BackgroundThe International Classification of Functioning, Disability and Health (ICF) was introduced by the World Health Organization as a common taxonomy to describe the burden of health conditions. This study focuses on the development of a scale for staging basic mobility and walking functions based on the ICF.MethodsThirty-three ICF codes were selected to test their fit to the Rasch model and their location. Of these ICF items, four were used to develop a Guttman- type scale of “basic mobility” and another four to develop a“walking” scale to stage functional performance in the elderly. The content validity and differential item functioning of the scales were assessed. The participants, chosen at random, were Japanese over 65 years old using the services of public long-term care insurance, and whose functional assessments were used for scale development and scale validation.ResultsThere were 1164 elderly persons who were eligible for scale development. To stage the functional performance of elderly persons, two Guttman-type scales of “basic mobility” and “walking” were constructed. The order of item difficulty was validated using 3260 elderly persons. There is no differential item functioning about study location, sex and age-group in the newly developed scales. These results suggested the newly developed scales have content validity.ConclusionsThese scales divided functional performance into five stages according to four ICF codes, making the measurements simple and less time-consuming and enable clear descriptions of elderly functioning level. This was achieved by hierarchically rearranging the ICF items and constructing Guttman-type scales according to item difficulty using the Rasch model. In addition, each functional level might require similar resources and therefore enable standardization of care and rehabilitation. Illustrations facilitate the sharing of patient images among health care providers. By using the ICF as a common taxonomy, these scales could be used internationally as assessment scales in geriatric care settings. However these scales require further validity and reliability studies for international application.

Aim:To clarify the performance situation of selected quality indicators: falls, pressure ulcers and dehydration, at health care facilities for the elderly in Japan, and what structural characteristics are related to them. Methods:The operational population consisted of 1057 institutionalized users (approximately 10 randomly selected per facility) from a survey answered by the care staff. The facilities were divided into two groups according to their prevalence of negative outcomes (falls, pressure ulcers, dehydration): the best 25% (the very good performers) and the remaining 75% (not so good performers). Logistic regression analysis was carried out to examine the relationship between the structure characteristics of the facilities and their performance regarding each quality indicator. Results:After controlling for sex, years of operation and average age of the users, our results showed a beneficial significant relationship between falls and the total number of nurses per 100 users with an adjusted odds ratio (AOR) of 0.77 (95% CI 0.59-0.98); In contrast, for pressure ulcers, harmful associations between a higher number of registered nurses (AOR 1.23, 95% CI 1.01-1.05) and the availability of 24-h nurse staffing (AOR 4.95, 95% CI 1.19-24.91) were found; regarding dehydration, we did not find any related staffing characteristics. Conclusion:Nursing staff might be considered as a potentially related variable in the quality of care in health care facilities for the elderly. The present study is the first to show a relationship between structural characteristics and quality outcomes in health care facilities for the elderly. Geriatr Gerontol Int 2014; 14: 301-308.

Objectives Alzheimer's disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture. Methods We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. Results We recognized that activities of cognitive function (p \ 0.001), eating (dysphagia) (p \ 0.001), eating (feeding) (p \ 0.001), and toilet use (p \ 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p \ 0.05), transfer and locomotion (p \ 0.001), and bathing (p \ 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p \ 0.001), dysphagia (p \ 0.01), feeding (p \ 0.001), and toilet use (p \ 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery. Conclusions These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

Background:The Typology of the Aged with Illustrations is a four-scale geriatric assessment measure of elderly function and activity of daily living. Illustrations are incorporated to facilitate the understanding of elderly function and activity status. The purpose of the study was to test the reliability and validity of the instrument and the effectiveness of the illustrations in improving performance.Methods: Reliability of the typology was investigated using the test-retest procedure, with a sample of 240 elderly persons. The effectiveness of the illustrations was measured, using the instrument with and without the illustrations, by kappa statistics and the c 2 test. The results were stratified to assess differences in reliability between experienced and nonexperienced evaluators, and for elderly persons in residential institutions compared with day care facilities. Both constructive and concurrent validities were also evaluated. Results:The intra-rater reliability (re-assessment by the same evaluator 1 week later) of the instrument was increased significantly on all four scales (average kappa statistics: 0.82 with illustrations, 0.65 without illustrations) with the inclusion of illustrations vs no illustrations, and the inter-rater reliability (re-assessment by a second evaluator within 24 hours) was significantly increased for the mobility and eating scales. There was no difference in reliability for experienced and inexperienced evaluators, or for different care situations. Conclusion:The inclusion of illustrations in the instrument facilitated the understanding of elderly persons' activity of daily living and increased its reliability. This instrument has wide applicability and can be used for communication between health care professionals and for on-the-job training in geriatric functional assessment.

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