilian older adults.

The Direct Assessment of Functional Status-Revised (DAFS-R) is an instrument developed to objectively measure functional capacities required for independent living. The objective of this study was to translate and culturally adapt the DAFS-R for Brazilian Portuguese (DAFS-BR) and to evaluate its reliability and validity. The DAFS-BR was administered to 89 older patients classified previously as normal controls, mild cognitive impairment (MCI) and Alzheimer's disease (AD). The results indicated good internal consistency (Cronbach's alpha = 0.78) in the total sample. The DAFS-BR showed high interobserver reliability (0.996; p < .001) as well as test-retest stability over 1-week interval (0.995; p < .001). Correlation between the DAFS-BR total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was moderate and significant (r = -.65, p < .001) in the total sample, whereas it did not reach statistical significance within each diagnostic group. Receiver operating characteristic curve analyses suggested that DAFS-BR has good sensitivity and specificity to identify MCI and AD. Results suggest that DAFS-BR can document degrees of severity of functional impairment among Brazilian older adults.

The Concord Centre for Mental Health's new 'phase of illness' model of care: are we on the right track?

OBJECTIVE: The aim of this study was to provide an overview of a new 'phase of illness' model of care after relocation of Rozelle Hospital to the new purpose built Concord Centre for Mental Health and discuss its implementation and progress thus far. METHOD: One year after relocation, staff were asked to provide feedback of their views of the new model of care in order to identify implementation barriers and ways forward. RESULTS: The new model has clear benefits for the consumer, but there are a number of practical challenges and dilemmas emerging that necessitate some refinement and evaluation. Feedback from staff provided a wide range of opinions indicating that some were quite cynical of the new model while others were very supportive and thought that patient care was enhanced. CONCLUSIONS: Further development and consolidation of the model is required, including more education sessions and a clear mission statement at unit, hospital and community levels. Further research is also required to assess the impact and ability of the new model to deliver better patient outcomes, especially in regard to continuity of care.

The relationship between short-term mortality and quality of care for hip fracture: a meta-analysis of clinical pathways for hip fracture.

OBJECTIVES: To assess the association between use of clinical pathways for hip fracture and changes in the rates of five inpatient complications and short-term mortality. DESIGN: Meta-analysis of published studies examining clinical pathways for hip fracture, identified through systematic searches of electronic databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) and hand searches of selected article bibliographies. SETTING: Observational and interventional studies of clinical pathways for hip fracture examining rates of deep venous thrombosis, pressure ulcer, surgical site infection, urinary tract infection, pneumonia, and inpatient or 30-day mortality. PARTICIPANTS: Two reviewers. MEASUREMENTS: Reviewers independently assessed eligibility and quality of studies and extracted data for outcomes of interest. RESULTS: Meta-analysis of nine studies (4,637 patients) demonstrated lower odds of deep venous thrombosis (odds ratio (OR)=0.33, 95% CI=0.14-0.75), pressure ulcer (OR=0.48, 95% CI=0.30-0.75), surgical site infection (OR=0.48, 95% CI=0.25-0.89), and urinary tract infection (OR=0.71, 95% CI=0.52-0.98) in patients managed according to clinical pathways than in those receiving usual care. Statistically significant differences were not observed in the odds of pneumonia (OR=1.01, 95% CI=0.67-1.53) or in a combined outcome of in-hospital or 30-day mortality (OR=0.86, 95% CI=0.66-1.13). CONCLUSION: An association was observed between clinical pathway use and lower odds of four common complications of hospitalization after hip fracture; only a small, statistically insignificant association was observed between pathway use and changes in short-term mortality, suggesting that assessments of hospital quality based on short-term mortality may not reflect important improvements in patient outcomes that hospitals may achieve using clinical pathways.