Alzheimer's disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ...ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients.
Objective: The present analysis aimed to examine the associations of isolation and loneliness, individually as well as simultaneously, with 2 measures of functional status (gait speed and ...difficulties in activities of daily living) in older adults over a 6-year period using data from the English Longitudinal Study of Ageing, and to assess if these associations differ by SES. Method: Loneliness was measured using the short form of the Revised UCLA scale, and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. Measures of functional status were assessed identically at baseline and 6 years later for 3070 participants (mean age 69 years). Wealth was used as an indicator of SES. Results: In fully and mutually adjusted models, social isolation and loneliness were found to be associated with a decrease in gait speed at follow-up, with stronger effects among more disadvantaged individuals. Loneliness was associated with an increase in difficulties with activities of daily living. Conclusions: Isolation and loneliness were adversely associated with different aspects of functional status. Interventions to reduce isolation and loneliness may be particularly beneficial for individuals in disadvantaged groups.
BackgroundAccumulation of soluble and insoluble aggregated amyloid-beta (Ab) peptides may initiate/potentiate Alzheimer’s disease (AD) pathology. The humanised IgG1 monoclonal antibody lecanemab ...binds Ab protein protofibrils with high affinity and is being tested in early AD.MethodsThis 18-month, multicentre, double-blind, Phase 3 trial in early AD enrolled individuals with a diagnosis of mild cognitive impairment or mild AD dementia. Participants were randomised to placebo or lecanemab 10-mg/kg IV biweekly. Primary endpoint was change from baseline at 18 months in Clinical Dementia Rating-Sum-of-Boxes (CDR-SB). Amyloid PET, AD-Assessment Scale-Cognitive Subscale-14 (ADAS- Cog14), AD Composite Score (ADCOM), AD Cooperative Study-Activities of Daily Living Scale for Mild Cognitive Impairment (ADCS MCI-ADL) and safety were also evaluated.Results1795 participants were enrolled (lecanemab:898; placebo:897). Adjusted least square mean change from baseline at 18 months was 1.21 and 1.66 for lecanemab and placebo, respectively (dif- ference: -0.45 points; 95% confidence interval: -0.67, -0.23; P<0.001). Results were consistent for amyloid PET, ADAS-Cog14, ADCOMS, and ADCS-MCI-ADL assessments. Lecanemab resulted in amyloid-related imaging abnormalities-edema in 12.6% of participants and infusion reactions in 26%.ConclusionsLecanemab reduced amyloid markers in early AD resulting in less decline in cognitive function measures than placebo at 18 months but was associated with adverse events.
Associations between daily functional trajectories and new-onset all-cause dementia and Alzheimer's disease (AD) and the role of body weight are underexplored.
Data were from the Health and ...Retirement Study (HRS) 1994–2020. Daily function was assessed using (instrumental) activities of daily living (IADLs). All-cause dementia and AD were defined by self- or proxy-reported physician diagnoses. Body weight was assessed using body mass index (BMI) and categorized as normal (18.5 kg/m2 ≤ BMI < 30 kg/m2) and abnormal (BMI < 18.5 kg/m2 or ≥30 kg/m2). The group-based trajectory modeling and Cox proportional hazards regression were utilized.
Of 18,763 adults included, 1236 developed new-onset dementia during a 10-year follow-up. The associations of ADL and IADL limitations at baseline with all-cause dementia and AD were much more pronounced in those with abnormal weight (P for interaction < 0.005). Five joint trajectories of ADL and IADL limitations were identified: No (72.7 %), Recovery (4.0 %), Recent emerging (16.4 %), Early emerging (4.8 %), and Severe (2.1 %). Furthermore, the ‘Severe’ joint trajectory (vs. ‘No’) was associated with 3.57- and 3.59-times higher risks of new-onset all-cause dementia and AD in participants with abnormal weight (P for interaction = 0.002 and 0.005). Notably, the Recovery joint trajectory (vs. No) was not associated with increased risks of all-cause dementia or AD.
Self-/proxy-reported all-cause dementia and AD may introduce misclassification bias. Lifestyle factors were not quantified. BMI at baseline, but not its trajectory, was utilized. Potential reverse causation deserved attention.
Body weight control can help reduce the risk of progression from functional limitations to all-cause dementia and AD.
•Functional limitations were associated with increased risk of new-onset dementia.•Five 16-year joint trajectories of functional limitations were identified.•Recovery from functional limitations was not at increased risk of dementia.•Weight control can help prevent functional limitations from progressing to dementia.•The findings of new-onset all-cause dementia and Alzheimer's disease were similar.
Fall incidents from unsafe home environments are frequent in older-adult homes but the literature is ambiguous whether it is the presence/absence, or the interplay of such conditions and physical ...functioning that is of salience. We therefore estimated whether unsafe home environment is adversely associated with subsequent falls among older adults and what proportion of this association was mediated through limitations in daily and instrumental activities of daily living (ADL/IADL).
Using a nationally representative sample of community-dwelling Medicare beneficiaries (≥65 years) in the 2018-2019 National Health and Aging Trends Study (n = 2,599), we conducted bivariate and multivariable analyses. We examined baseline conditions of home disorders, unsafe bathroom settings, unsafe house/building features, and house disrepairs in 2018 and their relation with subsequent falls in 2019, after controlling for covariates. To assess whether ADL/IADL limitations mediated this relationship, we employed the Karlson-Holm-Breen methodology.
In 2019, the self-reported prevalence of falls among older adults was estimated at 34.68%. Although baseline home disorders had both a direct (adjusted odds ratio aOR: 1.14, 95% confidence interval CI:1.03,1.26) and an indirect effect through limitations in ADL and IADL (aOR: 1.01; 95% CI: 1.00,1.03), the relation between unsafe bathroom settings and subsequent falls was unclear. Unsafe house/building features and house disrepairs were not statistically significantly related either directly or indirectly with subsequent falls.
Addressing home disorders through policy and housing assessments to highlight home environmental safety would be essential to address falls among older adults.
Abstract The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, ...as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio = OR = 1.089) per year of age, (OR = 2.48) in women's case; while there is an IADL correlation between age and the score ( r = −0.527; p < 0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r = −0.12, p = 0.018 and IADL: r = −0.97, p = 0.003), the number of visits to the doctor (ADL: r = −0.27, p < 0.001; IADL: r = −0.25, p < 0.001) or the presence of concomitant pathologies such as dementia (ADL: p < 0.001; IADL: p < 0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both.
Purpose
Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on ...the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival.
Methods
Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients’ characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS > 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE ≥ 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL ≤ 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaike’s information criterion across imputations was used to evaluate the goodness of fit of our models.
Results
We included 3920 patients with a median age of 84 years (IQR: 81–87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83–8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3–6); IQCODE: 3.19 (3–3.69); ADL: 6 (4–6); Comorbidity and Polypharmacy score (CPS): 10 (7–14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.–1.03,
p
= 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14–1.17,
p
< 0.0001) and CFS (per point): 1.1 (1.05–1.15,
p
< 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model.
Conclusion
We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.
With the rapid population aging, the challenge to provide care for disabled older adults is becoming bigger. This study aims to develop the Disability Index (DI) to assess disability to indicate care ...needs, and we evaluated the reliability and validity of the DI among older adults aged 65-105.
A total of 12 559 older adults (54.0% women; mean age = 84.3; SD = 11.2) from 22 provinces in China were investigated in 2017-2018. We developed the 21-item DI covering 4 subdomains, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), physical performance, and cognitive function. Cronbach's alpha was used to determine internal consistency. The convergent and divergent validity were assessed by Spearman rank order correlation coefficients and Pearson correlation coefficients. The known-group validity was assessed by Mann-Whitney U tests. The concurrent validity was assessed by the area under the receiver operating characteristic curve (AUC).
In the total sample, the internal consistency of the full DI and its subdomains were satisfactory with Cronbach's alpha ≥0.70; the convergent and divergent validity of the 4 subdomains were supported by all the alternative measures; the known-group validity of the full DI and its subdomains were supported by clear discriminative ability; and the concurrent validity of the full DI was supported with all the AUCs ≥0.70. The reliability and validity of the full DI and its subdomains were additionally supported by age subgroups and sex subgroups.
The DI is a reliable and valid instrument to assess disability status among older adults.
OBJECTIVES
To examine factors associated with caregiver burden from a multifactorial perspective by examining caregiver and care recipient characteristics and a full range of caregiving tasks.
DESIGN
...Nationally representative surveys of community‐dwelling older adults and their family caregivers residing in the United States.
SETTING
2011 National Health and Aging Trends Study and National Study of Caregiving.
PARTICIPANTS
Community‐dwelling older adults and their family caregivers.
MEASUREMENTS
Caregiver burden, comprising emotional, physical, and financial difficulties associated with caregiving.
RESULTS
An estimated 14.9 million caregivers assisted 7.6 million care recipients. More than half of caregivers reported burden related to caregiving. In a multivariable regression model, caregivers who assisted with more activities of daily living and instrumental activities of daily living, health management tasks, and health system logistics were more likely to experience burden, as were female caregivers, adult child caregivers, caregivers in poor health, caregivers with anxiety symptoms, and those using respite care. Dementia was the only care recipient characteristic associated with burden.
CONCLUSION
Caregiver characteristics and provision of caregiving tasks determine caregiver burden more than care recipient characteristics. Absence of an association between type of a care recipient's chronic conditions and burden, except for dementia, suggests that the tasks that caregivers who assist older adults with a variety of health conditions undertake shape the experience of caregiving. J Am Geriatr Soc 67:277–283, 2019.
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