GAMBARAN TINGKAT KEMANDIRIAN LANSIA DALAM PEMENUHAN ACTIVITY OF DAILY LIVING (ADL) DI ROJINHOME THINSAGUNO IE ITOMAN OKINAWA JEPANG

Abstrak Activity of daily living (ADL) adalah aktivitas pokok bagi perawatan diri. Activity of daily living meliputi antara lain: ke toilet, makan, berpakaian (berdandan), mandi, dan berpindah tempat. Pengkajian ADL penting untuk mengetahui tingkat ketergantungan lansia dalam rangka menetapkan level bantuan bagi lansia tersebut dan untuk menyusun rencana perawatan jangka panjang. Tujuan dari penelitian ini adalah untuk mengetahui gambaran tingkat kemandirian lansia dalam pemenuhan ADL yang tinggal di rojinhome Thinsaguno Ie Itoman Okinawa Jepang. Jenis penelitian ini adalah deskriptif observasional. Sampel dalam penelitian ini adalah seluruh lansia di rojinhome Thinsaguno Ie Itoman Okinawa Jepang sejumlah 34 responden. Penentuan sampel menggunakan teknik total sampling. Alat ukur yang digunakan adalah lembar checklist Barthel Index. Penelitian ini menggunakan analisis data univariat yang ditampilkan dalam distribusi frekuensi. Hasil penelitian menunjukan rata-rata umur yaitu 83,23 tahun dan paling dominan pada rentang umur old (75-90 tahun) yaitu 70,6%. Jenis kelamin sebagian besar perempuan yaitu 64,7%, tingkat kemandirian sedang dalam ADL yaitu 38,2%. Tingkat kemandirian lansia berdasarkan umur paling dominan pada rentang umur old (75-90 tahun) dengan tingkat kemandirian sedang (29,4%). Tingkat kemandirian lansia berdasarkan jenis kelamin paling dominan pada jenis kelamin perempuan dengan ketergantungan sedang (23,5%). Kata kunci: lansia, activity of daily living, tingkat kemandiria Abstract Activity of daily living (ADL) is a staple activity for self-care. Activity of daily living includes, among others: toileting, eating, dressing, showering, and moving places. ADL assessment is important to determine the level of dependence of the elderly in order to determine the level of assistance for the elderly and to develop a long-term care plan. The purpose of this study was to describe the level of independence of the elderly in fulfilling the ADL at rojinhome of Thinsaguno Ie Itoman Okinawa, Japan. The type of this research is descriptive observational with cross sectional approach. The sample in this research were all 34 elderly people at rojinhome Thinsaguno Ie Itoman Okinawa Japan. Determination of the sample using total sampling technique. The measuring instrument used is the Barthel Index checklist sheet. This study uses univariate data analysis which is displayed in the frequency distribution. The results showed that the average age was 83.23 years and the most dominant in the old age range (75-90 years) was 70.6%. The gender of most of the women was 64.7%, the level of independence was moderate in ADL, namely 38.2%. The level of elderly independence based on age is the most dominant in the old age range (75-90 years) with a moderate level of independence (29.4%). The level of independence of the elderly based on sex was the most dominant in the female sex with moderate dependence (23.5%). Keywords: elderly, activity of daily living, level of independence

LAZER: UM CONTRIBUTO DA ENFERMAGEM DE REABILITAÇÃO NA AUTONOMIA DA PESSOA COM DPOC

Introdução: É amplamente conhecido o impacto das doenças respiratórias na saúde física e mental da pessoa. O Enfermeiro Especialista em Enfermagem de Reabilitação sempre foi sensível a esta problemática, sendo foco de intervenção nos seus cuidados a definição de estratégias adaptativas. Para a pessoa com Doença Pulmonar Obstrutiva Crónica, o contexto atual da situação pandémica trouxe consequências aos vários níveis entre as quais: redução da atividade física, isolamento social e aumento da ansiedade. Este contexto veio reforçar a importância de uma reflexão acerca da adoção de estratégias adaptativas que promovam a redução da intolerância à atividade da pessoa com Doença Pulmonar Obstrutiva Crónica na execução das Atividades de Vida Diárias nomeadamente as atividades no domínio do “lazer”. Este estudo teve como objetivo avaliar o impacto de um Programa de Reabilitação Respiratória na realização das Atividades de Vida Diárias no domínio do “lazer”, medido pela escala London Chest Activity of Daily Living. Metodologia: Efetuou-se um estudo retrospetivo correlacional, que incluiu utentes com Doença Pulmonar Obstrutiva Crónica admitidos no Programa de Reabilitação Respiratória, sendo os resultados do domínio “Lazer” avaliados, através da escala London Chest Activity of Daily Living, antes e após o Programa de Reabilitação Respiratória. Foram incluídos 46 participantes, (67,39% do género masculino e 32,6% do género feminino). A idade dos participantes situou-se entre os 40 e os 89 anos, para uma média de idade de 63 anos (DP=10,5). A maioria dos participantes possui o 1º ciclo do ensino básico (52,2%). Resultados: Foram identificadas diferenças estatisticamente significativas (Z=-3,395, p=0,001) no domínio do “lazer” da escala London Chest Activity of Daily Living. Conclusão: Verificaram-se ganhos clínicos no domínio “lazer” da escala London Chest Activity of Daily Living após a realização do Programa de Reabilitação Respiratória.

Loneliness and Behavioral Changes During the COVID-19 Pandemic

Concerns for the health impact of loneliness, a risk factor for morbidity and mortality, have risen amid the COVID-19 pandemic. However, relationships between loneliness and behavioral changes remains unclear. Utilizing data from the National Health and Aging Trends Study COVID-19 Supplement, we examine the cross-sectional relationship between loneliness and self-reported increase in each of the following behaviors during the pandemic (n=2,924): walking, vigorous activity, eating, use of alcohol and tobacco, watching television and sleeping. Adjusting for age, race, education, activity of daily living limitations, and chronic conditions, loneliness was significantly associated with a higher odds of more eating (odds ratio- OR: 1.42, confidence intervals-CI: 1.24,1.62), sleeping (OR: 1.35, CI: 1.18,1.56), and watching television (OR: 1.45, CI: 1.30,1.61). These results indicate that during stressful times like our current pandemic, loneliness may lead to morbidity and mortality through sedentary behaviors.

Within-person Variation In Emotional Exhaustion Among Caregivers For Older Adults

Caregiving is everyday life for family members of older adults. Care recipients’ care requirements, service usage, and caregivers’ physical and emotional conditions differ day by day. Little is known how the differences and variances relate to informal caregivers’ mental health. This study aimed to examine informal caregivers’ day-to-day fluctuation in emotional exhaustion and discuss the within-person effects on mental health among informal caregivers. We developed the Caregiving Visualization Project toolkit (Care VIP), a software program for tracking on daily basis components of care experiences such as care task of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living, service usages, and caregiving burden, as well as eight items of caregivers’ emotional exhaustion. We recruited study participants between May 2018 to March 2019 who provided instrumental help to community-dwelling older adults. A total of 75 participants, who accessed the Care VIP every day by using tablets or computers and completed a one-month study, were analyzed in this study. Females comprised 80.0%, and the average age of caregivers was 52.7 years (SD=9.1). The majority were those who provided care to parents (69.3%), and those who provided to parents-in-law and spouses were 16.0% and 5.3%, respectively. The average score of the eight items on the emotional exhaustion scale, with a 4-point Likert scale, was 23.4 (SD=4.9); however, each question showed different variations. Within-person effects on mental health among informal caregivers will be discussed.

Moving the Needle on Outcome Measurement: A Longitudinal Analysis of Frailty Among Home-Delivered Meal Recipients

Frailty is a complex condition highly associated with malnutrition and can lead to the devastating loss of independence among older adults. Home-delivered meals (HDMs) aim to combat frailty and malnutrition and provide nutritional support to nearly 10 million older adults each year. Though self-reported metrics indicate that HDMs help older adults maintain their independence, few studies have systematically collected longitudinal data that objectively represent the health benefits of HDMs. The present study implemented two evidence-based instruments designed to measure frailty levels of HDM recipients (age 60 to 99 years) at two time points. HDM staff at one organization underwent multifaceted training to implement The Home Care Frailty Scale and the Clinical Frailty Scale with HDM recipients at the start of HDM enrollment and at three-month follow-up. Activity of daily living impairments (B = .46, p < .001) and instrumental activity of daily living impairments (B = .28, p < .001) were significant predictors of higher frailty levels at baseline (N = 245). Sixty-two recipients were analyzed at 3-month follow-up. Clinical Frailty Scale scores indicated stable frailty levels from baseline to follow-up (4.08 vs. 4.08). Home Care Frailty Scale scores indicated a slight increase in frailty levels (7.4 vs 7.63) though not statistically significant, t(61) = -.34, p = .74. These stable frailty metrics suggest that HDMs contribute to older adults’ ability to remain living in their own homes and communities and can support the importance of increased financial investments in HDM programs at the state and national levels.

Functional Trajectories for People With Dementia and Other Comorbidities in the Last Years of Life

A hallmark of end-of-life (EOL) is reduced functional ability. However, the impact of dementia and other comorbidities on EOL decline for older adults is less well understood. We estimated the effect of having dementia and comorbidities on activity of daily living (ADL) scores using the 2000-2012 Health and Retirement Study. We identified 5,853 people over age 65 who died and predicted monthly ADL impairments in the last 4 years of life controlling for dementia and other characteristics. Stroke and obesity were associated with significantly higher ADL scores, regardless of dementia status. However, if both dementia and either stroke or obesity were present, dementia was associated with significantly higher ADL scores approximately 1-4 years before death. Functional decline occurred closer to death if they had these conditions and no dementia. Differences in function when patients have dementia and comorbidities may affect understanding of survival time and access to appropriate care.

Managing Multiple Myeloma in Older Adults Using Real World Evidence and Clinical Integration of a Geriatric Assessment Tool in Clinical Practice

Background: Over two thirds of patients with Multiple Myeloma (MM) are ≥ 65 years old at the time of diagnosis. Older adults are at greater risk for treatment related toxicity and inferior survival; such risks are inadequately explained by chronologic age and performance status. In 2015, the International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based frailty index to identify older adults with MM at greatest risk of toxicities. Yet, routine implementation of GA in busy oncology practice remains challenging. We have previously shown the feasibility of a tablet-based modified Geriatric Assessment (mGA), capturing the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) score, and its impact on clinical decision-making and treatment outcomes (Nathwani, et al. JOP. 2020). In the prior study, physicians recommended integration of the mGA into the electronic medical record (EMR) to improve usefulness at the clinic. Methods: We conducted a single institution pilot study to test the feasibility of integrating an electronic care planning system within the EMR such that with a single sign on, the dashboard showing results of the mGA was visualized within the EMR. Eligible patients had symptomatic MM, > 60 years old, and seeing their oncology providers to make a decision about treatment. After completing informed consent, patients completed a tablet-based mGA in clinic just prior to seeing the physician. Survey results were compiled and were immediately available for evaluation on a dashboard within the EMR. Providers reviewed the mGA results before meeting with the patient and completed a short survey after the visit regarding their own subjective impression of frailty and how the mGA influenced their treatment decision making. Agreement between provider's subjective vs mGA based frailty categorization was measured using Cohen's Kappa statistic. We measured relevant toxicity outcomes at 3 months post treatment initiation. Results: 25 patients were enrolled, with a median age of 68 (range=61-82), 52% (n=13) female, and 68% (n= 17) white. One patient did not complete the mGA survey and was not included in the analysis. The remaining patients completed the mGA successfully without interrupting clinic flow and mGA was immediately available for providers to review during the clinic visit. The average time providers spent reviewing results was of 5 (range 1-10) minutes. Providers subjectively categorized patients as 42% (n=10) fit, 58% (n=14) intermediate fit, and 0% (n=0) frail. According to the mGA, patients were 50% (n=12) fit, 29% (n=7) intermediate fit, and 21% (n=5) frail. There was an overall 46% (n=11) concordance between physician and mGA result. The most agreement was in fit status (58%, n=7) and least was frail (0%, n=0). There was 33% (n=4) agreement on intermediate fit status. The unweighted Cohen's kappa statistic was 0.09 indicating only slight agreement between the two methods. Providers reported mGA influenced their treatment decision in 33% (n=8), with the decision being either chemotherapy modification (n=6) or reduced dose transplant (n=2). One patient, who was frail and received induction treatment, died during the 3-month study period. The remaining patients (n=23) received treatment as planned. Discussion: In this study, we report the feasibility of an EMR integrated mGA tool completed by the patient prior to meeting with the physician. Patients completed the survey with assistance and without disrupting the clinic workflow. The mGA results were reviewed by providers in real time and influenced treatment decisions one third of the time. Nearly all patients (96%, n=24) completed therapy as planned. Providers tended to view the patients as more fit than the mGA result, suggesting that the mGA uncovers additional information related to the patient's ability to tolerate therapy. Toxicity follow up is ongoing and will be updated at the time of presentation. Disclosures Giri: CareVive: Honoraria, Research Funding; PackHealth: Research Funding. Costa: BMS: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Karyopharm: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria, Speakers Bureau.