Hubungan Fungsi Kognitif dengan Tingkat Kemandirian pada Lansia

ABSTRACT : THE CORRELATION OF COGNITIVE FUNCTION WITH THE LEVEL OF INDEPENDENCE OF THE ELDERLY Introduction: The increasing of elderly population will increase new problems in various fields. Some problems and disorders that often arise or occur in the elderly are decreased of cognitive function. The physical changes that have decreased will cause various life aspects interference that have big influence on the level of independence of the elderly, include the decline in cognitive function. The results of research that have been developed by several experts suggest that 50% of elderly with cognitive impairment will feel dependence on their caregiver or closest companion such as the family. Objective: This research was to analyze the correlation between cognitive function and the level of independence of the elderly at RW 14 Public Health Center Cibeber.Methods: The research used an analytical survey with a cross sectional approach. The sample in this research amounted to 88 respondents using purposive sampling technique. The data collection use the results of interview with the Mini-Mental State Exam (MMSE) and the Katz Index. Analysis of Kolmogorof-Smirnov test data using SPSS results. Results: The results of this research were obtained with the results of the MMSE interview, most of (60.2%) of elderly had normal cognitive function, most of (64.8%) of elderly had a level of independence. The results of the analysis obtained (p value = 0.000 < (0.005) it means that there is a correlation between the two variables.Conclusion: There is a correlation between the cognitive function of the elderly and the level of independence in the elderly at RW 14 Public Health Center of Cibeber Area. The family is expected to be able to prevent or reduce the impact of physical decline and psychology in the elderly. Keywords: Elderly, Cognitive Function, Level of Independence. INTISARI: HUBUNGAN FUNGSI KOGNITIF DENGAN TINGKAT KEMANDIRIAN PADA LANSIA Pendahuluan: Semakin meningkatnya populasi lanjut usia maka akan meningkatkan masalah baru diberbagai bidang. Beberapa masalah dan gangguan yang sering muncul atau terjadi pada lansia adalah menurunnya fungsi kognitif. Perubahan fisik yang cenderung mengalami penurunan akan menyebabkan berbagai gangguan aspek kehidupan yang mempunyai pengaruh besar dalam tingkat kemandirian lansia, termasuk dalam penurunan fungsi kognitif. Hasil penelitian yang telah dikembangkan oleh beberapa ahli mengemukakan bahwa 50% lansia yang mengalami gangguan kognitif akan mengalami ketergantungan terhadap caregiver atau pendamping terdekatnya yaitu pihak keluarga.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan fungsi kognitif dengan tingkat kemandirian lansia di wilayah Puskesmas Cibeber RW 14. Metode: Penelitian menggunakan survey analitik dengan pendekatan cross sectional. Sampel dalam penelitian ini berjumlah 88 responden dengan menggunakan teknik purposive sampling. Pengumpulan data menggunakan hasil wawancara dengan Mini-Mental State Exam (MMSE) dan Katz Index. Analisa data uji Kolmogorof-Smirnov menggunakan hasil SPSS.Hasil: Hasil penelitian ini didapatkan dengan hasil wawancara MMSE sebagian besar (60,2%) memiliki fungsi kognitif normal, sebagian besar (64,8%) memiliki tingkat kemandirian mandiri. Hasil analisis didapatkan (p value = 0,000 < α (0,005) artinya ada hubungan antara dua variabel tersebut.Kesimpulan: Terdapat hubungan antara fungsi kognitif lansia dengan tingkat kemandirian pada lansia di Wilayah Puskesmas Cibeber RW 14. Pihak keluarga diharapkan mampu melakukan pencegahan atau pengurangan dampak kemunduran fisik dan psikis pada lansia. Kata kunci : Lansia, Fungsi Kognitif, Tingkat Kemandirian

The Association Between Parents’ Physical Function and Adult Children’s Caregiving Burden

Using data from 544 older parents-adult children Chinese American dyads, this study aims to understand the association between older parents’ physical function and their adult children’s perceived caregiving burden. Parents’ physical function was assessed by the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental ADL (IADL), with higher scores indicating more functional limitations. Adult children’s caregiving burden was assessed in five dimensions, including time dependence, developmental, physical, social, and emotion burden. Logistic regression was used to examine the association. More ADL limitations were associated with a higher likelihood of developmental burden (OR:1.14 (1.06-1.23)) and physical burden (OR:1.14 (1.06-1.23)) burden. More IADL limitations was associated with a higher likelihood of time dependence burden (OR:1.08 (1.03-1.12)), developmental burden (OR:1.06 (1.03-1.09)), and physical burden (OR:1.08 (1.04-1.12)). Parents’ physical function was not related to children’s social and emotional burdens. Practice and research implications will be discussed.

Deleterious effects of loss of independence assessed with the KATZ index after aortic valve replacement in elderly patient

Introduction: Surgical operative risk of valvular replacement has been widely studied and it has been shown that postoperative complications incidence and mortality increase with patients’ age. The aim of this study was to assess among elderly patients whom underwent surgical aortic valve replacement using various scoring system and Geriatric Assessment Indexes to predict post-operative risk and long-term outcome. Methods and Results: We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P =0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P = 0.03) and a Katz index ≤ 5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48 % [IQR 39-57]. The Katz index ≤ 5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P = 0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion: In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.

EFFECTIVENESS OF COMBINED USE OF ARM ABILITY TRAINING WITH ARM WEIGHT SUPPORT TO IMPROVE UPPER EXTREMITY FUNCTIONAL SKILLS AND ADL SKILLS IN PARKINSONISM PATIENTS

OBJECTIVE: This study is to determine the effectiveness of combined use of arm ability training with arm weight support to improve upper extremity functional skills and ADL skills in Parkinsonism patients. METHOD: Thirty subjects with parkinsonism ( 5 months to 10 years of Parkinson’s disease) were selected, who fulfilled the inclusion and exclusion criteria and according to the screening measures using UPDRS, Hoehn and Yahr scale and MMSE. Baseline assessment (Pre-test) was done using FMA, UEFI, and Katz index. After baseline assessment arm ability training (AAT) combined with arm weight support (45 minutes) was given to the patients for 12 weeks, 45 minutes in a day for 3 days in a week and post-intervention assessment (Post-test) was taken after 12 weeks by using the same outcome measures. RESULT: Post- training there was a significant improvement in all the outcome measures. The result of the study showed evidence of benefit of the practice of Arm ability training with Arm weight support in Parkinsonism; enhance improvement as a result of Arm ability training along with Arm weight support were found in FMA-UE is x= 97.00 (volitional movement), UEFI is x= 46.20 ( Hand functionality), Katz Index is x= 5.20 (Autonomy of ADL). The post-test has showed a greater improvement than from the pre-test in all the outcome measure (FMA-UE-P=0.001, UEFI-P=0.001 and Katz Index- P=0.001). The Pre and Post score comparison of outcome variables shown improvement in upper extremity functional skills and in Activities of Daily living skills following the intervention programme. CONCLUSION: The Arm ability training techniques with Arm weight support was found to be effective in improving upper extremity functional skills as well as ADL skills among the Parkinsonism patients. The Arm ability training combined with Arm weight support can be used with other occupational therapy intervention to provide additional benefits to the Parkinsonism patients. KEYWORDS: upper extremity functional skills, Activities of Daily Living, Arm ability training, Arm weight support, Parkinson’s disease.

Impact on the quality of life after mitral clip implantation

Background and objectives Mitral regurgitation is a very limiting disease for the patient. The objetctive is to analitze the effectiveness of the mitral clip implantation on the quality of life and the degree of dependence in patients with mitral regurgitation Methods Almost experiment study of time series. The quality of life was evaluated with the Minnesota Living With Heart Failure (MLWHFQ) and Short-Form 36 (SF-36) questionnaire, 6 months before the intervention, 1 day before, 1 month after and 6 months later. The degree of dependence was evaluated with the Katz Index. The intervention was considered effective when the MLWHDQ decreased in 10 points and/or the Katz Index 1 point. Other variables were socio-demographic and clinical factors Results Twenty patients were introduced with a mean age of 78,6 ± mostly men (75%) and with very prevalent cardiovascular risk factors. The total MLWHFQ score decreased significantly after the intervention by 26.63 points (p = 0.004) and in the physical dimension by 12.13 points (p = 0.004) and 5.75 points (p = 0.007). In contrast, the modification of the score in the Katz Index was 0.14 points (p = 0.257) There was a significant decrease in pre and post intervention symptoms: dyspnea (p = 0.063), fatigue (p = 0.000) and maleolar oedema (p = 0.063) In the SF-36 health transition question, 75% of patients reported feeling better or much better after 6 months of the intervention. Conclusions These results suggest that mitral clip implantation improves short-term quality of life in patients with mitral insufficiency, although it doesn"t change the degree of dependence for short-term daily life activities. In addition, mitral clip implantation improves the limiting symptoms of these patients and the health perception at 6 months.

High inter-rater reliability of Japanese bedriddenness ranks and cognitive function scores: a hospital-based prospective observational study

Background The statistical validities of the official Japanese classifications of activities of daily living (ADLs), including bedriddenness ranks (BR) and cognitive function scores (CFS), have yet to be assessed. To this aim, we evaluated the ability of BR and CFS to assess ADLs using inter-rater reliability and criterion-related validity. Methods New inpatients aged ≥75 years were enrolled in this hospital-based prospective observational study. BR and CFS were assessed once by an attending nurse, and then by a social worker/medical clerk. We evaluated inter-rater reliability between different professions by calculating the concordance rate, kappa coefficient, Cronbach’s α, and intraclass correlation coefficient. We also estimated the relationship of the Barthel Index and Katz Index with the BR and CFS using Spearman’s correlation coefficients. Results For the 271 patients enrolled, BR at the first assessment revealed 66 normal, 10 of J1, 15 of J2, 18 of A1, 31 of A2, 37 of B1, 35 of B2, 22 of C1, and 32 of C2. The concordance rate between the two BR assessments was 68.6%, with a kappa coefficient of 0.61, Cronbach’s α of 0.91, and an intraclass correlation coefficient of 0.83, thus showing good inter-rater reliability. BR was negatively correlated with the Barthel Index (r = − 0.848, p < 0.001) and Katz Index (r = − 0.820, p < 0.001), showing justifiable criterion-related validity. Meanwhile, CFS at the first assessment revealed 92 normal, 47 of 1, 19 of 2a, 30 of 2b, 60 of 3a, 8 of 3b, 8 of 4, and 0 of M. The concordance rate between the two CFS assessments was 70.1%, with a kappa coefficient of 0.62, Cronbach’s α of 0.87, and an intraclass correlation coefficient 0.78, thus also showing good inter-rater reliability. CFS was negatively correlated with the Barthel Index (r = − 0.667, p < 0.001) and Katz Index (r = − 0.661, p < 0.001), showing justifiable criterion-related validity. Conclusions BR and CFS could be reliable and easy-to-use grading scales of ADLs in acute clinical practice or large-scale screening, with high inter-rater reliabilities among different professions and significant correlations with well-established, though complicated to use, instruments to assess ADLs. Trial registration UMIN000041051 (2020/7/10).

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study

Introduction: Commensurate with demographic and lifestyle transition, increasing magnitude of multimorbidity is common among older adults in low- and middle-income countries (LMIC). At the same time the rising prevalence of elder abuse is concurrently observed in these populations. However, little is known about the elder abuse in the context of multimorbidity with no reports on their interplay from LMIC settings. This study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India. Methods: The data was collected as a part of our ASHETS study encompassing 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by previously validated MAQ PC tool. Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Care dependence was measured by Katz index questionnaire. We performed ordinal logistic regression models to identify the correlates of elder abuse. Results: Around 48.8% (95% CI:45.13-52.53%) older adults had multimorbidity while 33.8% (95% CI:30.35-37.35%) had some form of care dependence. Out of 725, 56.6% (CI 52.85 – 60.19%) were found to be at low-risk elder abuse and 15.9% (CI 13.27 – 18.72%) being at high-risk . The risk of elder abuse was significantly associated with multimorbidity (AOR=1.88; 95%CI: 1.54-2.21), economic dependence (AOR=1.62; 95%CI: 1.25-1.99) and functional dependence (AOR=1.86; 95%CI: 1.42-2.29). Staying alone (AOR= 1.75; 95%CI: 1.13-2.38) and lower socio-economic status (AOR=2.96; 95%CI: 2.09-3.84) were two other significant correlates. Conclusions: Older adults with multimorbidity are at 1.88 times higher risk of elder abuse compared to their non-multimorbid counterparts. Both economic and functional dependence are associated with an increase in elder abuse. This suggests the mediating role of care dependence in the pathway to elder abuse in multimorbidity. Future geriatric multimorbidity assessment studies should consider screening for care dependence as well as elder abuse while designing integrated care models.

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study

IntroductionCommensurate with demographic and lifestyle transition, increasing magnitude of multimorbidity is common among older adults in low- and middle-income countries (LMIC). At the same time the rising prevalence of elder abuse is concurrently observed in these populations. However, little is known about the elder abuse in the context of multimorbidity with no reports on their interplay from LMIC settings. This study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India.MethodsThe data was collected as a part of our ASHETS study encompassing 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by previously validated MAQ PC tool. Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Care dependence was measured by Katz index questionnaire. We performed ordinal logistic regression models to identify the correlates of elder abuse.ResultsAround 48.8% (95% CI:45.13-52.53%) older adults had multimorbidity while 33.8% (95% CI:30.35-37.35%) had some form of care dependence. Out of 725, 56.6% (CI 52.85 – 60.19%) were found to be at low-risk elder abuse and 15.9% (CI 13.27 – 18.72%) being at high-risk. The risk of elder abuse was significantly associated with multimorbidity (AOR=1.88; 95%CI: 1.54-2.21), economic dependence (AOR=1.62; 95%CI: 1.25-1.99) and functional dependence (AOR=1.86; 95%CI: 1.42-2.29). Staying alone (AOR= 1.75; 95%CI: 1.13-2.38) and lower socio-economic status (AOR=2.96; 95%CI: 2.09-3.84) were two other significant correlates.ConclusionsOlder adults with multimorbidity are at 1.88 times higher risk of elder abuse compared to their non-multimorbid counterparts. Both economic and functional dependence are associated with an increase in elder abuse. This suggests the mediating role of care dependence in the pathway to elder abuse in multimorbidity. Future geriatric multimorbidity assessment studies should consider screening for care dependence as well as elder abuse while designing integrated care models.