Search results for ‘Subject term:"older people"’ Sort:
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Everyday living in later life
- Editor:
- BYTHEWAY Bill
- Publisher:
- Centre for Policy on Ageing
- Publication year:
- 2003
- Pagination:
- 66p.,bibliogs.
- Place of publication:
- London
There has been comparatively little research into the day-to-day lives of older people. Through in-depth interviewing researchers know a lot about what older people have to tell us, and through longitudinal research quite a lot about how lives change over the course of time. What gerontology is less well informed about is how the lives of older people are managed from day to day.
Correlates of everyday competence in Chinese older adults
- Author:
- CHOU K. L.
- Journal article citation:
- Aging and Mental Health, 7(4), July 2003, pp.308-315.
- Publisher:
- Taylor and Francis
Whether older adults can maintain levels of adaptation that allow continuation of independent living is necessarily contingent upon the maintenance of levels of everyday competence. This study identifies factors correlated to everyday competence measured by a Chinese version of the Direct Assessment of Functional Abilities among Hong Kong Chinese elderly people. The respondents were 393 people aged 60 years or older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong and they were interviewed in a face-to-face format. In multiple regression analyses, we found that self-rated health, sight, and global cognitive ability were positively associated with everyday competence whereas the presence of arthritis had a negative impact on the everyday competence. All these findings are consistent with previous Western studies.
A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care
- Authors:
- POLITIS Antonios M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1087-1094.
- Publisher:
- Wiley
Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers. Most treatments for apathy, particularly non-pharmacologic interventions, have not been evaluated in controlled trials. This study evaluated the efficacy of a kit-based activity intervention, compared to a time and attention control (one-on-one meetings with an activity therapist) in reducing apathy and improving quality of life in 37 patients with dementia. The design was a randomized, controlled, partially masked clinical trial. All outcome measures were administered at baseline and follow-up. The primary outcome measure was the apathy score of the Neuropsychiatric Inventory (NPI). Other outcome measures were the NPI total score, the Alzheimer Disease Related Quality of Life scale(ADQRL), and the Copper Ridge Activity Index (CRAI). There was a significant reduction in NPI apathy scores in both treatment groups. The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale (p = 0.027), but not on the other CRAI subscales. There was also a greater within group improvement in quality of life ratings in the control intervention (p = 0.03). Despite the substantial improvement in apathy scores during the course of the study, there was no clear advantage to the reminiscence-based intervention over the time and attention, one-on-one control intervention. More research is needed to develop specific behavioral interventions for apathy in patients with dementia.
Measuring disability in patients with neurodegenerative disease using the Yesterday Interview
- Authors:
- LOMAX Claire L., BROWN Richard G., HOWARD Robet J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1058-1064.
- Publisher:
- Wiley
The aim was to illustrate the use of time-budget methodology as a means of measuring disability within the framework of the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) in a mixed group of patients with neurodegenerative disease. A semi-structured interview method (the Yesterday Interview) was used to reconstruct the preceding 24-hour period in terms of activity, social and environmental context, and subjective enjoyment. Data were collected on 40 elderly control subjects and a sample of 99 community based patients diagnosed with either Parkinson's disease without or with dementia, Alzheimer's disease, Dementia with Lewy bodies, Progressive Supranuclear Palsy or Multiple System Atrophy. All participants were seen in their own home. The results were translated hierarchically into the ICF framework of disability domains, and further into a higher level formulation based on the constructs of discretionary/obligatory activity. Disability profiles were obtained for the patient group as a whole and for the individual disorders. Restricted patterns of time-use were noted across a range of domains encompassing both obligatory and discretionary activity, and accompanied by a significant increase in passive activity such as day-time sleeping or sitting in front of the television. The data also illustrated the restrictions in both the social and environmental contexts of the patient's lives, and the diminished levels of subjective enjoyment associated with their pattern of daily time-use. With the exception of time spent on discretionary activities, these various indices were significantly associated with standard clinical measures disability. With further studies to assess reliability and validity, time-use and contextual data obtained from structured interviews may provide a useful means of measuring disability within the ICF framework in patients with degenerative neurological disease.
A new approach to the qualitative evaluation of functional disability in dementia
- Authors:
- KURZ X., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.1050-1055.
- Publisher:
- Wiley
Dementia patients suffer from the progressive deterioration of cognitive and functional abilities. Instrumental disabilities usually appear in the earlier stages of the disease while basic disabilities appear in the more advanced stages. In order to differentiate between mild, moderate and severe patients both instrumental and basic functional disabilities should be taken into account simultaneously. The objective of this study was to find a new method for classifying dementia patients based on their disabilities by using a basic and an instrumental Activities of Daily Living (ADL) scale. Functional disability was assessed in a Belgian cohort of dementia patients using the Katz and Lawton Instrumental Activities of Daily Living (IADL) scales. A k-means derived clustering method allocated patients to disability clusters according to their Katz and Lawton scores. In order to validate the classification, we compared socio-demographic, clinical and costs parameters between the groups. The clustering method allocated patients between three clusters: dependent, non-dependent with instrumental functional disability (ND-IFD) and non-dependent. Dependence, as defined by these clusters, significantly correlates with age, residential setting, MMSE, patient's quality of life and costs. This new classification of patients suffering from dementia will provide better understanding of functional disabilities and will complement the evaluation of disease severity based on cognitive function.
Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients
- Author:
- LECHOWSKI L.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(11), November 2003, pp.977-982.
- Publisher:
- Wiley
Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). The number of men with available data for IADL total score was too small to make any analysis. Group A gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. Group B, pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients
The impact of hearing loss on quality of life in older adults
- Authors:
- DALTON Dayna, et al
- Journal article citation:
- Gerontologist, 43(5), October 2003, pp.661-668.
- Publisher:
- Oxford University Press
The authors investigate the impact of hearing loss on quality of life in a large population of older adults. Data are from the 5-year follow-up Epidemiology of Hearing Loss Study, a population-based longitudinal study of age-related hearing impairment conducted in Beaver Dam, WI. Participants (N = 2,688) were 53-97 years old (mean = 69 years) and 42% were male. Difficulties with communication were assessed by using the Hearing Handicap for the Elderly-Screening version (HHIE-S), with additional questions regarding communication difficulties in specific situations. Health-related quality of life was assessed by using measures of activities of daily living (ADLs), instrumental ADLs (IADLs) and the Short Form 36 Health Survey (SF-36). Hearing loss measured by audiometry was categorized on the basis of the pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz. Of participants, 28% had a mild hearing loss and 24% had a moderate to severe hearing loss. Severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties. Individuals with moderate to severe hearing loss were more likely than individuals without hearing loss to have impaired ADLs and IADLs. Severity of hearing loss was significantly associated with decreased function in both the Mental Component Summary score and the Physical Component Summary score of the SF-36 as well as with six of the eight individual domain scores.
Characterization of worry according to severity of anxiety in elderly living in the community
- Authors:
- MONTORIO I., et al
- Journal article citation:
- Aging and Mental Health, 7(5), September 2003, pp.334-341.
- Publisher:
- Taylor and Francis
The goals of this study were to analyse the characteristics of the phenomenon of worry in old age, to analyse differential characteristics of worry in the elderly according to severity of anxiety, and to explore the discriminative ability of different DSM-IV criteria for generalized anxiety disorder (GAD) to reveal the presence of this disorder. Starting from a randomized sample of 97 individuals, those 85 representing three levels of severity of the anxiety were retained: 74 non-clinical, four with sub-threshold anxiety and seven with GAD. They were assessed with different variables typically considered to be relevant for the analysis and characterization of worry. Results indicate that the most remarkable differences in contents of worry as a function of severity of anxiety occurred in the domains of worries about health and personal worries. Furthermore, elderly people with high levels of anxiety worry more frequently, and about more issues, and perceive less control over their worrying. Significant differences between groups in past and present orientation of worry were found. Worries were more frequent in GAD and they were oriented mainly towards the present and minor everyday problems in both GAD and non- clinical people. Moreover, worry about minor things together with the extent to which worry interferes in daily life were the best discriminant variables for GAD, being better than the core DSM-IV GAD criteria. We conclude that this pattern of results suggests that the potential of a specific worry to affect daily well-being and quality of life is strongly related to the presence of a disorder.
Obstacles to implementing research outcomes in community settings
- Authors:
- BALL Karlene, WADLEY Virginia, ROENKER Daniel
- Journal article citation:
- Gerontologist, 43(Special Issue), March 2003, pp.29-36.
- Publisher:
- Oxford University Press
This American article argues that in contrast to controlled laboratory or clinic-based research that can fail to capture the real-world behaviors of older adults, field research offers the best opportunity for ecological validity. However, the tradeoff inherent in field studies is the potential sacrifice of scientific rigour. Applied research presents a unique set of challenges that vary with context. This article discusses these challenges along with possible solutions. Examples are drawn from an ongoing, longitudinal study of driving competence that is being conducted in Department of Motor Vehicles field sites. The challenges faced at each stage of the project are discussed. Methodological issues include identifying field collaborators, approaching administrators with the research proposal, producing a battery that is manageable and acceptable while maintaining scientific merit, training indigenous personnel to administer this battery, introducing the research and consenting potential participants, and managing large data sets offsite. Additional issues include quality control, the importance of distinguishing between individuals who consent and those who decline participation, and the collection of follow-up data via telephone.
Practically relevant research: capturing real world tasks, environments, and outcomes
- Authors:
- CZAJA Sara J., SHARIT Joseph
- Journal article citation:
- Gerontologist, 43(Special Issue), March 2003, pp.9-18.
- Publisher:
- Oxford University Press
Development of strategies to optimise the functional performance of older adults requires understanding the behaviour of older people doing tasks in real-world settings and capturing these interactions in research protocols. This is a major challenge as there is some degree of tension between capturing the contextual variables and constraints that operate in the real world and the scale of research that can be realistically conducted within controlled experimental settings. This article presents a research approach that can be used to help ensure the ecological validity of research protocols. The intent is to demonstrate how an ecologically valid approach affords greater insight into the performance of older adults in real world settings. The approach involves techniques such as task analysis and simulation. Examples from two research projects examining aging and the performance of real-world computer-based work tasks are used to demonstrate the application of this approach. The article demonstrates how an ecologically valid research approach yields information about human performance that can be translated into solutions for real-world problems.