A better way to measure disability in older people

Assessing Scientific Measures of Disability

In recent years, there has been an intense drive to promote quantitative measures of disability. Despite evidence demonstrating the existence of social and political dimensions of disability, medical definitions, emphasizing individual functional capacity, have tended to prevail. The present article reviews and critiques existing and emerging disability measures and discusses methodological alternatives based on the life experiences of disabled people as a strategy for improving the scientific measurement of disability.

The early identification of cognitive impairment

The early and accurate identification of dementia helps to ensure the delivery of appropriate treatment and allows people with dementia and their carers to plan for the future. This article describes a research evaluation of a new screening, assessment and referral service for people with early-stage dementia and their carers who reside in one of Northern Ireland’s integrated health and social services trusts.

A total of 435 referrals were made to the service during the first 33 months; most were female (70%) with an average age of 80 (SD = 7.68) and a mild/moderate (71%) cognitive impairment (mean Mini-mental State Examination score of 20.21 (SD = 6.10)). A research interview was conducted with 20 consecutive service users and their carers ( n = 21) following their initial assessment by a community psychiatric nurse and again four months later. Users recorded an overall improvement in self-reported quality of life and their use of health and social services remained unchanged. Carers valued highly the information and support provided by the project; their QoL improved and ‘stress and strain’ (as measured by the General Health Questionnaire-30 and Carers’ Checklist) decreased.

Generally, stakeholders such as referral agents reported that the new service made an important contribution to dementia care, although some professionals thought that the service needed to be better ‘networked’ in order to avoid duplication of resources. Overall, the findings from this evaluation help to address the lack of available information about ways in which to organize and deliver early-stage dementia care.

Functional assessment of the elderly with the use of EASY-Care Standard 2010 and Comprehensive Geriatric Assessment

BACKGROUND

The wide variation in performance among the elderly leads to the search for a suitable instrument to identify the necessary support. The aim of this study was to examine the scope of independent functioning of the elderly and to indicate the necessary support using basic instruments, Comprehensive Geriatric Assessment (CGA) and EASY-Care Standard 2010.

METHODS

For statistical analysis were qualified 101 questionnaires of patients from oncological surgery clinic.

RESULTS

The study group was dominated by women (79.2%). The average age for the entire group was 74.7 ± 7.5 years. In terms of basic life activities (Barthel Index), 75.2% of the elderly performed most of their activities independently. The Lawton IADL (Instrumental Activity of Daily Living Scale) median was 25 points. Moderate depression (Geriatric Depression Scale) reported 37.6% of the group. The influence of age, education, mode of movement and efficiency in basic and instrumental life activities and depression (Geriatric Depression Scale) was demonstrated in the results in three scales of the EASY-Care Standard 2010 questionnaire: Independence score, Risk of break down in care and Risk of falls. There was no difference in terms of gender and the nature of the residence.

CONCLUSION

The study group of the elderly was characterised by a good level of efficiency in basic and instrumental activities of daily living. Questionnaire EASY-Care Standard 2010 enables to identify functional limitations of the elderly that may form the basis for planning individual support.

Validation study of the Camberwell Assessment of Need for the Elderly (CANE) in Portugal

BACKGROUND

The Camberwell Assessment of Need for the Elderly (CANE) is widely used for multidimensional evaluation of older people with mental health problems. The aim of this study was to evaluate reliability and validity of a Portuguese version of CANE.

METHOD

A cross-sectional multicenter study was designed using a convenience sample of elderly mental health services' users. CANE was compared with EASYCare, GHQ12, MMSE, Barthel Index and GDS15 to assess criterion and construct validity. Inter-rater and test-retest reliability were also assessed.

RESULTS

79 patients (76% female), with mean age of 74 (+/- 6.6) years were included. Most patients lived at home with a family caregiver, generally female. Only 32% had no carer. Dementia was the commonest psychiatric diagnosis (61%) and somatic comorbidity was very prevalent (85%). Kappa values (kappa) for inter-rater item reliability ranged from 0.72 to 1.00 (mean values: 0.96 patient, 0.93 carer, 0.90 staff). The intraclass correlation coefficient (ICC) for total scores ranged from 0.95 to 0.98.For test-retest item reliability, the mean kappa value was: 0.80 patient, 0.77 carer, 0.81 staff. ICC for total scores ranged from 0.82 to 0.92. Given the absence of a gold standard, criterion validity was assessed by comparing CANE with EASYCare (rs 0.460; p < or = 0.01), GDS (rs 0.615; p < or = 0.01), GHQ (rs 0.581; p < or = 0.01) and Barthel Index (rs-0.435; p < or = 0.01). Overall, inter-item and item-total correlations for CANE and item comparison with other measures indicated reasonable construct validity.

CONCLUSION

The psychometric proprieties of CANE seem to be consistently good, in accordance with other studies. Robust results on ecological, face, content, criterion and construct validity, as well as good reliability, were achieved. This version is a promising tool for research and practical use in Portuguese old age settings.

Simple counts of ADL dependencies do not adequately reflect older adults' preferences toward states of functional impairment

OBJECTIVE

To use unweighted counts of dependencies in activities of daily living (ADLs) to assess the impact of functional impairment requires an assumption of equal preferences for each ADL dependency. To test this assumption, we analyzed standard gamble (SG) utilities of single and combination ADL dependencies among older adults.

STUDY DESIGN AND SETTING

Four hundred older adults used multimedia software (FLAIR1) to report SG utilities for their current health and hypothetical health states of dependency in each of 7 ADLs and 8 of 30 combinations of ADL dependencies.

RESULTS

Utilities for health states of multiple ADL dependencies were often greater than for states of single ADL dependencies. Dependence in eating, which is the ADL dependency with the lowest utility rating of the single ADL dependencies, ranked lower than 7 combination states. Similarly, some combination states with fewer ADL dependencies had lower utilities than those with more ADL dependencies. These findings were consistent across groups by gender, age, and education.

CONCLUSION

Our results suggest that the count of ADL dependencies does not adequately represent the utility for a health state. Cost-effectiveness analyses and other evaluations of programs that prevent or treat functional dependency should apply utility weights rather than relying on simple ADL counts.