Towards an ADL Taxonomy for Occupational Therapists

Reliability of interview-based ADL ability measures in older adults obtained by occupational therapists, physical therapists, and nursing staff

Purpose: To examine the reliability of ADL interview (ADL-I) ability measures when administered by different health professionals (HPs).Materials and methods:Older adults with stable ADL ability were invited to participate in three ADL-I interviews, administered by occupational therapists (OTs), physical therapists (PTs), and nursing staff (NS), respectively. Methods based on classic and modern test theory were applied.Results:Overall, n = 36 older adults and n = 11 HPs participated. Intraclass Correlation Coefficients were acceptable for research purposes (> 0.7), but not for clinical use. Mean differences in ADL ability measures were significant when comparing measures based on interviews by OTs to measures based on interviews by PTs and NS. Further, in 25 to 47% of the individuals, ADL-I ability measures differed significantly across HPs. Limits of Agreement revealed that measures based on interviews by OTs were systematically lower compared to measures based on interviews by PTs and NS. Four ADL-I items displayed Differential Item Functioning based on HP.Conclusion:When using the ADL-I, it is recommended to only involve one profession, to increase the reliability of measures. Results highlight the importance of evaluating reliability of measures based on instruments administered across HPs before implementation in rehabilitation practice and research.

Nutritional status in older people - An explorative analysis

BACKGROUND & AIMS

The nutritional status is seldom defined in general, but is considered to be important throughout life span, especially in times of diseases and disabilities. We previously proposed a theoretical model of the nutritional status from a functional perspective [1], however without proposing a definition of the nutritional status. The model comprises four domains that might affect the nutritional and functional status in a bidirectional way. These four domains are: Food and nutrition; Health and somatic disorders; Physical function and capacity; and Cognitive, affective, and sensory function. This study contributes to the existing literature and knowledge by empirically analysing patterns and relationships of possible nutritional status indicators within and between the four domains.

METHODS

This study is based on a sample of 69 men and women; older than 65 years, receiving home health care. They were followed up for three years. A broad set of nutritional status indicators in the participants were assessed in their home yearly. Given the small sample size and large number of variables, we used both correlation and factor analysis to explore patterns of nutritional status indicators within the four domains and relationships between the four domains suggested by the theoretical model of nutritional status which we proposed earlier.

RESULTS

At baseline, between 4 and 18 components were extracted from the four domains, separately, using factor analysis. The first three components of each domain (called main components) were correlated (p < 0.05) with at least one of the main components of each of the other three domains (r = -0.34-0.79 at baseline, 0.38-0.74 at year 1, 0.40-0.77 at year 2 and 0.47-0.71 at year 3). At baseline, these main components explained, respectively, 31%, 52%, 57% and 63% of the sample variation in the four domains. This remained stable throughout all three years of follow up. In all four domains, there were statistically significant differences in prevalence of malnutrition, frailty, sarcopenia, and dehydration (all different inadequate nutritional status) between individuals' individual component scores.

CONCLUSIONS

This study provides empirical evidence for the relationship between nutritional status indicators within and between the four domains suggested by our theoretical model of nutritional status. Components in all four domains were associated with inadequate nutritional status, highlighting that a wide perspective of the nutritional status assessment is necessary to be applied in clinical practice.

Measuring self-reported ability to perform activities of daily living: a Rasch analysis

Background

Since the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare ADL ability across diagnoses. Accordingly, the ADL-Interview (ADL-I) was developed to be used in rehabilitation research and clinical practice. The aim of this study was to investigate if the ADL-I can be used to provide valid and reliable ADL ability measures across gender and diagnostic groups.

Methods

ADL-I data were extracted from an existing research database on persons with chronic conditions including medical, rheumatological, oncological, neurological, geriatric and psychiatric diagnoses. Data were analysed based on Rasch Measurement methods to examine: the psychometric properties of the rating scale; ADL item and person fit to the Rasch model; if the difficulty of the ADL tasks differs across gender and diagnostic groups, and if the ADL-I provides precise and reliable measures of ADL ability.

Results

Data on n = 2098 persons were included in the final analysis. Initial evaluation of the 0–3 rating scale revealed threshold disordering between categories 1 and 2. After removal of 16 underfitting items, the variance explained by the Rasch dimension increased from 54.3 to 58.0%, thresholds were ordered, but the proportion of persons with misfitting ADL-I measures increased slightly from 8.7 to 9.1%. The person separation index improved slightly from 2.75 to 2.99 (reliability = 0.90). Differential test function analysis, however, supported that the 16 underfitting items did not represent a threat to the measurement system. Similarly, ADL items displaying differential item functioning across gender and diagnoses did not represent a threat to the measurement system. The ADL items and participants were well distributed along the scale, with item and person measures well targeted to each other, indicating a small ceiling effect and no floor effect.

Conclusions

The study results overall suggest that the ADL-I is producing valid and reliable measures across gender and diagnostic groups among persons within a broad range of ADL ability, providing evidence to support generic use of the ADL-I.

Trial registration

N/A.

Dehydration and loss of appetite: Key nutrition features in older people receiving home health care

OBJECTIVES

The aim was to describe a population of older people in home health care based on what is probably a novel theoretical model, previously published, and to analyze longitudinal changes in different dimensions of nutritional status.

METHODS

This explorative and longitudinal study examines nutritional status based on four domains in the novel theoretical model: health and somatic disorders; cognitive, affective, and sensory function; physical function and capacity; and food and nutrition. Inclusion criteria were age ≥65 y and need of home health care for more than three months. A total of 69 men and women were enrolled in the study. Participants' nutritional status was studied at baseline and regularly during the following three years.

RESULTS

At baseline, 44% (n = 27) reported one or more severe symptoms and 83% had polypharmacy (≥5 prescribed medications). The prevalence of malnutrition, sarcopenia, frailty, and dehydration at baseline were, respectively, 83% (n = 35), 44% (n = 24), 34% (n = 18), and 45% (n = 25). Participants that died during the 3-y follow-up (n = 14) differed from survivors in the following aspects: more reduced appetite, lower quality of life, worse cognitive function, lower physical activity, and less intake of dietary fiber and water. Dehydration at baseline was associated with lower function in several domains and with general decline over time.

CONCLUSIONS

Most participants had poor nutritional status. Dehydration and reduced appetite were important indicators of worsening nutritional and overall status and mortality.

The ADL taxonomy for persons with mental disorders - adaptation and evaluation

BACKGROUND

There is a lack of occupation-focused instruments to assess Activities of Daily Living (ADL) that are intended for persons with mental disorders. The ADL Taxonomy is an instrument that is widely-used within clinical practice for persons with physical impairment. The aim of this study was to adapt the ADL Taxonomy for persons with mental disorders and evaluate its validity.

METHODS

An expert group of Occupational Therapists (OTs) from psychiatric care adapted the ADL Taxonomy to fit the client group, including creating three new items. OTs in psychiatric care collected client data and evaluated the instrument for usability. Rasch analysis was used to evaluate the contruct validity of 16 activities separately.

RESULTS

The OTs collected 123 assessments from clients with various mental disorders. Ten activities had excellent, and four had acceptable, psychometric properties with regard to item and person fit and unidimensionality. The activity managing the day/time gave complex results and would benefit from further development. The OTs found the test version intelligible, relevant and easy to use.

CONCLUSIONS

The ADL Taxonomy for persons with mental disorders has 16 activities with three to six actions each, and is now ready for clinical use.

A client-centred programme focusing energy conservation for people with heart failure

AIM

The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF).

METHODS

The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed.

RESULTS

The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice.

CONCLUSIONS

This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.

A Comparison of Self-Report versus Observation of Performance Using the Assessment of Living Skills and Resources (ALSAR) with an Older Population

This study assessed the capacity of 15 older people to report their instrumental activities of daily living (IADL) function accurately. The Assessment of Living Skills and Resources (ALSAR) (Williams et al 1991) was used to measure IADL function in the clinical and home environments. The subject's self-reported function was also compared with performance-based measurement of three IADL tasks from the ALSAR (use of the telephone, meal preparation and medication management) in the subject's home environment. The sensitivity of the ALSAR 3-point scale was examined through comparison with the Medical Rehabilitation Follow Along scale (Granger et al 1995).

The findings highlighted problems associated with the use of self-reporting for the assessment of IADL in the older population. The ALSAR 3-point scale was shown to be sufficiently sensitive to detect IADL function when used with performance observation; however, further research is required to ascertain sensitivity when it is used as a self-report tool.

The findings suggest that occupational therapists attain more accurate results when carrying out IADL assessment procedures by using performance-based measures.

Thinking critically about client-centred practice and occupational possibilities across the life-span

BACKGROUND

Client-centred occupational therapy practice is tacitly guided by prevailing social values and beliefs about what are "normal" occupational possibilities. These values and beliefs privilege some occupations and negate others.

AIM

This study aims to identify and problematize assumptions regarding the value of approximating normal occupational possibilities, showing how these assumptions influence and may diminish client-centred practice.

METHODS

Using empirical research examples it demonstrates how occupational therapists and clients are immersed in contexts that shape values and beliefs about what are considered "normal" occupations and how these taken-for-granted values structure occupational therapy practice.

CONCLUSION

Critique of client-centred practice requires conscious reflexivity, interrogating our own and our clients' predispositions to value some occupations over others. Engaging in critical reflexivity can help therapists develop new perspectives of how client-centred practice can be applied that includes enabling possibilities for occupations that would be missed altogether in the pursuit of "normal'.

Performance of activities of daily living among hospitalized cancer patients

BACKGROUND

Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data.

METHODS

Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55).

RESULTS

All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments.

CONCLUSION

Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

Reablement in a community setting

PURPOSE

When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults.

METHODS

Ninety-one older adults (80 ± 9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310-592 d) using the ADL-Interview (ADL-I).

RESULTS

Overall, ADL ability improved significantly over time (p = 0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p = 0.042) and were maintained at follow-up 10 months after intervention (p = 0.674). There were no effects related to age (p = 0.787) or to whether the older adult had received help previously (p = 0.120).

CONCLUSION

A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program. [Box: see text].

Self-reported quality of ADL task performance among patients with COPD exacerbations

OBJECTIVE

Patients suffering from chronic obstructive pulmonary disease (COPD) experience problems in the performance of activities of daily living (ADL) tasks. The objective was to examine the self-reported quality of ADL task performance among COPD patients, and to investigate whether age, gender, and routine COPD characteristics correlate with the self-reported ADL ability.

METHODS

Eighty patients admitted to hospital with COPD exacerbations participated. In a cross-sectional study, the patients' self-reported ADL ability was assessed using the ADL-Interview (ADL-I) instrument. Data concerning age, gender, and routine COPD characteristics were drawn from the patients' medical records.

RESULTS

The patients reported being inefficient to markedly inefficient when performing ADL tasks within the personal hygiene, toileting, dressing, household, mobility, and transportation domains. While more than 90% of the participants reported increased effort and/or fatigue when performing the ADL tasks, up to 88% of the participants relied on help from others in the performance of general household chores like cooking and shopping. Self-reported ADL ability did not correlate with age, gender, or routine COPD characteristics.

CONCLUSIONS

Decreased quality of ADL task performance seemed to be extremely common among COPD patients. Therefore, addressing the problems in individually tailored pulmonary rehabilitation programmes may be advantageous.

Dealing with Real-Life Challenges: Outcome of a Home-Based Occupational Therapy Intervention for People with Severe Psychiatric Disability

The authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful daily occupations. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 and 66 years participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a 6-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made. These findings support the use of the ELR intervention and suggest that larger randomized clinical trials are needed.

Test-retest of computerized health status questionnaires frequently used in the monitoring of knee osteoarthritis: a randomized crossover trial

BACKGROUND

To compare data based on touch screen to data based on traditional paper versions of questionnaires frequently used to examine patient reported outcomes in knee osteoarthritis patients and to examine the impact of patient characteristics on this comparison

METHODS

Participants were recruited from an ongoing trial (http://ClinicalTrials.Gov Identifier: NCT00655941). 20 female participants, mean age 67 (SD 7), completed KOOS, VAS pain, function and patient global, SF-36, Physical Activity Scale, painDETECT, and the ADL Taxonomy. Patients were randomly assigned to one of two subgroups, completing either the paper or touch screen version first. Mean, mean differences (95% CI), median, median differences and Intraclass Correlation Coefficients (ICCs) were calculated for all questionnaires.

RESULTS

ICCs between data based on computerized and paper versions ranged from 0.86 to 0.99. Analysis revealed a statistically significant difference between versions of the ADL Taxonomy, but not for the remaining questionnaires. Age, computer experience or education-level had no significant impact on the results. The computerized questionnaires were reported to be easier to use.

CONCLUSION

The computerized questionnaires gave comparable results to answers given on paper. Patient characteristics did not influence results and implementation was feasible.

Meeting the needs of elderly with bathing disability

BACKGROUND/AIMS

Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients' abilities enabling them to bathe themselves, thus reducing the need for other, more long-term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy.

METHODS

A quasi-experimental non-equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home-help allocation were assessed at the baseline and after 15 weeks.

RESULTS

Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant.

CONCLUSION

Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.

Activities of daily living and quality of life in persons with newly diagnosed Parkinson's disease according to subtype of disease, and in comparison to healthy controls

OBJECTIVE

To describe activity of daily living (ADL) and quality of life (QoL) at first visit to a neurological centre, in patients subsequently diagnosed with Parkinson's disease (PD), according to subtype of disease and compared to healthy controls.

MATERIALS AND METHODS

99 patients and 31 controls were included. Patients were classified into three groups according to predominant symptoms: 50 Postural instability-gait difficulties (PIGD), 37 tremor dominant, 12 indeterminate. Evaluations included ADL-taxonomy, SF-36, and the Parkinson disease questionnaire (PDQ-39).

RESULTS

Patients experienced early on limitations in ADL and QoL compared to controls. Patients with PIGD subtype had already at first visit a worse status, clinically and in ADL and QoL, than patients with tremor dominant type.

CONCLUSIONS

Already at first visit to a neurological centre, patients who will eventually receive the diagnosis of PD exhibited restrictions in ADL and QoL. Patients with axial symptoms were affected most.

Couples’ happiness and its relationship to functioning in everyday life after brain injury

The objective of this survey was to identify couples' joint perception of their satisfaction with life as a whole when one of the persons in the couple had acquired brain injury between one and five years earlier. The focus was on the influence that functioning and disability in everyday life have on the couple's joint life satisfaction after brain injury. The sample consisted of 55 couples, and the mean age of the brain-injured persons was 51 years. Both persons in the couple answered a mailed questionnaire encompassing questions concerning perceived impairments, activity limitations, participation restrictions, and life satisfaction. The results showed that in 16 of the 55 couples both partners were satisfied with life as a whole. The joint experience of life satisfaction was significantly related to the couple's functioning in everyday life, and specifically to perceived participation in leisure time and in their social life, and in their ability to wash clothes. Important implications from this study, showing that only one-third of the couples were satisfied, are that the partners should be included to a greater extent in the rehabilitation process and the couple's perspective of what they find difficult to deal with should serve as a guide during rehabilitation.

Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living persons

OBJECTIVE

To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview.

DESIGN

Comparative study of a convenience sample.

SUBJECTS

Results in 36 persons with stroke >10 years previously.

METHODS

Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1-2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items).

RESULTS

There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons.

CONCLUSION

The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results.

Validation of the General Motor Function Assessment Scale - an instrument for the elderly

PURPOSE

The purpose of this study was to test the General Motor Function Assessment Scale (GMF) for content and criterion validity in geriatric home-rehabilitation. Furthermore, the GMF was analysed with respect to sensitivity, distribution, and for floor and ceiling effects.

METHOD

Content validity was explored by questionnaires circulated to ten experts in the field of geriatrics. Three assessment instruments were used to test 66 patients in home rehabilitation. In order to evaluate criterion validity GMF results were compared to results from the ADL-taxonomy test, and the Timed 'Up and Go' (TUG) test. GMF scores were analysed regarding, sensitivity, distribution and to check for floor or ceiling effects. Comparisons between pre-intervention assessments and post-intervention assessments were also made. Non-parametric statistics were used.

RESULTS

GMF covered and measured areas of relevance according to content validity. No floor effects in any of the subscales of GMF were seen. Comparison of pre-intervention and post-intervention assessments showed significant ceiling effects for all three subscales. As for criterion validity all subscales of GMF in terms of dependence, pain and insecurity correlated significantly with the activity parameter mobility of the ADL-taxonomy and TUG. GMF was sensitive enough to demonstrate changes between pre-intervention and post-intervention status.

CONCLUSIONS

GMF is a relevant instrument of assessment suitable for physiotherapists rehabilitating elderly in the home environment. For elderly with minor functional limitations the GMF shows ceiling effects.

Long-term effect of deep brain stimulation for essential tremor on activities of daily living and health-related quality of life

OBJECTIVES

To report long-term effects of thalamic deep brain stimulation (DBS) on activities of daily living (ADL) and health-related quality of life (HRQoL) in patients with essential tremor (ET).

MATERIALS AND METHODS

Nineteen consecutive patients were evaluated at baseline, at a mean of 1 year, then at a mean of 7 years after DBS using Tremor Rating Scale, Mini Mental Test, ADL Taxonomy, Nottingham Health Profile, Life Satisfaction Checklist, Visual Analogue Scale and interview.

RESULTS

There was a decrease of DBS efficacy on tremor between 1 and 7 years post-operatively. The marked improvement in ADL at 1 year was no longer sustained at long-term, except for the ability to eat. Social life remained improved.

CONCLUSION

Although there is a decrease of DBS effect on tremor at 7 years, and even though further ageing and co-morbidities may impact on the well-being of patients, there is still relevant benefit of DBS on few aspects of ADL and HRQoL in patients with ET.

Validity and reliability of the instrument Performance and Satisfaction in Activities of Daily Living (PS-ADL) and its clinical applicability to adults with rheumatoid arthritis

AIM

This study set out to evaluate the validity and reliability of the instrument Performance and Satisfaction of Activities of Daily Living (PS-ADL) in patients with rheumatoid arthritis (RA). The PS-ADL is a questionnaire including 39 actions divided into 12 activities measuring the degree of difficulty and satisfaction with activity performance.

METHOD

Construct validity was examined by factor analysis. For convergent and discriminant validity evaluation, the Performance and the Satisfaction scales were correlated to the Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Self-Conception (RASC), pain, fatigue, and mobility. Internal consistency was tested and repeated measurements were taken to establish the Percentage Agreement (PA) and correlation coefficients for test-retest reliability.

RESULTS

The factor analysis revealed the PS-ADL scale to be unidimensional. Significant correlations were seen between the Performance and Satisfaction scales and the HAQ (r(s) 0.78, 0.67), and between the RASC and Satisfaction scale (r(s) 0.45). Cronbach's alpha level ranged from 0.41 to 0.92 for the Performance scale and 0.66 to 0.94 for the Satisfaction scale. The percentage agreement (PA) at action level ranged from 68% to 91% for the Performance scale and from 59% to 91% for the Satisfaction scale.

CONCLUSION

The PS-ADL is a valid instrument with satisfactory reliability. It is easy to handle and can be recommended for use in RA patients.

Changes in the use of assistive devices among 90-year-old persons

BACKGROUND AND AIMS

The growing numbers of elderly people are expected to lead to an increasing demand for assistive devices. The purpose of this study was to examine changes in the use of assistive devices over time and their relation to dependence in daily activities among 90-year-old persons living at home.

METHODS

This retrospective longitudinal study examined the 90-year-old population at the ages of 85 and 90, and 195 persons participated.

RESULTS

92% of the 90-year-old population used assistive devices at the age of 90, compared with 74% at the age of 85. Between this interval, 19% became new users, 73% were permanent users, and 7% did not make any use of assistive devices. There was a significantly higher proportion of device-users among those who were dependent in both personal daily activities (PADL) and instrumental activities of daily living (IADL) (98.5%, p < 0.001) and among those who were dependent in IADL (94%, p < 0.001) compared with those who were independent in ADL (72%). At the age of 90, bathing and mobility devices were the most frequently used. Mobility devices such as walking-frames and wheel-chairs were the most widely distributed devices in this group.

CONCLUSIONS

The use of assistive devices increases with age, very few 90-year-olds remain nonusers at age 90, and the multiple use of assistive devices at 90 years of age is very common. This complexity put great demands on health care services, and highly skilled professionals are needed to meet these demands.

Attitudes towards rehabilitation needs and support from assistive technology and the social environment among elderly people with disability

This study aimed to survey the attitudes of elderly people with disabilities who were living at home regarding their support from assistive technology and the social environment. These attitudes were compared with their identified needs by an occupational therapist and in relation to perception of social engagement, loneliness and overall contentment with life. From a sample of 102 participants who were interviewed using a standardized procedure, 53 persons were included in the study. The results indicated that attitudes among elderly people towards social and occupational engagement and change have a greater influence on their rehabilitation status than their disability as indicated by their health condition and limitations in activities of daily living and instrumental activities of daily living. The elderly people who accepted rehabilitation were more able, and were better equipped and better supported with assistive technology, than those who declined rehabilitation. Rehabilitation needs that the occupational therapists recognized were not always shared by the disabled elderly people, for several reasons; one reason of particular importance was the elderly person's attitude towards change and social engagement. However, the small sample size limits the generalization of the findings to the population of elderly people with disabilities. An ethnographic research design that allows for repeated interviews and observations of elderly people with disabilities for a prolonged period of time in their ordinary everyday lives may present an avenue for future research and lead to a deeper understanding of the issues.

Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery

OBJECTIVES

To investigate eventual differences between women and men with Parkinson's disease (PD) before and after surgery, with respect to clinical status, disability and health-related quality of life (HRQoL).

MATERIAL AND METHODS

Twenty-four men and 14 women with PD received a total of 46 surgical procedures (pallidotomy, thalamotomy and deep brain stimulation of the thalamus, pallidum or subthalamic nucleus). The impact of PD on disability and other aspects of HRQoL was analysed separately in men and women before and at a mean of 11 months after surgery, using the following assessment tools: The Unified Parkinson's Disease Rating Scale (UPDRS), the ADL Taxonomy, the Nottingham Health Profile, the Life Satisfaction Questionnaire and a Visual Analogue Scale.

RESULTS

At surgery, women had a significantly longer duration of disease than men (mean: 15 vs. 10 years, P < 0.01). They had a higher stage on the Hoehn and Yahr scale and worse scores on UPDRS parts II (ADL) and IV (complications), as well as on the Schwab and England scale and on the ADL Taxonomy. Following surgery, both men and women showed improvement, but women experienced greater benefit than men in ADL, in emotions, and in social life.

CONCLUSIONS

Perhaps women with PD should be offered surgery more often and earlier in the course of their disease.

Development of multi-disciplinary team I-ADL assessment in community health care: an interrater reliability study of the measure of instrumental daily activity

This paper describes a development process concerning the active involvement of staff of different professions in developing and implementing methods for assessment of activities of daily living (ADL) in home-based geriatric rehabilitation. Although a variety of established ADL instruments exist, at the time for this study no I-ADL (Instrumental Activities of Daily Living) instrument suitable for communication among staff members of different professions was available. The specific aim was to test a new I-ADL instrument for interrater reliability. The developmental process resulting in the Measure of Instrumental Daily Activity (MIDA) is described. The instrument comprises 12 I-ADL items, defined on the basis of practical home rehabilitation experience. The study involved 36 clients with impairments, aged 65+ years. Multi-disciplinary interrater reliability was tested by 67 parallel independent assessments during a 3-month period, performed by pairs of raters of different professions. Overall agreement was very good (mean weighted kappa=0.89). The MIDA fulfils the basic requirements necessary for valid I-ADL assessment of elderly clients in community health care. An important quality is the active involvement of all staff in the assessment procedure, facilitating and stimulating the implementation of a general rehabilitative attitude in everyday practice.

Dietary intake and functional ability between 70 and 76 years of age

Functional ability as well as the sociological, psychological, physiological, and nutritional status are important parts of the multi-dimensional problems of older persons. The aim was to study the relationships between ability/disability in daily life activities (ADL) and dietary intake in elderly persons studied longitudinally between 70 and 76 years of age (N = 97) in Göteborg, Sweden. People living in sheltered accommodations were excluded. Dependence in ADL was measured by "The Staircase of ADL"; dietary intake was measured by a Diet History (DH) questionnaire. Most persons had no difficulties, or were dependent on personal help in ADL at age 70 (females 70%, males 80%), but the proportion decreased at the age of 76 (females 43%, males 54%). The sample was divided into subjects without disability both at 70 and 76 years of age (N = 41), subjects disabled only at 76 (N = 31), and subjects disabled both at 70 and 76 years of age (N = 20). Food choice was not affected by disability neither at age 70, nor at age 76. Dietary intake decreased between 70 and 76 years in all three groups. However, despite the fact that one could have expected a relationship between food and nutrient intake, and ADL, we did not find significant relationships. The main reason might be that the group is relatively young, and with ADL problems mainly in instrumental ADLs. It might, therefore, be anticipated that such trends could be more marked in higher age groups.

Elderly people's daily activities and need for mobility support

The aim of the present study is to describe elderly people's performance of some daily activities in relation to their need for mobility support in their living environment. Two groups of individuals, over the age of 65 and living in an old urban area with access to elevators in their housing, were compared, as regards mobility, shopping, hobbies and social contacts. The first group (n = 284) comprised persons who needed assistance from another person in using the elevator. The subjects in the second group (n = 325) were able to manage the elevator independently. The subjects in the first group experienced more problems in carrying out the activities than those in the second group. Weekly shopping was the only action in which the findings demonstrated no main differences between the groups. Throughout all the activities of daily living (ADL), and in both groups, there were persons who were rated as having the capacity to perform the activities, but did not do so and did not want to do so. The elderly, especially in the first group, wanted to engage in more activities than they were judged to have the capacity for and/or the environmental support to do. The implications of the result for the assessment of the homes of the elderly in relation to their environment are discussed.

Relationship between occupation and life satisfaction in people with multiple sclerosis

Activity is essential for all human beings, and provides a means through which human beings develop, gain recognition, and fulfil life's goals. The focus for this study was on activities performed by people with a chronic disease and their effects on experienced life satisfaction. Thirty subjects with multiple sclerosis (MS) were interviewed with regard to activities of daily living (ADL), and checklists were used for activity preferences and levels of satisfaction with life as a whole and with nine domain-specific forms of life satisfaction. The results of the study reveal 14 of the subjects to be satisfied and 16 to be dissatisfied. The main differences between the two groups were that the satisfied were less tired, and that they were more independent in self-care. Those in the satisfied group reported being more satisfied with leisure situation (57%, cf. 25% in the dissatisfied group) and housekeeping ability (36%, cf. 6% in the dissatisfied group). Leisure and housekeeping appear to have an impact on subjects' experienced satisfaction, and are factors to be taken into consideration by occupational therapists when treating MS patients.