Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols

Abstract

Objectives: Regular physical activity for older adults as they age is important for maintaining not only physical function but also independence and self-worth. To be able to monitor changes in physical function, appropriate validated measures are required. Reliability of measures such as the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk has been demonstrated; however, the appropriateness of such measures in a population of adults living with dementia, who may be unable to follow instructions or have diminished physical capacity, is not as well quantified. This study sought to test modified standard protocols for these measures. Methods: Modification to the standard protocols of the timed-up-and-go, five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second sit-to-stand, and four-metre walk was trialled. This occurred through modification of procedural components of the assessment, such as encouraging participants to use their hands to raise themselves from a seated position, or the incorporation of staged verbal cueing, demonstration, or physical guidance where required. The test–retest reliability of the modified protocols was assessed using Pearson’s correlation, and performance variances were assessed using the %coefficient of variation. Intraclass correlations were included for comparisons to previous research and to examine measurement consistency within three trials. Results: At least 64% of the population were able to complete all measures. Good test–retest reliability was indicated for the modified measures (timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93; and the four-metre walk = 0.83), and the %coefficient of variation (7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to good. Conclusion: This article describes the methodology of the modified assessments, presents the test–retest statistics, and reports how modification of the current protocols for common measures of physical function enabled more older adults living with dementia in a residential aged care facility to participate in assessments, with high reliability demonstrated for the measures.

Evaluation of an implementation project: The exercise physiology in aged care program

“…A paper reporting the outcomes has recently been published. 24 From the perspective of partners-in-care, the program resulted in greater improvement than deterioration postintervention for all factors measured, and not necessarily associated with physical function. Changes in perception of who might benefit from participation in such a program were evident; however, there was still a perception that residents who are most severely declined will not benefit from participation.…”

“…Such concerns led to trialing modified protocols for the assessments as a part of the study reported here, with a subset of our participants. A paper reporting the outcomes has recently been published …”

“…The small sample size for some outcome measures is also a limitation, attributed in part to the inability of some residents to complete the measures due to their level of decline, which is an issue for this population. This has resulted in modifications to the standard protocol for these assessments for future research …”

“…This has resulted in modifications to the standard protocol for these assessments for future research. 24…”