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

[Need for Care in Old Age: Characterization of Informal Caregivers and the Care Situation with Regard to Care Levels in Home Care]

OBJECTIVE

In Germany, people in need of care can be supported by benefits from care insurance. Prerequisite is an official assessment of the need for care, which is carried out by assigning care levels (1 to 5) according to the Second Care Strengthening Act. One of the reasons for introducing care levels was to pay more attention to the needs of people with dementia. In this article, characterization of care levels were based on characteristics of care recipients, their relatives, and the care situation. The aim was to map the current state of health care and providing practical suggestions to improve health care.

METHODS

Data was collected as part of the cross-sectional study "Benefits of being a caregiver" by a written survey of informal caregivers throughout Bavaria on aspects of the caregiving situation as well as on current and desired future use of 15 care services. To compare care levels, group differences were analyzed using χ2-tests and one-factor analysis of variance. The effect size measures odds ratio and Cohen's d were reported for significant group differences comparing care levels 1 and 4. The sample consisted of 958 cases of people in need of care aged 65 and above.

RESULTS

The proportion of people with dementia increased significantly with care level. For informal caregivers, subjective burden, functional coping strategies, and the caregiving motive of not wanting to place the care recipient in a nursing home increased with care level. Informal caregivers of those with higher care levels spent significantly more time on supporting activities of daily living and supervision; they received more informal help, and more often lived together with the care recipient in a household. For 9 of the 15 care services surveyed (e. g. 24-h care), current use increased significantly with increasing care level. However, we recorded a low overall utilization rate of care services across all care levels (M=2.20; SD=1.90).

CONCLUSIONS

As a result of the Second Care Strengthening Act, people with dementia get good access to care insurance benefits. The increasing amount of time required for assisting in activities of daily living and supervision is reflected by care levels. Despite the increasing caregiving burden, care services are rarely used. Therefore, we recommend that measures to increase the use of support and counselling services be expanded.

Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study

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.

Disparities in First Instrumental Activity of Daily Living Difficulty between Black and White Older Adults: Findings from the Advanced Cognitive Training in Independent and Vital Elderly Study

Objectives: Few studies have examined differences in age of onset of first self-reported instrumental activities of daily living difficulty, much less differences by race. Our objective was to determine whether there are differences in the first reported difficulty with IADLs between Black and white older adults. Methods: We analyzed data from N = 1168 participants in the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study. A multiple group discrete-time multiple-event process survival mixture (MEPSUM) model was used to estimate the hazard of incident IADL difficulty in seven IADL task groups. Results: No statistically significant differences were identified in the first reported IADL task group difficulty between Black and white older adults. Discussion: Our findings indicate similar patterns of early IADL difficulty in Black and white older adults, suggesting that previously reported racial disparities in ability to perform IADLs may be attributable to differences in absolute risk, not timing.

The longitudinal associations of sarcopenia definitions with functional deterioration: a comparative study

OBJECTIVE

Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center.

METHODS

In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27 kg/16 kg, and 35 kg/20 kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1.

RESULTS

Among a total of 1970 patients, 195 had follow-up of median 560 days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan-Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07-3.30), and 1.9 (1.04-3.6); for Model 1 and Model 2, respectively)].

CONCLUSION

Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis.

Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease

Background

Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline.

Objective

The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD.

Methods

Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed.

Results

Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8).

Conclusion

The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018

Background and Objectives

Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.

Research Design and Methods

We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.

Results

A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents.

Discussion and Implications

Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

Prediction tool for disability progression and mortality in older adults eligible for Japanese long-term care insurance: Koriyama study

This study aims to create a simple model for predicting disability progression and death among older adults with Japanese long-term care insurance certification. This retrospective study analyzed the anonymized data provided by Koriyama City. The participants were 7706 older adults who were initially certified to be support levels 1 and 2 or care levels 1 and 2 for the purpose of obtaining Japanese long-term care insurance. The results of the certification questionnaire at the initial survey stage were used to create decision tree models intended to predict whether disability progression and death would occur within 1 year. In support levels 1 and 2, among those who scored both "daily decision making" item as other than "possible" and the "taking drugs" item as other than "independent," 64.7% had an adverse outcome. In care levels 1 and 2, among those who scored both the "shopping" item as "totally dependent" and the "defecation" item as other than "independent," 58.6% had an adverse outcome. The accuracy of classification of the decision trees were 61.1% in support levels 1and 2, and 61.7% in care levels 1 and 2. The overall accuracy of the decision tree is low, making it impractical to use it for all subjects. Nevertheless, based on the results of the 2 assessments in this study, the process of identifying a particular group of older adults at a high risk of an increased need for long-term care or possible death within a year is very simple and useful.

Longitudinal Changes in Dual Decline in Memory and Gait Speed Association with Instrumental Activities of Daily Living: Findings from the National Social Life, Health, and Aging Project

Objective: We investigated the association between dual decline (DD) (loss of memory and gait speed) and the instrumental activities of daily living (IADL) degeneration in older adults. Methods: Data were drawn from the National Social Life, Health, and Aging Project (NSHAP) reflecting changes over 5 years. This study used the NSHAP data set wave 2 (2010-2011, N = 3196) and wave 3 (2015-2016, N = 4377). Results: Data from 1640 participants were retrieved. There were 601 people with DD and 1039 people without-DD. The DD group had a 28.4% (95% CI = 1.013-1.626) greater risk of degrading in IADL than the without-DD group (odds ratio = 1.284, p < .05). Conclusion: Current research can be used when establishing intervention programs or policies that can prevent IADL degradation through simple memory training and walking activities for older adults living in the community.

Study on Two Typical Progressive Motions in Tai Chi (Bafa Wubu) Promoting Lower Extremity Exercise

BACKGROUND

By comparatively investigating the joints, muscles and bones of the lower extremity during two progressive motions in Bafa Wubu and normal walking, this paper aims to enrich the diversity of walking exercise and scientifically provide theoretical guidance for primary practitioners. The scientific training methods and technical characteristics of Bafa Wubu, as well as its contribution to comprehensive exercise of the lower extremities, are further explored.

METHODS

A total of eight professional athletes of Tai Chi at the national level were recruited. The kinetic parameters of the lower extremity were calculated using AnyBody 7.2 musculoskeletal modeling. Stress analysis of the iliac bone was performed using an ANSYS 19.2 workbench.

RESULTS

In Bafa Wubu, the ground reaction force during two progressive motions was significantly smaller than that noted during normal walking. During warding off with steps forward and laying with steps forward, the load at the three joints of the lower extremity was significantly smaller than that during normal walking in the frontal plane, but significantly greater than that noted during normal walking in the vertical axis. In addition, the lower limb joint torque was higher than that of normal walking in both progressive movements, and lower limb muscle activation was higher. The iliac bone loads during the two progressive motions were larger than those during normal walking, and the maximum loading point differed.

CONCLUSIONS

This is the first study to demonstrate the biomechanical performance of Bafa Wubu in professional athletes of Tai Chi. Two progressive motions of Bafa Wubu require the lower extremity to be slowly controlled, thereby resulting in a smaller ground reaction force. In addition, the loads of the three joints at the lower extremity all increase in the vertical direction and decrease in the lateral direction, reducing the possibility of lateral injury to the joints. In addition, the two progressive motions significantly enhance the muscle strength of the plantar flexion muscles, dorsiflexor, and muscles around the thigh, and effectively stimulate the bones of the lower extremity. Therefore, progressive motion training contributes to improving the controlling and supporting capabilities of the lower extremities during normal walking.

Effects of functional limitations and activities of daily living on the mortality of the older people: A cohort study in China

Introduction

Prevalence of functional limitations (FLs) and disabled activities of daily living (ADL) cause heavy burdens to the health of the older people. Stratified by gender, this study aimed to explore the effects of FL and ADL on the mortality of the older people in China, and the mechanism was then discussed.

Methods

We used survey data of a prospective 10-year cohort (2008-2018), from the China Longitudinal Healthy Longevity Survey (CLHLS). The primary outcome was all-cause mortality, and Independent variables included FL, basic ADL (BADL), and instrumental ADL (IADL). Covariates involved socio-demographic characteristics, health-related behaviors, and health status of the participants in the CLHLS project.

Results

There were 967 (19.20%) male and 2,235 (32.36%) female older people performed functional limitations, and their survival time was 60.98 (SE = 0.66) and 55.19 (SE = 0.55) months, respectively. Old adults with FL had significantly poorer survival than the ones without (Log-rank test, P < 0.001). Weibull regression suggested that FL (P < 0.001), abnormal BADL (P < 0.001) and IADL (P < 0.001) were negatively associated with the survival of the older people. Further analysis showed that BADL and IADL performed significantly mediating roles in the relation of FL and survival time in old adults; additionally, for female older people, BADL also exhibited a significant moderating role in the effect of FL on survival.

Conclusions

Prevalence of FL was serious among the older people in China, especially for the women. Disabilities of BADL and IADL and FL were negatively associated with the survival time of the older people in China. Regarding the effect of FL on survival, BADL and IADL performed significantly mediating roles, and the moderating role of BADL existed only for the female. These suggested evidence to implement strategies to maintain health in the older people.

Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment

OBJECTIVE

To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia.

METHODS

Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3 years and participant predictors of change were examined using multilevel modeling (MLM).

RESULTS

The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia.

CONCLUSIONS

Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Efficacy of cognitive remediation on activities of daily living in individuals with mild cognitive impairment or early-stage dementia: a systematic review and meta-analysis

INTRODUCTION

Instrumental activities of daily living are essential for ageing well and independent living. Little is known about the effectiveness of cognitive remediation on instrumental activities of daily living performance for individuals with mild cognitive impairment or early-stage dementia. The objective of this study was to evaluate the immediate and long-term carryover effects of cognitive remediation on improving or maintaining instrumental activities of daily living performance in older adults with mild cognitive impairment and early-stage dementia.

METHODS

Randomized controlled trials published from 2009 to 2022 were identified in OvidSP versions of MEDLINE and Embase, EBSCO versions of CINAHL and PsycINFO, and the Cochrane Central Register of Controlled Trials. A narrative synthesis of the findings was reported on the outcomes of the included studies. Relevant data was extracted and analysed using R software's 'metafor' package with a random effect model with 95% CI.

RESULTS

Thirteen studies, totalling 1414 participants, were identified in the narrative analysis. The results of meta-analysis, inclusive of 11 studies, showed that cognitive remediation elicited a significant improvement in the instrumental activities of daily living performance (SMD: 0.17, 95% CI 0.03-0.31). There was insufficient evidence of any lasting effect.

DISCUSSION

Cognitive remediation is effective in improving instrumental activities of daily living performance immediately post-intervention in older adults with mild cognitive impairment and early-stage dementia. It appears that individualized interventions with a short duration, such as 10 hours, might be beneficial.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016042364.

The Effectiveness of Multicomponent Intervention on Daily Functioning among the Community-Dwelling Elderly: A Systematic Review

The deterioration of physical and cognitive functioning in the elderly is an impairment to their independent self-management and to improving their ability to perform daily functions. Nurses should support the elderly to experience a healthy and a successful aging process by preventing dependence on daily functioning and understanding the care assistance that such persons need. This study aimed to gain insight into the evidence on the effectiveness of multicomponent intervention on the activities of daily living (ADL) and instrumental activities of daily living (IADL) among the community-dwelling elderly without cognitive impairment. The design is a systematic review of a randomized controlled trial. The language of the published literature was English, and the search period was from January 2000 to December 2020. Articles were included under the PICO (population, intervention, comparison, and outcome) framework for: (a) community-dwelling elderly without cognitive impairment; (b) multicomponent intervention; (c) comparison group who did not receive the intervention; and (d) measurement of the effect of ADL and IADL. A total of 4413 references were found, 6 studies were included. Most studies (n = 5) reported that the multicomponent intervention exerted a beneficial effect on ADL and IADL. Only one study showed the highest methodology and reporting quality in the Cochrane review. Common components of the programs included: occupational therapy, physical therapy, exercise, memory training, cognitive–behavioral therapy, interdisciplinary intervention, and cognitive training. Multicomponent intervention may be a beneficial way to improve dependence on ADL and IADL as an important area of functional evaluation in the elderly. Considering the physical condition of the elderly, multicomponent interventions, including physical activity, exercise, occupational therapy, and especially individually customized coaching related to ADL and IADL training, may be useful.

Predictors of activities of daily living in heathy older adults: Who benefits most from online cognitive training?

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.

Functional Differences Found in the Elderly Living in the Community

Introduction: Successful aging lies in cognitive and functional maintenance, and in the optimal performance of daily tasks that keep the elderly free of disability and dependence. However, there is little evidence for functional differences for gender and age, and how cognitive and physical demands in past working lives can affect them, to design more personalized occupational therapy interventions to prevent functional and cognitive impairment. Method: This observational descriptive study evaluated 367 older adults living in a community with subjective memory complaints and scored between 24 and 35 with the Spanish version of the “Mini-Mental State Examination (MEC-35)”. Basic activities of daily living (BADL) were studied with the Barthel Index, while instrumental ADL (IADL) were examined with the Lawton–Brody scale. Functional differences for gender, age, and physico-mental occupation were examined. Results: The significant differences found for gender indicated that men did better in BADL (p = 0.026) and women better performed IADL (p < 0.001). Differences between age groups suggest that the younger group (aged 64–75) obtained better results for BADL (p = 0.001) and IADL (p < 0.001). For physico-mental occupation, statistically significant differences were found only in IADL for mental (p = 0.034) and physical occupation (p = 0.005). Conclusions: Gender, age, and the cognitive and physical demands of occupational stages, can be important predictors of cognitive and functional impairment. These results can be generalized to other health centers in the province and to other Spanish Autonomous Communities because their socio-demographic variables are similar. It would be interesting to carry out multimodal personalized interventions that consider the factors that might affect functional impairment to preserve personal autonomy.

Activities of Daily Living and Categorization Skills of Elderly with Cognitive Deficit: A Preliminary Study

Cognitive dysfunction affects the performance of Activities of Daily Living (ADL) and the quality of life of people with these deficits and their caregivers. To the knowledge of the authors, to date, there are few studies that focus on knowing the relationship between personal autonomy and deductive reasoning and/or categorization skills, which are necessary for the performance of the ADL. The aim of this study was to explore the relationships between ADL and categorization skills in older people. The study included 51 participants: 31 patients with cognitive impairment and 20 without cognitive impairment. Two tests were administered to assess cognitive functions: (1) the Montreal Cognitive Assessment (MoCA); and (2) the digital version of Riska Object Classification test (ROC-d). In addition, the Routine Tasks Inventory-2 (RTI-2) was applied to determine the level of independence in activities of daily living. People with cognitive impairment performed poorly in categorization tasks with unstructured information (p = 0.006). Also, the results found a high correlation between cognitive functioning and the performance of ADLs (Physical ADL: r = 0.798; p < 0.001; Instrumental ADL: r = 0.740; p < 0.001), a moderate correlation between Physical ADLs and categorization skills (unstructured ROC-d: r = 0.547; p < 0.001; structured ROC-d: r = 0.586; p < 0.001) and Instrumental ADLs and categorization skills in older people (unstructured ROC-d: r = 0.510; p < 0.001; structured ROC-d: r = 0.463; p < 0.001). The ROC-d allows the assessment of categorization skills to be quick and easy, facilitating the assessment process by OT, as well as the accuracy of the data obtained.