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Murugappan MN, King-Kallimanis BL, Bhatnagar V, Kanapuru B, Farley JF, Seifert RD, Stenehjem DD, Chen TY, Horodniceanu EG, Kluetz PG. Patient-reported frailty phenotype (PRFP) vs. International Myeloma Working Group frailty index (IMWG FI) proxy: A comparison between two approaches to measuring frailty. J Geriatr Oncol 2024; 15:101681. [PMID: 38104480 DOI: 10.1016/j.jgo.2023.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Frailty assessments may help to identify patients at highest risk for treatment-related toxicity, early treatment discontinuation due to toxicity, and death in Multiple Myeloma. We aimed to compare the patient-reported frailty phenotype (PRFP) and a modified version of the International Myeloma Working Group frailty index (IMWG FI) in terms of their strengths, limitations, and classification of frailty in a cohort of patients with relapsed/refractory multiple myeloma (RRMM). MATERIALS AND METHODS Data were pooled from six RRMM Phase 3 randomized clinical trials submitted to the Food and Drug Administration for regulatory review between 2010 and 2021. Patients were classified as fit, intermediate fit/pre-frail, or frail using both PRFP and the IMWG FI proxy. Agreement between the two approaches in classification of patient frailty was assessed using weighted Cohen's kappa. A contingency table and Venn diagram were generated to analyze overlap in categorization of patient frailty across the different severity groups. Descriptive statistics were used to summarize and compare the clinical and demographic characteristics of patients categorized as frail by PRFP vs. IMWG FI proxy. RESULTS Of the 2,750 patients included in this analysis, IMWG FI proxy classified 16.4% (452) patients as frail, 28.1% (772) as intermediate fit/pre-frail, and 55.5% (1,526) as fit. Meanwhile, PRFP classified 21.7% (597) of patients as frail, 24.5% (675) as intermediate fit/pre-frail, and 53.8% (1478) as fit. Fair agreement was observed between PRFP and IMWG FI proxy (weighted Cohen's Kappa = 0.34 [0.31-0.37]). On average, patients who were categorized as frail by IMWG FI proxy were older and had higher Charlson Comorbidity Index scores than patients classified as frail by PRFP. In contrast, patients who were classified as frail by PRFP had worse EORTC QLQ-C30 Physical Functioning subscale summary scores as compared to patients in the IMWG FI proxy frail group (median score of 40 vs. 47 out of 100). DISCUSSION Our analysis found fair concordance between IMWG FI proxy and PRFP. This demonstrates that while both frailty models measure the same underlying construct, the variables that constitute each approach may result in differing frailty categorizations for the same patient. Further prospective studies are needed to establish and compare the predictive and prognostic abilities of the different frailty indices in MM.
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Affiliation(s)
- Meena N Murugappan
- ORISE Fellow, Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA; Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA.
| | | | - Vishal Bhatnagar
- Oncology Center for Excellence U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA
| | - Bindu Kanapuru
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA
| | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
| | - Randall D Seifert
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
| | - David D Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
| | - Ting-Yu Chen
- ORISE Fellow, Office of Oncologic Diseases, Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA
| | - Erica G Horodniceanu
- Oncology Center for Excellence U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA
| | - Paul G Kluetz
- Oncology Center for Excellence U.S. Food and Drug Administration (U.S. FDA), Silver Spring, MD, USA
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Moon S, Oh E, Chung D, Hong GRS. Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study. PLoS One 2024; 19:e0296796. [PMID: 38206920 PMCID: PMC10783775 DOI: 10.1371/journal.pone.0296796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea. METHOD This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020. RESULTS The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender. CONCLUSION The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.
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Affiliation(s)
- SeolHwa Moon
- Department of Nursing, Hoseo University, Cheonan, Republic of Korea
| | - Eunmi Oh
- Research Institute of Nursing Science, Hanyang University, Seoul, Republic of Korea
| | - Daum Chung
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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Jain U, Sheehan CM. Comparative Analysis of Gender and Age Patterns in Informal Care Received among Disabled Older Adults: A Cross-National Study across the United States, Mexico, China, and Indonesia. J Cross Cult Gerontol 2023; 38:389-415. [PMID: 37725209 DOI: 10.1007/s10823-023-09488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/21/2023]
Abstract
This paper examines cross-national differences by gender and age in receipt and sources of help for limitations with activities of daily living or instrumental activities of daily living among older adults in the United States, Mexico, China, and Indonesia. Respondents aged 50 + from the Health and Retirement Study, Mexican Health and Aging Study, China Health and Retirement Longitudinal Study, and Indonesia Family Life Survey are included. Descriptive methods, logistic and multinomial regression analyses are used to examine patterns in any help received and main source of help respectively. After controlling for age, marital status, and co-residence with child(ren), it is found that men in all four countries overwhelmingly relied on their spouse for care, while children are more likely to be the main source of care for women. Children as the main source of care increased with age in each country and among men and women, surpassing spouse in China and Indonesia, and to a lesser extent in Mexico, but not in the United States where spouse was found to be more likely to be main caregiver even among the oldest age groups. Caregiving for the disabled is important for the well-being of the care recipient and for caregivers. Our results shed light on the asymmetric burden of caregiving on female spouses, across four diverse and aging countries.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance, and Real Estate, Mitchell College of Business, University of South Alabama, 5811 USA S Dr, MCOB 310, Mobile, AL, USA.
| | - Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
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Sheehan CM, Garcia MA, Chiu CT, Cantu PA. Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life. Res Aging 2023; 45:620-629. [PMID: 36548945 DOI: 10.1177/01640275221146478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.
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Affiliation(s)
- Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Marc A Garcia
- Department of Sociology, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, New York, USA
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Phillip A Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Marroig A. Transitions across states with and without difficulties in performing activities of daily living and death: a longitudinal comparison of ten European countries. Eur J Ageing 2023; 20:18. [PMID: 37202643 DOI: 10.1007/s10433-023-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Ageing has been related to the onset of disability and dependency in older adults. There is a need to better understand the disability and dependency trajectories of older adults and their relationship with socio-demographic characteristics and institutional or cultural context. This study analyses the role of age, sex, education and self-perceived health in disability, dependency and death transitions, addressing the heterogeneity across European countries and inconsistencies when using different measures of disability. Multi-state models were adjusted to evaluate the role of risk and protective factors in the transitions to disability, dependency and death. Difficulties in performing activities of daily living (ADLs) assess disability and dependency states. Data were from the Survey of Health, Ageing and Retirement in Europe conducted in 2004-2013, considering individuals aged 65 and older at baseline from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland. The results showed that transitions to disability and dependency varied with age, sex, education and self-perceived health. The probability of transition to disability and dependency states increases until the age of 70 for all countries. However, there was heterogeneity in the disability and dependency trajectories with ageing between men and women. In most countries, women live with difficulties and may need help for longer than men. Care policies should consider sex differences to decrease the burden of care of informal caregivers, particularly in countries where care systems are absent or partially developed and a high level of family obligations to care needs exist.
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Affiliation(s)
- Alejandra Marroig
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay.
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Bhatta TR. Intersecting Early-Life Selection Mechanisms: Socio-Historical Changes in Racially Stratified Effects of Education on Functional Limitations in the United States. J Aging Health 2023; 35:242-255. [PMID: 36073190 DOI: 10.1177/08982643221124657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Scant research has focused on the role of sociohistorical changes in shaping intersecting early-life selection mechanisms and their impacts on racially stratified effects of education on health across cohorts. METHOD Drawing from the Health and Retirement Survey, this study fitted negative binomial regression models to assess the impacts of childhood socioeconomic status (SES) on the relationship between education and functional limitations for Black and White adults across birth cohorts (n = 16,269, born 1931-1959). RESULTS The disparities between Black adults and White adults in impacts of childhood SES on both education and functional limitations were more pronounced in recent cohorts. The racial stratification in the impacts of education on functional limitations was documented across cohorts. However, after adjusting for childhood SES, this stratification narrowed considerably in recent cohorts. DISCUSSION This study underscores the role of a sociohistorical context in shaping the effects of education on health at the intersection of race and cohort.
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Affiliation(s)
- Tirth R Bhatta
- Department of Sociology, University of Nevada, Las Vegas, NV, USA
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Johansson A, Torgé CJ, Fristedt S, Bravell ME. Relationships and gender differences within and between assessments used in Swedish home rehabilitation - a cross-sectional study. BMC Health Serv Res 2022; 22:807. [PMID: 35729529 PMCID: PMC9215038 DOI: 10.1186/s12913-022-08177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Home rehabilitation programmes are increasingly implemented in many countries to promote independent living. Home rehabilitation should include a comprehensive assessment of functioning, but the scientific knowledge about the assessment instruments used in this context is limited. The aim of this study was to explore relationships between standardised tests and a self-reported questionnaire used in a home rehabilitation programme. We specifically studied whether there were gender differences within and between assessments. Method De-identified data from 302 community-dwelling citizens that participated in a municipal home rehabilitation project in Sweden was analysed. A Mann Whitney test and an independent t-test were used to analyse differences within the following assessment instruments: the Sunnaas Activity of Daily Living Index, the General Motor Function assessment scale and the European Quality of Life Five Dimension Five Level Scale. Spearman’s bivariate correlation test was used to analyse relationships between the instruments, and a Fischer’s Z test was performed to compare the strengths of the correlation coefficients. Result Gender differences were found both within and between the assessment instruments. Women were more independent in instrumental activities of daily living than men. The ability to reach down and touch one’s toes while performing personal activities of daily living was stronger for men. There was a difference between men’s self-reported performance of usual activities that included instrumental activities of daily living and the standardised assessment in performing instrumental activities of daily living. The result also showed an overall difference between the self-reported assessment and the standardised test of motor function for the total group. Conclusion The results indicate that a comprehensive assessment with the combination of standardised tests, questionnaires and patient-specific instruments should be considered in a home rehabilitation context in order to capture different dimensions of functioning. Assessment instruments that facilitate a person-centred home rehabilitation supporting personally meaningful activities for both men and women should be applied in daily practice. Further research about gender-biased instruments is needed to facilitate agreement on which specific instruments to use at both individual and organisation levels to promote gender-neutral practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08177-x.
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Affiliation(s)
- Anette Johansson
- Health Care Administration, Jönköping Municipality, Jönköping University, School of Health and Welfare, SE 551 11, Jönköping, Sweden.
| | | | - Sofi Fristedt
- Jönköping University, School of Health and Welfare, Jönköping, Sweden
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Roheger M, Kalbe E, Corbett A, Brooker H, Ballard C. Predictors of activities of daily living in heathy older adults: Who benefits most from online cognitive training? Brain Behav 2021; 11:e2388. [PMID: 34661996 PMCID: PMC8613408 DOI: 10.1002/brb3.2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the course of activities of daily living (IADL) functioning and possible predictors of performance changes in healthy older adults conducting either a General Cognitive Training (GCT) or a Reasoning Cognitive Training (ReaCT) or no training (control group, CG) over a period of 6 weeks, 3 months, and 6 months. SETTING AND PARTICIPANTS An online, home-based GCT and ReaCT including n = 2913 healthy participants (GCT: n = 1096; ReaCT: n = 1022; CG: n = 794) aged 60 years and older. METHODS Multilevel analysis were calculated to explore the nature of our outcome variables of IADL part A (independence) and part B (difficulty of tasks), and to detect possible predictors for participants' performance on IADL after CT. RESULTS The random slopes models fitted better for the outcomes IADL Part B in the GCT group (χ2 (2) = 18.78, p < .01), and both IADL Part A and Part B in the ReaCT group (χ2 (2) = 28.57, p < .01; χ2 (2) = 63.38, p < .01, respectively), indicating different changes over time for individual participants. Female sex was a significant predictor of IADL change in the ReaCT group, showing that females benefited most in both IADL scores (IADL A: 0.01, p < .01; IADL B: 0.004, p < .01). No other significant predictors for IADL changes were identified. CONCLUSION AND IMPLICATION The particular effectiveness in women is of clinical relevance, as IADL is typically more impaired in women than in men in advanced age. Following a personalized medicine approach, identifying predictors of non-pharmacological intervention success is of utmost importance.
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Affiliation(s)
- Mandy Roheger
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anne Corbett
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen Brooker
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Clive Ballard
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Mueller Y, Schwarz J, Monod S, Locatelli I, Senn N. Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial. CMAJ 2021; 193:E1289-E1299. [PMID: 34426445 PMCID: PMC8412422 DOI: 10.1503/cmaj.202887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although assessment of geriatric syndromes is increasingly encouraged in older adults, little evidence exists to support its systematic use by general practitioners (GPs). The aim of this study was to determine whether a systematic geriatric evaluation performed by GPs can prevent functional decline. METHODS We conducted a controlled, open-label, pragmatic cluster-randomized trial in 42 general practices in Switzerland. Participating GPs were expected to enrol an average of 10 community-dwelling adults (aged ≥ 75 yr) who understood French, and had visited their GP at least twice in the previous year. The intervention consisted of yearly assessment by the GP of 8 geriatric syndromes with an associated tailored management plan according to assessment results, compared with routine care. Our primary outcomes were the proportion of patients who lost at least 1 instrumental activity of daily living (ADL) and the proportion who lost at least 1 basic ADL, over 2 years. Our secondary outcomes were quality-of-life scores, measured using the older adult module of the World Health Organization Quality of Life Instrument, and health care use. RESULTS Forty-two GPs recruited 429 participants (63% women) with a mean age of 82.5 years (standard deviation 4.8 yr) at time of recruitment. Of these, we randomly assigned 217 participants to the intervention and 212 to the control arm. The proportion of patients who lost at least 1 instrumental ADL in the intervention and control arms during the course of the study was 43.6% and 47.6%, respectively (risk difference -4.0%, 95% confidence interval [CI] -14.9% to 6.7%, p = 0.5). The proportion of patients who lost at least 1 basic ADL was 12.4% in the intervention arm and 16.9% in the control arm (risk difference -5.1%, 95% CI -14.3% to 4.1%, p = 0.3). INTERPRETATION A yearly geriatric evaluation with an associated management plan, conducted systematically in GP practices, does not significantly lessen functional decline among community-dwelling, older adult patients, compared with routine care. TRIAL REGISTRATION ClinicalTrials.gov, NCT02618291.
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Affiliation(s)
- Yolanda Mueller
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Joëlle Schwarz
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stéfanie Monod
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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10
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Amato C, Burridge G, Basic D, Huynh D, Gibbons E, Ní Chróinín D, Liu KPY. Assistance provided in daily tasks and difficulty experienced by caregivers for people living with dementia. Aust Occup Ther J 2021; 68:236-245. [PMID: 33533025 DOI: 10.1111/1440-1630.12720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION There is a growing body of research that addresses caregivers for people living with dementia. However, there is limited research looking at the perceptions of caregivers in specific daily tasks. To address this gap, this study investigated the assistance caregivers provided and the difficulty they faced when completing daily tasks for people with dementia and, additionally, how these experiences might relate to their perceived burden. METHODS Sixty-two caregivers for people living with dementia completed the study. Data were collected, through a survey, on the level of assistance caregivers provided, and the difficulties they experienced. The Zarit Burden Scale was used to measure the level of perceived burden. Descriptive statistics and Spearman's correlation coefficient were used to report the results and the relationship between the perceived burden, the level of assistance provided, and the difficulty experienced. RESULTS The activities of daily living that caregivers provided the most assistance for was dressing and showering. Most instrumental activities of daily living required maximal to total assistance. Overall, the caregivers did not experience a high level of difficulty with assisting with these daily tasks in comparison to the level of assistance provided. The caregiver burden was associated significantly with the difficulties experienced in dressing, toileting, and showering (rho = 0.30-0.75), most instrumental activities of daily living (rho = 0.29-0.47), but not with the level of assistance provided. CONCLUSION Caregivers are assisting in many daily tasks. Their level of difficulty is relatively low in comparison to the level of assistance they provide. Significant correlations were found between the difficulties experienced and the burden scale. There is a need for occupational therapists to address the specific daily tasks and the concerns experienced by caregivers and to provide them with adequate support to improve the quality of care for people with dementia.
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Affiliation(s)
- Carmen Amato
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Gemma Burridge
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - David Basic
- Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Danielle Huynh
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Emma Gibbons
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
| | | | - Karen P Y Liu
- School of Health Sciences, Translational Health Research Institute, Western Sydney University, NSW, Australia
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11
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Feger DM, Willis SL, Thomas KR, Marsiske M, Rebok GW, Felix C, Gross AL. Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study. Front Neurol 2020; 11:550577. [PMID: 33192982 PMCID: PMC7642324 DOI: 10.3389/fneur.2020.550577] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/09/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group. Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty. Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.
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Affiliation(s)
- Danielle M Feger
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelsey R Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California San Diego School of Health Sciences, La Jolla, CA, United States
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - George W Rebok
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Alden L Gross
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Abstract
The risk of developing severe illness from COVID-19 and of dying from it increases with age. This statistical association has led to numerous highly problematic policy suggestions and comments revealing underlying ageist attitudes and promoting age discrimination. Such attitudes are based on negative stereotypes on the health and functioning of older adults. As a result, the lives of older people are disvalued, including in possible triage situations and in the potential limitation of some measures against the spread of the pandemic to older adults. These outcomes are unjustified and unethical. We develop six propositions against the ageism underlying these suggestions to spur a more adequate response to the current pandemic in which the needs and dignity of older people are respected.
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Affiliation(s)
- Hans-Joerg Ehni
- Professor, Institute for Ethics and the History of Medicine, University of Tuebingen , Tuebingen, Germany
| | - Hans-Werner Wahl
- Professor, Network of Aging Research, Heidelberg University , Heidelberg, Germany
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13
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Kim S, Won CW. How Can We Evaluate Disability without Bias? Ann Geriatr Med Res 2020; 24:152-153. [PMID: 32743336 PMCID: PMC7370790 DOI: 10.4235/agmr.20.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023] Open
Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
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Dubbelman MA, Verrijp M, Facal D, Sánchez‐Benavides G, Brown LJ, van der Flier WM, Jokinen H, Lee A, Leroi I, Lojo‐Seoane C, Milošević V, Molinuevo JL, Pereiro Rozas AX, Ritchie C, Salloway S, Stringer G, Zygouris S, Dubois B, Epelbaum S, Scheltens P, Sikkes SA. The influence of diversity on the measurement of functional impairment: An international validation of the Amsterdam IADL Questionnaire in eight countries. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12021. [PMID: 32420446 PMCID: PMC7219786 DOI: 10.1002/dad2.12021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To understand the potential influence of diversity on the measurement of functional impairment in dementia, we aimed to investigate possible bias caused by age, gender, education, and cultural differences. METHODS A total of 3571 individuals (67.1 ± 9.5 years old, 44.7% female) from The Netherlands, Spain, France, United States, United Kingdom, Greece, Serbia, and Finland were included. Functional impairment was measured using the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. Item bias was assessed using differential item functioning (DIF) analysis. RESULTS There were some differences in activity endorsement. A few items showed statistically significant DIF. However, there was no evidence of meaningful item bias: Effect sizes were low (ΔR 2 range 0-0.03). Impact on total scores was minimal. DISCUSSION The results imply a limited bias for age, gender, education, and culture in the measurement of functional impairment. This study provides an important step in recognizing the potential influence of diversity on primary outcomes in dementia research.
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Affiliation(s)
- Mark A. Dubbelman
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Merike Verrijp
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - David Facal
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - Laura J.E. Brown
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
| | - Hanna Jokinen
- Clinical NeurosciencesNeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Department of Psychology and LogopedicsFaculty of MedicineUniversity of HelsinkiFinland
| | - Athene Lee
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Iracema Leroi
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Cristina Lojo‐Seoane
- Department of Developmental PsychologyUniversity of Santiago de CompostelaA CoruñaSpain
| | | | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
| | | | | | - Stephen Salloway
- Butler HospitalWarren Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Gemma Stringer
- Faculty of BiologyMedicine and HealthUniversity of ManchesterManchester Academic Science CentreManchesterUK
| | - Stelios Zygouris
- School of MedicineAristotle University of ThessalonikiThessalonikiGreece
- Network Aging ResearchHeidelberg UniversityHeidelbergGermany
| | - Bruno Dubois
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Stéphane Epelbaum
- Department of NeurologyInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A) of the Pitié‐Salpêtrière Hospital & ARAMISSorbonne UniversityInria de ParisInstitut du cerveau et de lamoelle épinière (ICM)ParisFrance
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
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15
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Sheehan CM. Education and Health Conditions among the Currently Incarcerated and the Non-Incarcerated Populations. POPULATION RESEARCH AND POLICY REVIEW 2019; 38:73-93. [PMID: 36860891 PMCID: PMC9974178 DOI: 10.1007/s11113-018-9496-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Previous research has found a strong link between educational attainment and health, where the highly educated live longer and healthier lives than those with lower levels of education. Because such research has relied on samples of the non-institutionalized population, previous research has not explored the association between education and specific chronic and infectious health conditions among the currently incarcerated. Analyzing the relationship between education and health conditions among the incarcerated, whom tend to be less healthy and for whom many of the intermediate mechanisms between education and health are held relatively constant in prison, may yield new insights. Using the 2002-2004 National Health Interview Study (N=74,881), the 2004 Survey of Inmates in State and Federal Correctional Facilities (N=17,553), and interaction terms from logistic regression models, I compared the strength of the association between educational attainment and the presence of chronic and infectious health conditions among the incarcerated and non-incarcerated populations. These models indicated generally stronger negative associations between educational attainment and chronic conditions among the non-incarcerated, while the negative relationship between education and hepatitis was stronger for the incarcerated. These results suggest that while education may play a lesser role for chronic conditions for the incarcerated, it can still important for avoiding risky health behaviors.
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Affiliation(s)
- Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University
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