Cross-cultural adaptation and psychometric evaluation of the Sinhala version of Lawton Instrumental Activities of Daily Living Scale

An assessment of the content and properties of extended and instrumental activities of daily living scales: a systematic review

PURPOSE

We performed a systematic review to assess the psychometric properties of extended Activities of Daily Living (eADL) scales.

MATERIALS AND METHODS

Articles assessing eADL scales' properties were retrieved by searching multidisciplinary databases, and reference screening. Data on the following properties were extracted: validity, reliability, responsiveness, and internal consistency. The COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) risk of bias checklists are used to assess the quality of included articles. All aspects were performed by two independent researchers.

RESULTS

Of 245 titles, 26 articles were eligible, comprising 15 different eADL scales. The Lawton scale had the most papers describing properties, while the Performance-based Instrumental Activities of Daily Living received the highest COSMIN rating. Properties most often assessed were convergent validity and reliability, no articles assessed all COSMIN properties. The COSMIN assessment rated 43% of the properties as 'positive', 31% 'doubtful' and 26% 'inadequate'. Only Lawton was assessed in more than one paper, available data suggest that this scale has excellent reliability, construct validity, internal consistency, and medium criterion validity.

CONCLUSION

Despite their common use, there are limited data on the properties of eADL scales. Where data are available there are potential methodological issues in the studies.

Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India

OBJECTIVES

Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults.

SETTING

Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017-2018 across all states and union territories, were used.

PARTICIPANTS

The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status.

PRIMARY OUTCOME MEASURE

The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as 'frail'.

RESULTS

Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45-59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant.

CONCLUSIONS

There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.

The relationships between physical function, nutrition, cognitive function, depression, and sleep quality for facility-dwelling older adults with dynapenia

BACKGROUND

The growing population of older adults worldwide is associated with an extended life expectancy and an increasing proportion of older adults with dynapenia. Most research on dynapenia has involved only populations of older adults living in the community; little research has examined the effects of risk factors on sleep quality among older adults with dynapenia residing in assisted living facilities.

AIM

This study examined the relationships among physical function, nutrition, cognitive function, depression, and sleep quality among older adults with dynapenia residing in assisted living facilities.

METHODS

In this cross-sectional study, data on physical function, nutrition, cognitive function, depression, and sleep quality was collected from 178 older adults with dynapenia residing in assisted living facilities, who were selected using purposive sampling. Descriptive statistical analysis, independent-sample t tests, chi-squared tests, and logistic regression analysis were performed using SPSS 25.0.

RESULTS

The statistical analyses revealed correlations between sleep quality and age (t = 2.37, p < 0.05), level of education (χ2 = 3.85, p < 0.05), grip strength (t = 3.40, p < 0.01), activities of daily living (t = 4.29, p < 0.001), instrumental activities of daily living (t = 2.23, p < 0.001), calf circumference (t = 2.89, p < 0.01), Mini Nutritional Assessment scores (t = 2.29, p < 0.05), Mini Mental State Exam (MMSE) scores (t = 4.50, p < 0.001), and Geriatric Depression Scale (GDS) scores (t = - 4.20, p < 0.001). Calf circumference (OR = 0.8, 95% CI = 0.650.97, p < 0.05), GDS score (OR = 1.42, 95% CI = 1.05-1.92, p < 0.05), and MMSE score (OR = 0.85, 95% CI = 0.73-0.97, p < 0.05) were related to sleep quality among the sample population.

CONCLUSION

Physical function, nutrition, cognitive function, and depression affect the sleep quality of older adults with dynapenia residing in assisted living facilities. Facility nurses must regularly assess these aspects of their patients to ensure that facility-dwelling older adults can maintain their physical function and improve their health to improve the quality of their sleep.

Quality of life and its associated factors among home-dwelling older people residing in the District of Colombo, Sri Lanka: a community-based cross-sectional study

INTRODUCTION

This community-based cross-sectional study explored the factors affecting overall and domain-specific (physical health, psychological health, social relationships and environmental) quality of life (QOL) of home-dwelling older residents of the District of Colombo, Sri Lanka.

METHODS

A representative sample (n=723) of older adults aged >65 years was obtained by the multistage cluster sampling technique. QOL was assessed using the validated Sinhala version of WHOQOL BREF Questionnaire. Data analysis was done using SPSS V.20.

RESULTS

The mean±SD age was 72.23±6.3 years with the overall QOL score being (mean±SD) 56.73±12.57/100. The mean±SD QOL score of physical health, psychological health, social relationships and environmental domains were 55.81±15.80, 59.25±14.68, 46.36±20.08 and 64.61±11.96, respectively. The overall QOL in the adjusted model showed a significant positive association with the educational status, living conditions (with spouse, with spouse and children), participation in religious activities, being visited by friends or relatives and financial independence. The overall QOL was negatively associated with limitations in activities of daily living and instrumental activities of daily living, chronic arthritis and heart disease in the adjusted model. Living with the spouse was positively associated with the psychological domain of QOL. Osteoporosis and chronic arthritis affected the physical health domain, while cancer and disabling stroke affected the psychological domain of QOL negatively. All statistical significances were considered at p<0.05.

CONCLUSION

The overall QOL of home-dwelling elders of the Colombo District is moderate, with the lowest score being in social relationships and the highest in the environmental domain. Educational status, engaging in religious activities and financial independence are key factors associated with a better QOL. Limitations in physical activity and chronic diseases are associated with a reduced QOL. Living with the spouse is a key factor associated with the psychological health domain.

Analysis of Lower Extremity Motor Capacity and Foot Plantar Pressure in Overweight and Obese Elderly Women

BACKGROUND

Overweight, obesity and falls are major public health problems and old people are the biggest group suffering falls.

METHODS

92 females were divided into the overweight or obesity (O) group (68.85 ± 3.85) and regular-weight (R) group (67.90 ± 4.02). Lower extremity motor capacity and plantar pressure were compared between the two groups. The IRB approval number is 20190804.

RESULTS

(1) Functional Movement Screen and Fugl-Meyer Assessment scores in the O group were significantly lower than in the R group. The time to complete the Timed Up and Go test in the O group was significantly longer than in the R group. (2) Foot flat phase, double support distance, and left foot axis angle in the O group were significantly higher than in the R group. Distance and velocity, left-foot minimum subtalar joint angle and right-foot maximum subtalar joint angle in the O group were significantly shorter than in the R group. (3) Peak force, average force and pressure of metatarsal 1-4, mid-foot, heel medial and lateral, peak pressure of metatarsal l, midfoot, heel medial and lateral in the O group were significantly higher than in the R group. (p < 0.05).

CONCLUSIONS

Overweight and obese elderly women have a lower sensorimotor function, flexibility and stability in functional movements, but higher loads on the foot.

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (β = .52, p < .01) and reduces the time required to complete physical functions (β = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Development and validation of the Quality of Work Life Scale for elderly workers

BACKGROUND

With the rapid rise in the elderly population and their labour force participation, quality of work life (QoWL) of elderly workers becomes an important concept. A valid instrument to measure elderly workers QoWL is a prerequisite to further in this direction.

OBJECTIVE

To develop and validate the Quality of Work Life Scale-Elderly (QoWLS-E) for elderly workers 60 years and above in Sri Lanka.

METHODS

The development and validation of 35 items in QoWLS-E was carried out in two stages. Using a literature search and expert opinion, the items were developed in English language and later translated to Sinhala language. The initial scale consisted of 38 items and a principle component analysis (PCA) was conducted among 275 elderly workers in selected administrative divisions of Colombo district. Then a confirmatory factor analysis (CFA) was conducted among a separate group of 250 elderly workers to confirm the factor structure of the developed scale.

RESULTS

PCA identified 9 principle components accounting for a variance of 71%, which was later confirmed in the CFA (RMSEA-0.07, SRMR-1.0, NNFI-0.87, GFI-0.82, CFI-0.96). The final QoWLS-E with a structure of 9 domains namely; physical health, psychological, welfare facility, safety, job content, co-worker, supervisor, flexibility and autonomy having 35 items correlated satisfactorily with Cronbach's alpha of 0.77 and test - retest reliability of 0.82.

CONCLUSION

QoWLS-E is conceptually and culturally appropriate to assess Quality of Work Life Scale in elderly. It could be a useful tool to describe and monitor improvement of QOWL in elderly.

Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice

OBJECTIVE

To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition).

METHODS

We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice.

RESULTS

The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described.

CONCLUSIONS

The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.

Grandparenting activities and mental health in Northern Sri Lanka

Grandparenting activities are of increasing interest to researchers seeking to understand reduced social engagement and depression among aging adults. Heterogeneity in the population and caretaking roles complicate its measurement. We piloted a measure of grandparenting activities among 79 grandparents (aged 55+) in Sri Lanka and correlated those activity levels with psychological distress. Second, we explored whether the aforementioned correlation varied by grandparent functional limitations. We found that greater engagement in generative grandparenting activities was correlated with lower distress, and that association was stronger among grandparents with more functional limitations. We discuss possible explanations and implications of these findings.

Development and Validation of Peer Relationship Scale for Chinese Community-Dwelling Elderly

INTRODUCTION

This study aimed to develop and psychometrically test the peer relationship scales (PRSs) for the Chinese community-dwelling elderly.

METHODS

Based on the Adams-Blieszner-Ueno integrative conceptual framework, we first drafted item-pool from the literature review, in-depth interviews, and group discussion. After a cross-sectional study in Chongqing, PR, China, we recruited a random sample of 404 community-dwelling individuals aged ≥ 65 years. Subsequently, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the scales. Cronbach's alpha coefficient and split-half reliability were used to assess internal consistency. Moreover, test-retest reliability, concurrent validity, and construct validity were all calculated.

RESULTS

The results supported a two-factor (ie, quantity of intimate peer relationship, the quantity of non-intimate peer relationship) model for PRS-Quantity and a 12-item three-factor (ie, cognitive process, affective process, behavioral process) model for PRS-Quality. The Cronbach's alpha was 0.870 for PRS-Quantity and 0.851 for PRS-Quality. Both scales showed good test-retest reliability (r = 0.890 for PRS-Quantity, r = 0.889 for PRS-Quality), concurrent validity (r = 0.832 for PRS-Quantity, -0.800 for PRS-Quality), and acceptable construct validity.

DISCUSSION

Overall, our findings suggested that the PRSs are reliable and valid measurements to evaluate the quantity and quality of peer relationships among Chinese community-dwelling elderly. The scales may serve as attempted tools for researchers and practitioners to access the social health of the elderly and evaluate the effectiveness of related services.

Psychometric assessment of the Bahasa Malaysia version of the Older Americans Resources and Services-Instrumental Activities of Daily Living

OBJECTIVE

This study aimed to determine the psychometric properties of the Bahasa Malaysia (BM) version of the Older Americans Resources and Services-Instrumental Activities of Daily Living (OARS-IADL) questionnaire among older persons in Malaysia.

METHODS

The English version of OARS-IADL was translated to BM. The psychometric properties of the BM version of OARS-IADL were tested among older persons attending a health-care facility.

RESULTS

Two hundred and seventy-one older persons participated in the study. The mean age of participants was 67.7 ± 6.1 years. Internal consistency of the items was good (Cronbach's alpha, >0.7). Exploratory factor analysis revealed a single dimension with item factor loadings of >0.5. Confirmatory factor analysis results confirmed a single-factor model (AVE > 50%, CR > 0.7 and CR > AVE).

CONCLUSION

The BM version of the OARS-IADL questionnaire is a valid and reliable instrument that can be used to assess the IADL among older persons in Malaysia.

Association between frailty and disability among rural community-dwelling older adults in Sri Lanka: a cross-sectional study

OBJECTIVE

We examined the association between frailty and disability in rural community-dwelling older adults in Kegalle district of Sri Lanka.

DESIGN

A population-based cross-sectional study.

PARTICIPANTS

A total of 746 community-dwelling adults aged ≥60 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Frailty was assessed using the Fried phenotype. Disability was operationalised in terms of having one or more activity limitation/s in instrumental activities of daily living (IADL) and basic activities of daily living (BADL).

RESULTS

The median age of the sample was (median 68; IQR 64-75) years and 56.7% were female. 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 IADL limitations was high, 84.4% among frail adults. 38.7% of frail adults reported ≥1 BADL limitations. Over half of frail older adults (58.3%) reported both ≥1 physical and cognitive IADL limitations. Being frail decreased the odds of having no IADL limitations, and was associated with a higher count of IADL limitations. No significant association was found between prefrailty and number of IADL limitations.

CONCLUSIONS

The prevalence of ≥1 IADL limitations was high among rural community-dwelling frail older adults. Findings imply the greater support and care required for rural Sri Lankan frail older adults to live independently in the community.

Role of physical performance measures for identifying functional disability among Chinese older adults: Data from the China Health and Retirement Longitudinal Study

Background

Functional disability is a common health burden in older adults and follows a hierarchical pattern. Physical performance measures are useful for the objective estimation of functional disability. This study primarily aimed to compare the validity of handgrip strength and gait speed, alone and in combination, for recognizing the functional disability among Chinese older adults. This study also aimed to stratify the functional disability according to the criterion-referenced values of handgrip strength and gait speed.

Methods

We selected 6127 respondents from the 2011 wave of the China Health and Retirement Longitudinal Study. Here, we defined functional disability as needing any help in any items of activities of daily living (ADL) and instrumental activities of daily living (IADL). To assess the validity of physical performance measures alone and in combination for the recognition of functional disability, we conducted the receiver operating characteristic analysis.

Results

Compared with handgrip strength, the gait speed could better discriminate ADL disability and showed a satisfactory discriminant validity (area under the curve ≥ 0.7) in men. However, this finding was not found in the recognition of IADL disability. When combining these two measures, the parallel test showed a high sensitivity with a poor specificity, whereas the serial test showed a perfect specificity with a poor sensitivity.

Conclusion

We developed the hierarchical cut-off values of handgrip strength and gait speed for identifying and stratifying the functional disability among Chinese adults over 60 years old. The speed test was superior to handgrip strength in identifying ADL disability. The parallel tests of those with high sensitivity perhaps could help identify the functional disability. Further work on cost-utility analysis is warranted.

Evaluation of Higher-Level Instrumental Activities of Daily Living via Micro-Doppler Radar Sensing of Sit-to-Stand-to-Sit Movement

This paper presents an evaluation technique for higher-level instrumental activities of daily living (HL-IADLs), which are defined as relatively complicated modern daily activities to perform independently, using micro-Doppler radar (MDR) signatures of sit-to-stand-to-sit (STSTS) movements. Because HL-IADLs are useful for evaluating the degree of disability and cognitive decline in daily life, this study aims to develop a system that enables the identification of individuals with HL-IADL impairments in an unconstrained manner. The study participants were elderly adults of age 65–74 years of rural communities in Japan, and their motion parameters in natural STSTS were extracted via a single 24-GHz MDR installed on the ceiling. Their HL-IADLs were evaluated using a questionnaire-based scale called the Japan Science and Technology Agency Index of Competence (JST-IC). The relationship between the HL-IADLs scaled with the JST-IC and the extracted STSTS parameters were statistically analyzed, and the results revealed that the extracted parameters were associated with the JST-IC score. Furthermore, an appropriately accurate screening method was verified for elderly adults with HL-IADL impairment using the extracted parameters.