Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living.

Abstract

Objective-To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living.Design-Population based randomised controlled trial of subjects aged e85 living independently in an inner London borough.Setting-21 Electoral wards of the London Borough of Hackney.Subjects-1255 Subjects aged ¢c85 living in their own home whose names were obtained from general practitioner lists and cross checked against the electoral register, 511 of whom were subsequently found to be ineligible. Of the 744 remaining, those with disability on screening were randomised and allocated to an intervention group (36) or a control group (43), in which intervention was postponed until four weeks, after the follow up assessment. Subjects with aids supplied previously were excluded from the intervention phase.Interventions -Provision of raised toilet seat, teapot tipper, tap turner, shoe horn and elastic laces, and double handled saucepan.Main outcome measures-Degree of difficulty (grades 1-4) with specific tasks (getting on and off a toilet, pouring from a teapot into a cup, turning taps on and off, carrying a saucepan of standard weight, and putting on shoes) and time taken to perform them.Results-545 (73%) Of the 744 eligible subjects assessed; 428 had no disability and 118 had difficulty with at least one task. Some had had their disability recognised before the study and already had aids, representing half of those with difficulty getting on and off the toilet but 24% for putting on shoes and 13% for pouring from a teapot and turning on a tap. The mean number ofdifficulties was similar between the groups (intervention group 1*7, control group

Underutilization of Environmental Adaptations for Bathing in Community‐Living Older Persons

“…31 A series of studies that systematically assessed and implemented environmental adaptations for bathing provided more direct evidence, demonstrating reductions in self-reported difficulty in bathing, 32,33 healthcare costs, 15 and the need for home-based nursing and institutional care. 15,34 Additional randomized trials are needed to more rigorously evaluate the effectiveness of environmental adaptations for bathing across the continuum of disability. Living situation (living alone vs living with others) could explain, at least partly, differences in the utilization of environmental adaptations by type of disability.…”

Associations with Changes in Level of Functional Ability. Results from a Follow-up Survey at Two and a Half Years of People Aged 85 Years and Over at Baseline Interview

“…Occupational therapy in the domiciliary setting has been demonstrated to be effective among people with arthritis and rheumatism in relation to increasing their ability to perform tasks of daily living. 52 ' 53 The study relied on respondents' own reporting of the degree of difficulty encountered in the performance of tasks of daily living. This is not thought to have affected the validity of the results in a major way.…”

Use of a Cane for Ambulation: Marker and Mitigator of Impairment in Older People Who Report No Difficulty Walking

“…Because physical functioning is fundamental to the quality of life of older people, clinicians and researchers have worked to understand, predict, and prevent physical disability 1 . Asking patients about difficulty in performing daily tasks has commonly been used to detect disability in epidemiological 2–4 and intervention studies, 5 yet recent work suggests that inquiring about modifications in daily tasks may be a more sensitive method for ascertaining early or mild functional problems; even among older people who deny difficulty with a task, those who report a modification in task performance have reduced functional ability as measured by performance tests than do those who do not report having modified their task performance 6 . Fried et al have also shown that older people who deny difficulty walking half a mile or climbing 10 steps but who nonetheless report modification in these tasks are at increased risk for incident difficulty performing these tasks 7 .…”