The Association of Judgement Ability and Functional Status in Older Adult Rehabilitation Inpatients

2018 ◽  
Vol 19 (3) ◽  
pp. 235-245 ◽  
Author(s):  
C. G. Quinn ◽  
L. A. Rabin ◽  
G. C. Sprehn
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Clinical Utility ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Practical Judgment ◽  
Physical Risk Factors ◽  
Patients At Risk ◽  
Global Cognition ◽  
Adult Rehabilitation

Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.Methods: Inpatients of mixed diagnoses (n= 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.

scholarly journals Caída y factores demográficos y clínicos en adultos mayores: estudio de seguimiento

2021 ◽  
Vol 20 (1) ◽  
pp. 139-171
Author(s):  
Jack Roberto Silva Fhon ◽  
Rosalina Aparecida Partezani Rodrigues
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Mixed Model ◽  
Descriptive Analysis ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Wilcoxon Test ◽  
Clinical Factors ◽  
Chi Squared ◽  
State Examination

Objetivo: Analizar los factores demográficos y clínicos relacionados a las caídas en el adulto mayor que viven en el domicilio en un seguimiento de cinco años Método: Estudio cuantitativo y longitudinal retrospectivo realizado entre 2007/2008 y 2013 con 262 participantes brasileños con edad superior a 65 años. Se utilizaron los instrumentos de perfil demográfico, Mini Examen del Estado Mental, enfermedades autorreferidas, caídas y sus características, Escala de Fragilidad de Edmonton, Escala de Lawton y Brody y Medida de Independencia Funcional. Se realizaron análisis descriptivo, Chi cuadrado, prueba de Wilcoxon y prueba de modelos mixtos. Estudio aprobado por el comité de ética.Resultados: La mayoría era del sexo femenino, con edad entre 65 a 79 años, escolaridad entre 1 a 4 años y jubilados. La prevalencia de caídas fue de 21,8% y 37,8% en ambas evaluaciones. Se verificó que para cada enfermedad más que el adulto mayor tiene, aumenta la chance de sufrir una nueva caída. Además, para cada punto más en la escala de fragilidad, el adulto mayor tiene mayor chance de caer. Por otro lado, para cada medicamento a menos que el adulto mayor utiliza, presenta 10% menos chance de caer.Conclusión: La caída estuvo asociado a factores clínicos en el adulto mayor siendo necesario que el profesional de salud realice evaluaciones constantes para identificar este evento y sus desencadenantes. Objective: To analyze the demographic and clinical factors related to falls of older adults living at home in a five-year follow-up Materials and methods: Retrospective quantitative and longitudinal study conducted between 2007/2008 and 2013 with 262 Brazilians participants over 65 years old. We used the demographic profile, Mini-Mental State Examination, self-reported diseases, falls and their characteristics, Edmonton Frail Scale, Lawton and Brody Scale, Functional Independence Measure instruments. We performed descriptive analysis, Chi-squared, Wilcoxon test and mixed model test.Results: Most participants were women, aged between 65 to 79 years, schooling between 1 to 4 years and retired. The prevalence of falls was 21.8% and 37.8% in both evaluations. We verified that the chance of suffering a new fall increases for each additional disease of the older adult. In addition, for each point to more on the frail scale, the older adult has a greater chance of falling. On the other hand, for each medication withdrawn, the chance of falling decreases 10%.Conclusion: The fall was associated with clinical factors in older adults, therefore constant evaluations must be carried out to identify this event and its triggers. Objetivo: Analisar os fatores demográficos e clínicos relacionados à queda no idoso que vive no domicílio em um seguimento de cinco anos. Método: Estudo quantitativo e longitudinal retrospectivo realizado entre 2007/2008 e 2013 com 262 participantes brasileiros com idade superior de 65 anos. Foram utilizados os instrumentos de perfil demográfico, Mini Exame do Estado Mental, doenças autorreferidas, quedas e suas características, Escala de Fragilidade de Edmonton, Escala de Lawton y Brody y Medida de Independência Funcional. Realizaram-se análise descritivo, Qui quadrado, Teste de Wilcoxon e prova de modelos mistos. Estudo aprovado pelo comitê de ética.Resultados: A maioria era do sexo feminino, com idade entre 65 e 79 anos, escolaridade entre 1 a 4 anos e aposentados. A prevalência da queda foi de 21,8% e 37,8% em ambas as avaliações. Verificou-se que para cada doença a mais que o idoso sofre, aumenta a chance de sofrer uma nova queda. Ademais, para cada ponto a mais na escala de fragilidade, o idoso apresenta uma maior chance de cair. Por outro lado, para cada medicamento a menos que o idoso utiliza, presenta chance 10% menor de cair.Conclusão: A queda esteve associada a fatores clínicos no idoso sendo necessário que o profissional de saúde realize avaliações constantes com a finalidade de identificar esse evento e seus desencadeantes.

scholarly journals The association between the functional incapacity of the older adult and the family caregiver's burden

2013 ◽  
Vol 21 (5) ◽  
pp. 1096-1103 ◽  
Author(s):  
Edileuza de Fatima Rosina Nardi ◽  
Namie Okino Sawada ◽  
Jair Licio Ferreira Santos
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Functional Capacity ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Cross Sectional ◽  
The North ◽  
Active And Healthy Ageing ◽  
The Family

OBJECTIVE: to identify the association between the older adult's functional capacity and the caregiver's burden. METHOD: a cross-sectional, quantitative study, undertaken in a municipality in the north of the Brazilian state of Paraná, with 178 older adults with functional incapacity, and their caregivers. The Functional Independence Measure was used for evaluating the older adults' functional capacity, and the Zarit Burden Interview was used for evaluating the caregiver burden, with the results being analyzed quantitatively. The majority of the older adults were females, widowed, with a mean age of 79.9 years old, and needing assistance for up to 50% of the daily living tasks. The majority of the caregivers were females, daughters, married, and had a mean age of 56.7 years old. RESULT: the majority of the caregivers reported moderate burden; the men presented higher probabilities of lower burden than the women; and the more independent the older adult was, the higher the probabilities of the caregiver having low burden. CONCLUSION: encouraging actions directed at the promotion of active and healthy ageing centered on the maintenance of functional capacity and the older adult's autonomy, and implanting strategies for the organizing of care in the home which include the caregiver's health, can contribute to minimizing the effects of burden and improve quality of life.

scholarly journals Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia

2021 ◽  
Vol 15 (2) ◽  
pp. 200-209
Author(s):  
Patrícia Helena Figueirêdo do Vale-Britto ◽  
Laura Rabin ◽  
Livia Spindola ◽  
Ricardo Nitrini ◽  
Sonia Maria Dozzi Brucki
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Utility ◽  
Area Under The Curve ◽  
The Elderly ◽  
Relevant Information ◽  
Practical Judgment ◽  
Brazilian Sample ◽  
Everyday Problems

ABSTRACT. Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions. Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both. Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br). Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82. Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

scholarly journals Functional capacity assessment of long-lived older adults from Amazonas

2019 ◽  
Vol 72 (suppl 2) ◽  
pp. 49-55 ◽  
Author(s):  
Daiane de Souza Fernandes ◽  
Lucia Hisako Takase Gonçalves ◽  
Angela Maria Rodrigues Ferreira ◽  
Maria Izabel Penha de Oliveira Santos
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
High Energy ◽  
Capacity Assessment ◽  
Cognitive Screening ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test

ABSTRACT Objective: To evaluate the functional capacity of long-lived older adults from Amazonas. Method: A cross-sectional epidemiological study was carried out with 116 older adults aged 80 years or older, registered in a primary health care unit in Belém, in the state of Pará, Brazil. The Functional Independence Measure (FIM) was used for functional capacity assessment and the Mini-Mental State Examination (MMSE) for cognitive screening. Univariate and bivariate analyses were carried out, in addition to the Pearson’s chi-square test. Results: The older adults presented modified independence in the self-care, sphincter control and locomotion dimensions, and needed supervision for mobility/transfers. In mobility, men presented complete independence. Modified independence was found in the 80-89 age group. It was observed that, the lower the education level, the worse the cognitive performance. Conclusion: In spite of their advanced age, long-lived older adults still present functional capacity for activities of daily living, even though they required supervision for high energy expenditure tasks, such as mobility and transfers.

scholarly journals Clinical utility of the Functional Independence Measure for assessment of patients with Alzheimer's disease and vascular dementia

2013 ◽  
Vol 13 (4) ◽  
pp. 199-205 ◽  
Author(s):  
Naofumi Tanaka ◽  
Masahiro Nakatsuka ◽  
Hiroshi Ishii ◽  
Rie Nakayama ◽  
Ryoko Hosaka ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Vascular Dementia ◽  
Clinical Utility ◽  
Functional Independence Measure ◽  
Functional Independence

Digital Home Assistants and Aging: Initial Perspectives from Novice Older Adult Users

2020 ◽  
Vol 64 (1) ◽  
pp. 1367-1371
Author(s):  
Kenneth A. Blocker ◽  
Travis Kadylak ◽  
Lyndsie M. Koon ◽  
Christopher E. Kovac ◽  
Wendy A. Rogers
Keyword(s):  
Older Adults ◽  
General Population ◽  
Older Adult ◽  
Functional Independence ◽  
Daily Activities ◽  
Structured Interviews ◽  
Digital Home ◽  
General Utility ◽  
Positive Attitudes ◽  
Novice Users

Digital home assistants like the Amazon Echo are increasing in popularity each year among the general population and provide assistance across a wide array of daily activities. Despite their general utility, they may be most useful for supporting older adults with the various challenges of aging. However, little is known about older adults’ opinions regarding these devices, which is necessary to encourage their adoption of these devices. We conducted semi-structured interviews with 18 older adult novice users to learn about their initial opinions regarding two digital home assistants, the Amazon Echo smart speaker and Echo Show smart display. Results revealed an overall trend of positive attitudes toward them and their capabilities, with a preference toward the Echo Show. These findings provided insights into older adults’ first impressions of digital home assistants, plus the foundation for investigating their potential in supporting older adults in maintaining functional independence.

scholarly journals The use of functionality scales in patients with Post-Polio Syndrome

2019 ◽  
Vol 6 (13) ◽  
pp. 367-379
Author(s):  
Aline Simão Helou ◽  
Anna Elisa Basto Ramos ◽  
Acary Souza Bulle Oliveira ◽  
Abrahão Augusto Juviano Quadros ◽  
Francis Meire Fávero
Keyword(s):  
Functional Status ◽  
Older Adult ◽  
Barthel Index ◽  
Nottingham Health Profile ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Health Profile ◽  
Functional Status Questionnaire ◽  
Katz Index

Post-Polio Syndrome (PPS) is a neurological disease, resulting in the decrease of the neuromuscular functions being characterized by a set of clinical manifestations that occur in individuals who had acute paralytic poliomyelitis. The patients with PPS begin to present new limitations on the performance of their ADLs and, at the same time, tend to ignore them, continuing their daily work with greater physical effort. The need for a functional evaluation is therefore necessary to find out where the commitments are in the ADLs and to help them without aggravating the degenerative PPS. To identify the main functional assessment scales used in individuals with PPS. A study review of the literature was performed on the functional scales used in patients with PPS described in the articles in the database. We found 12 functional scales in activities of daily living, as follows: Nottingham Health Profile (NHP), International Classification of Impairments, Disability's and Handicaps (ICIDH), Functional Status Questionnaire (FSQ), Physical Activity Scale for the Elderly (PASE), Sunnas ADL Index, Katz Index, Falls Efficacy Scale (FES), ADLs-Staircase, Barthel Index, Functional Independence Measure (FIM), Older Adult Resource Survey (OARS), and Self-Reporter ADL. None of the 12 scales mentioned in our study is validated for the use in patients with PPS, the most scales found in the literatures reviewed in this research were NHP and ICIDH. Therefore, we found 9 scales validated in Brazil, Barthel Index, Functional Independence Measure (FIM), Functional Status Questionnaire (FSQ), Falls Efficacy Scale (FES), Nottingham Health Profile (NHP), International Classification of Impairments, Disability's and Handicaps (ICIDH), Older Adult Resource Survey (OARS), Katz Index and Self-Reporter ADL.

Introducing a clinically effective allied health rapid discharge team within a complex aged subacute in-patient cohort on a cost recovery basis: the Supported Patient centred Early Discharge (SPeED) initiative

2020 ◽  
Vol 44 (6) ◽  
pp. 931
Author(s):  
Peter Hough ◽  
Stephanie Gleeson ◽  
Nataliya Shkuratova ◽  
Freya Coker ◽  
Cylie Williams
Keyword(s):  
Older Adult ◽  
Allied Health ◽  
Functional Independence Measure ◽  
Early Discharge ◽  
Functional Independence ◽  
Care Patient ◽  
Historical Control ◽  
Control Group ◽  
Study Cohort ◽  
Early Supported Discharge

This case study reports the outcomes of an early supported discharge program. This model of care was trialled after Victoria introduced subacute weighted inlier equivalent separations funding to subacute in-patients in 2016. An allied health team (Supported Patient centred Early Discharge (SPeED)) managed patients suitable for assessment, intervention and early supported discharge (ESD). The SPeED cohort was compared to a matched historical control. Data included no advantage financially (NAF) days, length of stay (LOS), functional independence measure (FIM) scores and 30-day readmission rates. Staff and patient experiences were collected through surveys and call-back data. Regression analysis compared quantitative data, whereas a broad thematic approach compared qualitative data. There were no differences between the study cohort and historical control in age or sex (P&gt;0.05). The SPeED cohort had lower median NAF days (F=−21.38; 95% confidence interval (CI) −37.70, −15.00; P&lt;0.001), shorter LOS (F)=4.65; 95% CI −0.41, −0.02; P=0.034), fewer readmissions within 30 days (odds ratio 0.14; 95% CI −0.03, 0.68; P=0.014) and greater change in FIM scores during admission (F=4.20; 95% CI 0.16, 10.74; P=0.044). Staff morale was high in recognition of improved patient care. Patient satisfaction remained positive across the SPeED cohort and historical control group. The introduction of a dedicated allied health ESD team within a geriatric evaluation and management population is effective and enhances patient outcomes. What is known about the topic?Changing public subacute in-patient funding models places increased demand on providers to attain shorter patient LOS with finite staffing resources. Current published literature confirms the efficacy of rapid discharge programs in complex older adult cohorts only in the areas of stroke and respiratory conditions. What does this paper add?For clinicians and health service executives, this paper explores the potential to extend rapid discharge programs for complex older adult patients across a broad cohort of conditions through the introduction of a dedicated allied health rapid discharge team. It presents an intervention that seeks to balance patient-centred care with optimal funding and organisational outcomes. What are the implications for practitioners?The study findings highlight a promising opportunity for dedicated allied health rapid discharge teams within complex older adult in-patient populations to both optimise early patient preferred discharge and improve organisational financial performance.

scholarly journals Functional status change in older adults undergoing coronary artery bypass surgery

2011 ◽  
Vol 129 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Márcio Niemeyer Martins de Queiroz Guimarães ◽  
Clineu de Mello Almada Filho
Keyword(s):  
Older Adults ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Elderly Patients ◽  
Functional Status ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Bypass Grafting

CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.

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