BackgroundThe global epidemiological shift of disease burden towards long-term conditions means understanding long-term outcomes of cardiovascular disease is increasingly important. More people are ...surviving stroke to experience its long-term consequences, but outcomes in people living more >10 years after stroke have not been described in detail.MethodsData were collected for the population-based South London Stroke Register, with participants followed up annually until death. Outcomes were survival, disability, activity, cognitive impairment, quality of life, depression and anxiety.FindingsOf 2625 people having first-ever stroke, 262 (21%) survived to 15 years. By 15 years, 61% (95% CI 55% to 67%) of the survivors were male, with a median age of stroke onset of 58 years (IQR 48–66). 87% of the 15-year survivors were living at home and 33.8% (26.2% to 42.4%) had mild disability, 14.3% (9.2% to 21.4%) moderate disability and 15.0% (9.9% to 22.3%) severe disability. The prevalence of disability increased with time but 1 in 10 of the 15-year survivors had lived with moderate-severe disability since their stroke. At 15 years, the prevalence of cognitive impairment was 30.0% (19.5% to 43.1%), depression 39.1% (30.9% to 47.9%) and anxiety 34.9% (27.0% to 43.8%), and survivors reported greater loss of physical than mental quality of life.ConclusionsOne in five people live at least 15 years after a stroke and poor functional, cognitive and psychological outcomes affect a substantial proportion of these long-term survivors. As the global population of individuals with cardiovascular long-term conditions grows, research and health services will need to increasingly focus on preventing and managing the long-term consequences of stroke.
Objectives
To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability.
...Design & Setting
A prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands.
Measurements
Disability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item. Disability in any of these activities was defined as the inability to perform the activity without assistance. The risk of disability by age for each individual ADL, IADL, and for mobility was assessed using Generalized mixed models.
Results
Disability in activities as household tasks, traveling, shopping, and continence had the highest risk and increased rapidly with age. The risk traveling disability among people aged 65 with two comorbidities increase from 9% to 37% at age 85. Disability in using the telephone, managing medications, finances, transferring, and toileting, had a very low risk and hardly increased with age. Compared to those without chronic conditions, those with ≥ 3 chronic conditions had a 3 to 5 times higher risk of developing disability. Males had a higher risk of disability in managing medication (P=0.005), and preparing meals (P=0.019), whereas females had a higher risk of disability with traveling (P=0.001). No association between education and disability on the individual ADL, IADL, and mobility was observed.
Conclusions
Older adults were mostly disabled in physical related activities, whereas disability in more cognitive related activities was less often experienced. The impact of multimorbidity on disability in each activity was substantial, while education was not.
Objective: Compensatory strategies such as assistive technology, external reminders, and environmental cues may help support instrumental activities of daily living (IADLs) and independence. However, ...functional ability is most often evaluated in clinical settings where everyday compensation cannot be readily observed. The present study used a novel, real-world evaluation of everyday activities (prospective memory, household chores, complex IADLs, and planning tasks) to examine the impact of compensation. Method: Fifty community dwelling older adults were recruited with cognitive status ranging from healthy to mildly impaired. Participants completed a battery of validated performance-based and cognitive tasks, an IADL questionnaire (also completed by an informant), and real-world activities carried out in their own homes. Results: The real-world evaluation demonstrated adequate interrater reliability (intraclass coefficient = 0.92) and construct validity (r = 0.55). Compensation improved real-world task outcome on prospective memory and household chores tasks. Further, cognition emerged as a moderator between compensation and prospective memory task outcome. Participants' ratings on an IADL questionnaire were related to real-world and performance-based functioning whereas informants' ratings were related to performance-based tasks and cognition. Conclusions: Our results suggest that proxy measures of functional ability (i.e., performance-based, cognitive, and IADL questionnaire measures) do not fully capture the complexity of real-world performance for nondemented community dwelling older adults. Compensation appeared to improve prospective memory performance, particularly for individuals with average to low average cognitive abilities. A difference in IADL questionnaire ratings suggest that participants may be better able to judge their real-world performance than informants.
General Scientific Summary
Neuropsychologists are often asked to determine whether a person can safely complete everyday tasks such as cooking, bill payment, and medication management independently. However, it is not well understood how sufficient clinic-based tools for assessing everyday tasks are at accurately estimating a person's functioning in the real-world. Results from the current study suggest that current clinic-based tools are limited because they do not account for a person's ability to compensate for cognitive weaknesses in the real-world. For example, a person may use an alarm to remind them to do something in the future. Targeted interventions to improve and maintain compensation at the earliest stages of cognitive change may enhance independence.
In the present study, we examined three experimental cognitive interventions, two targeted at training general cognitive abilities and one targeted at training specific instrumental activities of ...daily living (IADL) abilities, along with one active control group to compare benefits of these interventions beyond expectation effects, in a group of older adults (N = 230). Those engaged in general training did so with either the web-based brain game suite BrainHQ or the strategy video game Rise of Nations, while those trained on IADL skills completed instructional programs on driving and fraud awareness. Active control participants completed sets of puzzles. Comparing baseline and postintervention data across conditions, none of the preregistered primary outcome measures demonstrated a significant interaction between session and intervention condition, indicating no differential benefits. Analysis of expectation effects showed differences between intervention groups consistent with the type of training. Those in the IADL training condition did demonstrate superior knowledge for specific trained information (driving and finances). Twelve months after training, significant interactions between session and intervention were present in the primary measure of fraud detection, as well as the secondary measures of the letter sets task and Rey's Auditory Verbal Learning Test. However, the specific source of these interactions was difficult to discern. At 1-year follow-up those in the IADL condition did not maintain superior knowledge of driving and finances gained through training, as was present immediately postintervention. Hence, the interventions, when compared to an active control condition, failed to show general or specific transfer in a meaningful or consistent way.
Declines in activities of daily living (ADL) and instrumental activities of daily living (IADL) performances due to cognitive impairments hinder mild cognitive impairment (MCI) and Alzheimer's ...disease (AD) patients' independent and safe daily lives. In order to prevent and treat this, several cognitive interventions have been implemented, but their ecological validity was not ensured due to that their contents are far from real life. Virtual reality (VR) can resemble real life with immersive stimuli, but there have been few studies confirming its ecological effects on ADL and IADL. Therefore, this study conducted a meta-analysis of VR-based cognitive training to investigate its ecological effects on ADL and IADL in MCI and AD patients. From February 2012 to February 2022, a search was conducted for articles published in PubMed, Cochrane, Science Direct, and Web of Science. Quality assessment was assessed by the PEDro scale, and the Cochrane Collaboration tool was used to assess risk of bias. Publication bias was assessed by Egger's regression. Five studies that met inclusion criteria were included in this study. The VR-based cognitive training showed significant effects on ADL and IADL in both MCI and AD patients. When comparing effects in each group, both MCI and AD patients showed significant effects on ADL and IADL, but MCI patients showed lower effects on ADL and IADL than AD patients. The results indicated that VR-based cognitive training would be beneficial to improve ADL and IADL in MCI and AD patients, suggesting that VR-based cognitive training is ecologically valid.
Abstract
Background
During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living ...(ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs.
Method
Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5–7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge.
Results
Acute hospitalization per se led to significant in-patient’s functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5–6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05).
Conclusions
An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations.
Clinical Trials Registration Number
NCT02300896.
BackgroundPatients with knee injury appear to have worse postural orientation (i.e., alignment between body segments), at the knee, measured with gold standard three-dimensional motion analysis, ...compared with controls. However, there is a lack of studies on postural orientation for other joints than the knee, e.g., hip and trunk, as well as with a clinically applicable method.ObjectiveTo investigate whether visual assessment of Postural Orientation Errors (POEs) differs between patients with anterior cruciate ligament reconstruction (ACLR) and healthy controls.DesignCross-sectional studySettingClinical settingParticipantsInclusion criteria were: age 18–39 years, >16 weeks post-ACLR, and initiated jumping exercises. Fifty-three patients with ACLR (45% women), mean age 26.7 (SD 6.5) years, and 30 controls (50% women), mean age 28 (SD 7.9) years, were included.InterventionsSix POEs of the lower extremity and trunk, e.g., knee medial-to-foot position and femoral valgus, were visually assessed as good, fair, or poor, from video-recordings of 5 functional tasks. A score from 0 (good) to 100 (poor) was calculated for two subscales; activities of daily living (ADL) (single-leg squat, stair descending, forward lunge) and Sport (single-leg hop, side-hop), and a Total POE score (all 5 tasks). The injured leg was assessed in patients, and the right leg in controls.Main Outcome MeasurementsPOE scoresResultsPatients with ACLR had significantly worse POE scores compared with controls, POE subscale ADL (ACLR: median 18.5 (quartiles 11–26), controls: 11 (3.7–14.8), p=0.0001), POE subscale Sport (ACLR: 26 (16.7–29.6), controls: 7.4 (3.7–15.7), p=0.0001), and Total POE score (ACLR: 23.2 (14.3–25.9), controls: 8 (5.4–16), p=0.0001).ConclusionsPatients with ACLR appear to have worse postural orientation, measured with visual assessment, compared with controls. Visual assessment of POEs could be used to guide injury treatment aimed at improving postural orientation before return to sport, and potentially also to guide prevention training.
Objective: This review describes the relatively small body of neuropsychological and cognitive research conducted over the past 100 years focused on theoretical models explaining the neurocognitive ...processes that support everyday functioning and the breakdown of functional abilities in the face of neurological damage or disease. Method: The historical roots of the theories of everyday activities based on direct observation of behavior in neurology and diary reports of everyday errors in cognitive psychology are presented, followed by a review of the empirical findings and resulting theoretical conceptualizations from case studies and group studies of various clinical populations in neuropsychology. Results: We conclude with a new framework (the goal-control model) that integrates the most recent empirical findings in neuropsychology with mechanisms proposed by cognitive models. Conclusions: The goal-control model offers empirically supported solutions to understanding and predicting functioning in the real world. This new model generates testable predictions for future research and provides guidance for clinical assessment and interventions.
Key Points
Question: Neuropsychological theories of memory and language help us understand and predict specific cognitive problems people experience after brain damage or disease, but what is our current theoretical understanding of everyday activities that are important for people's day-to-day lives, like preparing a meal? Findings: The empirical data and theories pertaining to everyday activities described over the past century by behavioral neurologists and cognitive psychologists were integrated into a novel framework called the goal-control model. Importance: The goal-control model promotes understanding of functional difficulties, particularly for individuals with moderate-to-severe cognitive impairments, and offers testable hypotheses for future research and implications for neuropsychological assessment and intervention. Next Steps: Future studies are needed to extend the goal-control model for individuals with mild cognitive impairments and to evaluate the clinical assessments and interventions informed by the model.
Interdependence and Cooperation in Daily Life Columbus, Simon; Molho, Catherine; Righetti, Francesca ...
IDEAS Working Paper Series from RePEc,
03/2021, Letnik:
120, Številka:
3
Journal Article, Paper
Recenzirano
Odprti dostop
Philosophers and scientists have long debated the nature of human social interactions and the prevalence of mutual dependence, conflict of interests, and power asymmetry in social situations. Yet, ...there is surprisingly little empirical work documenting the patterns of interdependence that people experience in daily life. We use experience sampling to study how people think about 3 dimensions of interdependence in daily life and how these dimensions relate to cooperation. In Study 1, 139 romantic couples (n = 278) reported on situations experienced with their partner (k = 6,766); in Study 2, individuals (n = 284) reported on situations experienced with any other person (k = 7,248), over the course of 1 week. Across both samples, we found that most social interactions were perceived as containing moderate mutual dependence, equal power, and corresponding interests. When couples reported on the same situation (Study 1), they largely agreed on their experienced interdependence and cooperation, suggesting that their reports reflect an underlying shared reality. In daily interactions across both samples, higher mutual dependence and lower conflict of interests were associated with more cooperation, whereas relative power was not directly related to cooperation. These associations replicated in laboratory experiments (Study 2). In daily life, high mutual dependence and high relative power exacerbated the negative relation between conflict of interests and cooperation. Finally, prevalent patterns of interdependence and the experience of specific interdependent situations affected multiple relationship outcomes. Our findings stress the importance of studying a diverse array of interdependent situations-and especially situations with corresponding interests-to better understand cooperation in daily life.
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