Improving the ability to carry out activities of daily living for adults with a diagnosed psychotic disorder following discharge from hospital: design and methods

Background: Older patients are usually assessed by occupational therapists in hospital before going home. However, for many frail older adults, this assessment in an unfamiliar environment might not be as representative of their functional abilities as an assessment at home. The aim of this literature review was to determine if differences exist between home and clinical instrumental activities of daily living (IADL) assessments of frail older adults and identify factors that might explain those differences, if any. Method: The sources of the review data were Medline, CINAHL, AMED, PsycINFO, Embase and Current Content from 1988 to 2008. As few relevant studies concerning frail people were found, the search was extended to mixed-age and older adult populations. Ten articles were retained. Main findings: The results suggest differences in IADL assessment between settings for older adults without dementia. Some factors, such as familiarity with the environment and coping skills, might explain those differences. Based on this review, similar results might be expected with frail older people. Implications for practice: Given the dearth of literature on this topic, further research is needed to compare home and clinical assessments and measure relevant factors in a frail population. Helping occupational therapists to identify frail patients, who may show different abilities in unfamiliar settings, could mean more appropriate services after discharge from hospital.

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PRACTICES OF CHRONIC WOUNDS HOME CARE PERFORMED BY THE ELDERLY AND THEIR CAREGIVERS

Revista Eletronica Gestão & Saúde ◽

10.26512/gs.v0i0.23319 ◽

2019 ◽

pp. 162-175

Author(s):

Carolina Leite Ossege ◽

Andréa Mathes Faustino

Keyword(s):

Home Care ◽

Activities Of Daily Living ◽

Daily Living ◽

Chronic Wounds ◽

The Elderly ◽

Lower Limbs ◽

Support Network ◽

Network Profile ◽

Discharge From Hospital

Regarding the indispensable care for the treatment of chronic wounds, the dependence and the reduction of functional ability can lead to the reduction of care attitudes, just as autonomy can be a contributing factor for the quality of life of the elderly. Thus, the present study aimed to identify the practices of home care of chronic wounds performed by the elderly and their caregivers. The age of the elderly ranged from 60 to 81 years; the majority were male (60%), married (60%), with family caregiver (80%), hospitalized for oncology (40%), independent for activities of daily living (90%) and partially dependent for instrumental activities of daily living (50%). The most common chronic lesions found in the elderly were those located in the lower limbs, related to diabetes and tumors. It was concluded that the elderly presented functional capacity and family support network profile compatible with the practice of home care; however, regarding the care of chronic injuries, not all steps of care were appropriately performed, suggesting unpreparedness to deal with the adverse situation, which reinforces the need of preparation for discharge from hospital.

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A Comprehensive Overview of Activities of Daily Living in Existing Frailty Instruments: A Systematic Literature Search

The Gerontologist ◽

10.1093/geront/gnz147 ◽

2019 ◽

Author(s):

Axelle Costenoble ◽

Veerle Knoop ◽

Sofie Vermeiren ◽

Roberta Azzopardi Vella ◽

Aziz Debain ◽

...

Keyword(s):

Activities Of Daily Living ◽

Work Engagement ◽

Social Life ◽

Daily Living ◽

Literature Search ◽

Leisure Activities ◽

Systematic Literature Search ◽

Comprehensive Overview ◽

Design And Methods ◽

The Relationship

Abstract Background and Objectives The relationship between frailty and disability in activities of daily living (ADLs) can be seen in different ways, with disability being—to varying degrees—a characteristic, negative outcome, or predictor of frailty. This conflation of definitions is partly a result of the different frailty tools used in research. Aiming to provide a comprehensive overview, this systematic literature search analyzed (i) if, (ii) to what extent, and (iii) how ADLs are evaluated by frailty instruments. Research Design and Methods A search was performed in PubMed, Web of Knowledge, and PsycINFO to identify all frailty instruments, followed by categorization of the ADL items into basic (b-), instrumental (i-), and advanced (a-) ADLs. Results In total, 192 articles described 217 frailty instruments, from which 52.1% contained ADL items: 45.2% b-ADLs, 35.0% i-ADLs, and 10.1% a-ADLs. The most commonly included ADL items were bathing (b-ADLs); using transportation (i-ADLs); and semiprofessional work engagement in organized social life or leisure activities (a-ADLs). These instruments all had a multidomain origin (χ 2 = 122.4, p < .001). Discussion and Implications Because 52.1% of all instruments included ADL items, the concepts of frailty and disability appear to be highly entangled. This might lead to circular reasoning, serious concerns regarding contamination, and invalid research results.

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Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China

10.1101/2020.08.26.20182246 ◽

2020 ◽

Author(s):

Siyi Zhu ◽

Qiang Gao ◽

Lin Yang ◽

Yonghong Yang ◽

Wenguang Xia ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Activities Of Daily Living ◽

Daily Living ◽

Retrospective Cohort ◽

Protective Factor ◽

Significant Proportion ◽

Length Of Hospital Stay ◽

Adjusted Risk ◽

Discharge From Hospital

Objective: To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. Design: Multi-center retrospective cohort study. Setting: Twenty-eight hospitals located in eight provinces of China. Methods: A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton's IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung's self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan). Results: Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39-41.46). ADL dependence was present in 16.44% (95% CI: 13.23-20.23) and 28.70% (95% CI: 24.63- 33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80-3.40), ADL dependence (RR 2.07, 95% CI 1.15-3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69-3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations. Conclusion: A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.

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Prevalence and risk factors of disability and anxiety in a retrospective cohort of 432 survivors of Coronavirus Disease-2019 (Covid-19) from China

PLoS ONE ◽

10.1371/journal.pone.0243883 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243883

Author(s):

Siyi Zhu ◽

Qiang Gao ◽

Lin Yang ◽

Yonghong Yang ◽

Wenguang Xia ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Activities Of Daily Living ◽

Daily Living ◽

Retrospective Cohort ◽

Protective Factor ◽

Significant Proportion ◽

Length Of Hospital Stay ◽

Adjusted Risk ◽

Discharge From Hospital

Objective To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures. Design Multi-center retrospective cohort study. Setting Twenty-eight hospitals located in eight provinces of China. Methods A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton’s IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung’s self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan). Results Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39–41.46). ADL dependence was present in 16.44% (95% CI: 13.23–20.23) and 28.70% (95% CI: 24.63–33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80–3.40), ADL dependence (RR 2.07, 95% CI 1.15–3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69–3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations. Conclusion A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.

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Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

The Gerontologist ◽

10.1093/geront/gnz023 ◽

2019 ◽

Vol 60 (1) ◽

pp. 101-111 ◽

Cited By ~ 7

Author(s):

Xiaoling Xiang ◽

Jieling Chen ◽

MinHee Kim

Keyword(s):

Risk Factors ◽

Older Adults ◽

Activities Of Daily Living ◽

Social Isolation ◽

Daily Living ◽

Multinomial Logistic Regression ◽

Community Dwelling ◽

Medicare Beneficiaries ◽

Nationally Representative ◽

Design And Methods

Abstract Background and Objectives The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories. Research Design and Methods The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1–Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories. Results Three trajectory groups were identified: the “never” group (65.5%) remained nonhomebound; the “chronic” group were largely persistently homebound (8.3%); and the “onset” group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the “onset” and “chronic” versus the “never” trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the “chronic” trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk. Discussion and Implications The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

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Effective Measurement of the Functional Progress of Stroke Clients

British Journal of Occupational Therapy ◽

10.1177/030802260506800603 ◽

2005 ◽

Vol 68 (6) ◽

pp. 253-259 ◽

Cited By ~ 3

Author(s):

Hilary A Jacob-Lloyd ◽

Orla M Dunn ◽

Nicola D Brain ◽

Sarah E Lamb

Keyword(s):

Activities Of Daily Living ◽

Lower Limb ◽

Barthel Index ◽

Daily Living ◽

Functional Performance ◽

Validity And Reliability ◽

Mobility Index ◽

Measure Change ◽

Discharge From Hospital ◽

Nine Hole Peg Test

There is a need for occupational therapists to establish a range of outcome measures that can measure change effectively. The aim of this study was to identify effective methods of measuring the functional performance of individuals who had experienced a stroke and had been discharged from a rehabilitation ward. Measures with recorded validity and reliability and in clinical use were selected. The measures were the Barthel Index (Shah version), Nottingham Extended Activities of Daily Living scale, Motricity Index (Upper and Lower Limb), Rivermead Mobility Index and Nine-Hole Peg Test. Assessments were carried out at the point of discharge from hospital and 6 months later. Responsiveness was analysed using effect size and relative efficiency statistics. The practicality (feasibility) was established by comparing completion rates. The Nottingham Extended Activities of Daily Living scale and the Rivermead Mobility Index were found to be more responsive than the Barthel Index and Lower Limb Motricity Index respectively and to be practical after discharge from hospital. The Nine-Hole Peg Test was found to be more responsive than the Upper Limb Motricity Index but less practical. The analysis suggested that some measures are more suitable than others for tracking change in function after discharge from hospital for a wide case mix of people who have experienced a stroke.

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