Underestimation of Disability in Community‐Living Older Persons

Gill, Thomas M.; Hardy, Susan; Williams, Christianna S.

doi:10.1046/j.1532-5415.2002.50403.x

Cited by 175 publications

(287 citation statements)

References 38 publications

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“…For the evaluation of those with cognitive impairment, the primary caregiver provided information on weight loss, level of physical activity, exhaustion, socio-demographic characteristics, medical conditions and functional aspects 27 . The use of the primary caregiver as the respondent was based on the difficulty elderly individuals with cognitive impairment have remembering facts and properly evaluating their physical and functional capacities, which compromises the reliability and accuracy of the information 27 . Individuals without cognitive impairment (according to the screening process) answered the questions themselves.…”

Section: Methodsmentioning

confidence: 99%

Frailty and cognitive impairment among community-dwelling elderly

Alencar¹,

Dias²,

Figueiredo³

et al. 2013

Arq. Neuro-Psiquiatr.

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Frailty is an important geriatric syndrome that results from a reduction in the reserves of multiple systems, leading to a state of increased vulnerability to stressors 1,2 . Frailty is generally associated with an increased risk of functional decline, institutionalization, hospitalization, and death 1-3 and has therefore been described as an important clinical and public health problem that merits further study 1 .Recent studies have identified an association between frailty and subsequent cognitive decline in 3-and 12-year cohorts 4,[6][7][8] . Moreover, associations have been found between frailty and an increased incidence of mild cognitive impairment 7 and Alzheimer's diease 6 . In a study involving frail older adults with and without cognitive impairment, Ávila-Funes et al. 5 report that cognitive impairment increases the predictive validity of frailty for the occurrence of adverse outcomes in a four-year period.Longitudinal studies report that the progression rate of cognitive impairment among older adults ranges from 1 to 2% a year 9 . Moreover, older adults with cognitive impairment progress to more severe stages on an annual basis and the conversion rate to dementia can reach 10 to 30% a year 10,11 . However, there is little knowledge on the factors related to progressive cognitive impairment within a one-year period and whether this progression is associated with frailty. Thus, gaining a better understanding of the association between frailty and cognitive impairment within a short period of time may assist in establishing strategies aimed at prevention and treatment.Study carried out at Universidade Federal de Minas Gerais (UFMG), Belo Horizonte MG, Brazil. AbstrActThe aim was to evaluate associations between frailty status and cognitive decline and the incidence of cognitive impairment over 12-month period. Two hundred seven older adults were assessed. Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low level of activity. Cognitive decline was assessed using the Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Relative risk (RR) was calculated with a 95% confidence interval (CI). Frailty was associated with subsequent cognitive decline in 12-month when assessed using the MMSE (p=0.005; RR=4.6; 95%CI 1.93-11.2). No association was found between frailty and cognitive decline measured by the CDR (p=0.393; RR=2.1; 95%CI 0.68-6.7) or between frailty and the incidence of cognitive impairment (p=0.675; RR=1.2; 95%CI 0.18-8.3). These findings reveal an association between frailty and subsequent cognitive decline when measured by the MMSE, even within a short period of time.Key words: aged, frail elderly dementia.resumo O objetivo foi avaliar a associação entre fragilidade e o declínio cognitivo e a incidência de alteração cognitiva, em 12 meses. Foram avaliados 207 idosos. Fragilidade foi definida como ter pelo menos três dos critérios: perda de peso, fraqueza, exaustão, lentidão e baixo nível de atividad...

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Section: Methodsmentioning

confidence: 99%

Frailty and cognitive impairment among community-dwelling elderly

Alencar¹,

Dias²,

Figueiredo³

et al. 2013

Arq. Neuro-Psiquiatr.

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“…30 Potential participants were identified from a large health plan in greater New Haven, Connecticut. Exclusion criteria, present in 8 individuals, included considerable cognitive impairment with no available proxy, 31 plans to move out of the area, inability to speak English, or terminal illness. Only 4.6% of persons contacted declined screening, and 75.2% of those eligible agreed to participate and were enrolled from March 1998 to October 1999.…”

Section: Parent Populationmentioning

confidence: 99%

“…for each of the 4 basic activities, 5 instrumental activities (shopping, doing housework, preparing meals, taking medications, and managing finances), and 3 mobility activities (walking one-fourth of a mile, climbing a flight of stairs, and lifting/carrying 10 pounds). 29,31,35 For these 12 activities, disability was operationalized as the need for personal assistance (yes/no). Participants were also asked about a fourth mobility activity, "Have you driven a car during the past month?"…”

Section: Assessment Of Disabilitymentioning

confidence: 99%

Functional Trajectories in the Year Before Hospice

Stabenau

Morrison

Gahbauer

et al. 2015

The Annals of Family Medicine

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PURPOSE We undertook a study to identify distinct functional trajectories in the year before hospice, to determine how patients with these trajectories differ according to demographic characteristics and hospice diagnosis, and to evaluate the association between these trajectories and subsequent outcomes.METHODS From an ongoing cohort study of 754 community-living persons aged 70 years or older, we evaluated data on 213 persons who were subsequently enrolled in hospice from March 1998 to December 2011. Disability in 13 basic, instrumental, and mobility activities was assessed during monthly telephone interviews through June 2012. RESULTSIn the year before hospice, we identified 5 clinically distinct functional trajectories, representing worsening cumulative burden of disability: late decline (10.8%), accelerated (10.8%), moderate (21.1%), progressively severe (24.9%), and persistently severe (32.4%). Participants with a cancer diagnosis (34.7%) had the most favorable functional trajectories (ie, lowest burden of disability), whereas those with neurodegenerative disease (21.1%) had the worst. Median survival in hospice was only 14 days and did not differ significantly by functional trajectory. Compared with participants in the persistently severe trajectory, those in the moderate trajectory had the highest likelihood of surviving and being independent in at least 1 activity in the month after hospice admission (adjusted odds ratio = 5.5; 95% CI, 1.9-35.9). CONCLUSIONSThe course of disability in the year before hospice differs greatly among older persons but is particularly poor among those with neurodegenerative disease. Late admission to hospice (as shown by the short survival), coupled with high levels of severe disability before hospice, highlight potential unmet palliative care needs for many older persons at the end of life. INTRODUCTIONO lder persons with persistent levels of severe disability have high mortality and substantial care needs.1,2 One option for addressing these needs is palliative care, a specialized medical and interdisciplinary care approach that aims to alleviate stress, pain, and other distressing symptoms among those with serious illness, independent of prognosis or treatment being pursued, with the goal of optimizing quality of life for both patients and families.3 Hospice care, a similar approach, is a second option. In the United States, hospice is largely defined by the Medicare Hospice Benefit, which restricts services to persons who have an expected survival of 6 months or less. Because hospice also limits the pursuit of curative and most life-prolonging therapies, it is often considered only for patients who have end-stage, terminal conditions, or when death is imminent. [4][5][6][7][8][9][10][11][12][13][14][15] Palliative care is often confused with hospice and can be difficult to access. 16 Consequently, many older persons do not receive hospice or palliative care near the end of life, 17,18 which can place a high burden on caregivers 19 and result in suffering. 20Alt...

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“…Functional status was measured by assessing the degree of assistance required in 7 instrumental activities of daily living (IADL)-telephone use, shopping for groceries, using transportation, meal preparation, housework, taking medications, and handling finances-and in 4 basic activities of daily living (ADL)-bathing, dressing, ambulating, and transferring from a chair. 12,13 Each item on the 7-item IADL scale is rated from 0 to 2 and each item on the 4-item ADL scale ranges is rated from 0 to 3, with higher scores indicating higher functional status. IADL impairment was defined as needing assistance in any of the 7 IADLs, and ADL impairment was defined as needing assistance in any of the 4 ADLs.…”

Section: Standard Protocol Approvals Registrations and Patient Consmentioning

confidence: 99%

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

et al. 2012

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Objective: The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA. Methods:We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.Results: Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p Յ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03-5.92) and IADL impairment (OR 3.86, 95% CI 1.60-9.28).Conclusions: Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population. Neurology ® 2012;79:981-987

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Underestimation of Disability in Community‐Living Older Persons

Abstract: The occurrence of disability is substantially underestimated by longitudinal studies with long assessment intervals. More frequent assessments of functional status could lead to an improved understanding of the course and overall burden of disability in community-living older persons.

Cited by 175 publications

References 38 publications

Frailty and cognitive impairment among community-dwelling elderly

Frailty and cognitive impairment among community-dwelling elderly

Functional Trajectories in the Year Before Hospice

Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis

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