社区老年人日常生活功能异常对其认知功能的影响

目的探讨社区老年人日常生活功能(ADL)下降对其认知功能损害(MCI)的影响。方法采用巢式病例对照研究方法,病例为随访期间新发生的MCI患者105例,对照为随访队列中未发生MCI人群按年龄、性别、受教育程度进行1:4比例选择的420例对象。采用单因素和多因素分析方法,分析ADL,躯体生活自理能力(BADL)、工具性日常生活能力(IADL)受损对MCI发生的影响。结果 ADL和IADL受损者认知功能得分下降值均高于未受损老人(P<0.05),且发生MCI的危险性较高,其OR(95%CI)分别为2.75(1.208～6.236)和2.86(1.216～6.702),而BADL受损则未发现其影响。结论 ADL受损是MCI发生的重要高危因素,其中IADL受损可能是重要主因。     

农村老年人日常生活活动能力现状

目的以湖南省郴州市下洞村老年人为例,阐明农村老年人的日常生活活动能力(ADL)现状并探索可改进的危险因素,从而延缓失能。方法采用按户籍册随机抽样、入户调查的方法,使用一般人口学资料调查表、ADL量表对下洞村194名60岁及以上常住老年人进行问卷调查。结果 ADL总受损率为28.4%,躯体性ADL(PADL)中以行走受损较为明显,达6.7%;工具性ADL(IADL)中以使用公共车辆、打电话比较明显,达18%;IADL的受损率显著高于PADL(P<0.05);Logistic回归分析显示,高龄是PADL的危险因素,而高龄、女性、低文化程度、家庭经济差、患多种慢性疾病是IADL的危险因素。结论中国农村老年人ADL受损率不容忽视,加强对女性、高龄、贫困老年人的关注并减少老年人患慢性病数对提高农村老年人ADL具有至关重要的作用,最终将提高老年人生命质量,延缓失能。     

巴马地区267例长寿老人认知功能与日常生活功能的相关分析

目的 了解广西巴马地区长寿老人认知功能与日常生活功能的相互关系.方法 截断面调查,整群抽取巴马县甲篆乡80岁以上老人.应用"巴马地区长寿老人心理健康调查表",包括人口学资料、简易智力状态检查(MMSE)、日常生活能力量表(ADL).结果 MMSE得分与ADL、躯体生活自理量表(PSMS)、工具性日常生活活动量表(IADL)得分,MMSE各因子均分与ADL得分均呈极显著负相关.按不同年龄、性别、文化程度因素分层后,绝大部分因素的MMSE得分与ADL得分均呈显著负相关.MMSE得分影响因素依次为ADL、文化程度、年龄、性别.结论 广西巴马地区长寿老人的认知功能与日常生活功能存在着密切的相关关系,提高日常生活功能有助于保持认知功能,反之亦然.     

空巢老人生活自理能力及其心理、社会相关因素

目的 了解空巢老人生活自理能力的心理、社会影响因素.方法 调查城乡空巢老人日常生活能力(ADL)和功能性日常生活能力(IADL),应用单因素和多因素Logistic回归模型分析其心理、社会影响因素.结果 空巢老人ADL、IADL丧失率分别为36.9%、74.3%.单因素分析显示,年龄、性别、丧偶、居住状况、日常开支、健康自评、抑郁及家庭功能状况影响空巢老人的ADL,经济来源、日常开支、单人月收入、健康自评及家庭功能状况影响IADL.多因素分析显示,居住状况、健康自评、抑郁、家庭功能状况影响ADL,健康自评、抑郁和家庭功能状况影响IADL.结论 健康自评、抑郁等心理因素,年龄、性别、丧偶、居住状况、日常开支及家庭功能状况等社会因素与空巢老人的生活自理能力有关.     

安徽省两城市老年人生活自理能力及其相关因素的研究

目的：了解老年人生自理能力状况及其影响因素,方法：应用整群随机抽样方法,调查安徽省合肥,铜陵两城市老年日常生活活动能力,应用单因素和多因素logistic回归模型分析老年人生活自理能力受损的主要影响因素,结果：老年人日常生活动动（PADL）和日常家务活动功能（IADL）丧失率分别为7．2％和20．9％,女性功能丧失率高于男性,且随年龄的增长,功能丧失率逐渐升高,经多因素分析,活活自理能力功能丧失率与年龄,性别,教育程度,患病,经济和有无工作有关,结论：老年人生活自理能力随年龄增长而下降,女性知活自理能力低于男性,IADL功能丧失率高于PADL,老年人健康状况应引起重视。     

北京老年人日常活动上的依赖及有关因素分析

根据北京老龄化多维纵向研究课题，1992年基线调查资料，利用ADL和IADL量表，评价老年人日常活动上的依赖程度，并分析其有关影响因素．根据对2783例60以上老人的材料，76.1％老人生活中不依赖，IADL有困难看占18.4％，ADL有困难占5．5％，其中严重困难不足1％．洗澡．做饭分别为ADL和IADL请项活动中最容易出现困难的项目，高龄女性．受教育程度低，无偶、经济情况较差．自评健康较差，依赖的发生率较高。疾病史中仅有卒中史一项与依赖发生有关，挺示日常生活上的依赖是多种因素的综合作用结果．     

高龄老人慢性病和日常生活能力调查及影响因素

目的 研究高龄老人慢性病的患病状况以及日常生活功能的受损情况,为高龄老年人群的健康管理和医疗保健提供科学依据.方法 采用整群抽样方法,对上海市杨浦区的1027名80岁及以上老年人进行慢性病和日常生活能力(ADL)的问卷调查.结果 高龄老人慢性病患病率为97.66％,ADL受损率高达65.63％,年龄、脑梗死、慢性支气管炎、哮喘、前列腺增生是导致高龄老人ADL损害的主要危险因素.结论 各种慢性疾病可不同程度地引起ADL损害,但与其患病率的高低无直接关系,高龄老人ADL损害受年龄、疾病性质的影响更为明显.应建立高龄老人的网络化管理系统,采取针对性的综合干预措施.     

青海老年住院患者认知功能状况及影响因素分析

目的:评估青海地区老年住院患者认知功能情况,并分析其影响因素。方法:入选老年住院患者1 077例,进行一般资料、微型营养评估简表(MNA-SF)、简版老年抑郁量表(GDS-15)、FRAIL量表、日常生活能力(ADL)、工具性日常生活活动能力(IADL)和简易精神状态量表(MMSE)调查。结果:本研究共纳入1 077例...     

锦州市老年人日常生活能力及居家护理需求分析

目的调查锦州市老年人日常生活能力及居家护理需求,为提高居家护理质量提供依据。方法采用日常生活能力量表(ADL)和自行设计的居家护理需求调查问卷对锦州市769名老年人的日常生活能力和居家护理需求进行调查,并使用多因素logistic回归对居家护理需求进行分析。结果锦州市老年人慢性病的发病率为85.5%,14.2%的老年人日常生活能力有不同程度的功能障碍,在IADL、PADL及ADL总分中男性得分均高于女性,差异有统计学意义。在居家护理需求所有条目中,老年人对上门救护、营养饮食、合理运动等方面需求较高,ADL有障碍的老年人需求得分高于ADL正常者。居家护理需求影响因素logistic回归模型共筛选出四个影响因素,依次是:体检情况(X1)、子女情况(X2)、患病种数(X3)、年龄(X4),方程模型:Y=7.115+1.875X1-4.030X2+1.383X3+0.301X4。结论加强老人慢性病防治工作,关注高龄老人、老年男性及空巢老人,提倡老年人健康检查,做到定期体检,提倡新居家护理理念,推广对老年人进行全面居家护理,为提高居家老人的生活质量提供保障。     

农村老年人认知功能障碍及其影响因素

目的：了解农村老年人的认知功能障碍现状及其影响因素。方法采用分层整群抽样的方法,对山东省郓城县年龄≥60岁的农村老年人488名进行面对面的问卷调查。结果郓城县农村老年人的简易精神状态量表（MMSE）得分为（21．02±6．48）;195名（40．0％）存在认知障碍;日常生活自理能力（ADL）得分与MMSE得分负相关（r＝－0．730,P＜0．05）;ADL得分与 MMSE 各因子得分的轮廓分析,三组间轮廓不平行（F＝30．780,P＜0．05）,正常组的轮廓得分高于下降组,高于明显障碍组。女性、体力劳动、离婚或丧偶、收入低、患有慢性病、ADL差是老年人认知障碍的危险因素,受教育水平高是保护因素。结论农村老年人的认知功能较低、影响因素较多,可从病有所医、老有所养、老有所学等方面进行早期干预。     

Dementia as a predictor of functional disability: a four-year follow-up study

BACKGROUND: Prospective studies have shown that cognitive impairment is a strong and consistent risk factor of physical disability. However, cognitive impairment has been based on the result of a single screening tool. OBJECTIVE: To investigate the role of cognition in the subsequent incidence and decline of functional disability in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) after a full assessment of dementia. METHODS: A group of 1,358 Japanese atomic bomb survivors aged 61 years or older who lived in the community or in institutions in Hiroshima City were followed for 4 years. During the baseline survey (1993-1995), subjects were administered a screening test for cognitive impairment. Those suspected of dementia underwent a series of cognitive tests (Hasegawa's dementia scale, Clinical Dementia Rating) and a neurological examination. The diagnosis of dementia was made according to DSM-III-R criteria. Study subjects were questioned about their reported ADL and their IADL. During the follow-up period, deaths were recorded and a follow-up survey (1997-1999) used to assess ADL and IADL performance. RESULTS: Dementia, even after adjustment for age, sex and history of stroke, was a strong predictor of functional disability, as indicated by ADL (odds ratio, OR = 14.0; confidence interval, CI = 5.4-36.3), IADL (OR = 10.1, CI = 2.2-46.4), and also by assessment of decline in ADL (OR = 9.8, CI = 4.2-22.8) or IADL status (OR = 3.9, CI = 1.8-8.3). CONCLUSION: Dementia is an important determinant of functional status. Deterioration in ADL is more significant than deterioration in IADL, suggesting that factors other than cognition, such as motivation or perceptual, sensory and motor abilities, may be important in IADL performance. This study confirms previous findings on risk factors that affect functional ability and extends our knowledge by examining several criteria of function that are important in the daily lives of elderly people.     

Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.     

Factors associated with ADL and IADL dependency among Korean centenarians: reaching the 100-year-old life transition

This study aims to examine the functional status of Korean centenarians, who have crossed the relatively rare but increasingly common life transition of living for a century. As functional health is one of the essential components of healthy aging, our primary objective is to identify the correlates of two aspects of functioning, activities of daily living (ADL) and instrumental activities of daily living (IADL). Using a census survey conducted by the Korean National Statistical Office (KNSO) in 2005, we documented ADL and IADL limitations and analyzed their relationship to sociodemographic factors, health behaviors, social connectedness, and presence of diseases. The study participants were 796 adults aged 100 years or older. The mean age was 101.5 +/- 1.8, and females were 89.9% of the sample. Both ADL and IADL dependences were more common among females, those who did less physical activity, those who had more diseases, and those who did not participate in social activities. Intervention programs designed to address life-stage issues such as focusing on initiating healthy behaviors from youth, managing chronic diseases in mid-life, and fostering social participation in later life are recommended ways to improve functional independence and promote healthy aging among current and future generations of Korean centenarians.     

Successful aging in centenarians: myths and reality

The term “successful aging” appeared in the first issue of “The Gerontologist” in 1961. During the successive years, this expression has changed its meaning. Nowadays, successful aging means “absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities”. It has become a common opinion that the centenarians may represent the prototypes of the successful aging. This motivated our work to study the clinical, psychical, and functional aspects in a centenarian group, verifying the real autonomy, instrumental capacities, and working abilities. Our study pool consisted of 602 centenarians, who were also subjects of then epidemiological studies of the Italian Multicenter Studies on Centenarians (IMUSCE). All subjects underwent a clinical-anamnestic evaluation, cognitive-functional tests by means of the mini mental state examination (MMSE), the independence index in activities of daily living (ADL), the instrumental activities of daily living (IADL) scale. The centenarians were classified in three groups, according to the criteria elaborated previously by us, based on their psychophysical status and autonomy, as follows. Group A: centenarians in good health status; Group B: centenarians in an intermediate health status. Group C: centenarians in bad health status. Group A represented 20.0% of the total pool, Group B amounted to 33.4%, and the Group C was 46.6%. The centenarians of Group A presented normal ADL values, and 47.9% of them were autosufficient in all functions; 5.7% of them were independent in all IADL items. These data confirm that the centenarians of Group A are free of invalidating chronic diseases, are autonomous, maintain good physical and cognitive capacities, however, have not maintained any social or productive activities. Therefore, they cannot be considered as prototypes of successful aging.     

卒中后患者生活质量的性别差异

目的探讨卒中患者卒中3个月后日常生活能力（ADL）的独立性和生存质量的性别差异。方法前瞻性地选择2010年3月—2011年3月顺序进人阜新市第二人民医院的初次卒中患者200例,其中男115例,女85例。以改良Barthel指数（mBI）≥95分为ADL独立,评估卒中后3个月患者的性别、年龄、卒中亚型（缺血性、出血性）、既往病史、随访类型（患者回答、代理人回答）、卒中和出院时mBI评分对ADL独立性的影响,以及不同性别间卒中生活质量（SIS）量表评分的差异。结果①所有患者均完成随访,无失访、死亡病例。卒中时mBI评分无性别差异;出院时男性卒中患者达到ADL独立的比例高于女性（67．8％,48．2％）,差异有统计学意义（P〈0．01）;卒中后3个月改良Rankin评分（mRS）评分,男性好于女性,差异统计学意义（P〈0．05）。②卒中后3个月121例mBI≥95分,其中79例为男性,42例为女性,差异有统计学意义（P〈0．01）。校正年龄、卒中亚型、不同随访类型的单因素Logistic回归分析显示,性别是卒中后ADL的独立影响因素（OR=0．39;95％CI．0．19—0．87）。③在卒中生活质量（SIS）各项评分中,力气、交流、日常活动／日常器械活动、记忆与思维、社会参与及总体健康评分的得分均为男性高于女性,差异有统计学意义,P〈0．05—0．01。由患者回答的情绪得分为男性高于女性（P〈0．01）,由代理人回答的情绪得分男、女性别间差异无统计学意义。结论性别是影响卒中患者卒中后生活质量的因素之一。     

Setting eligibility criteria for a care-coordination benefit

OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served. DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older. SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey. PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries). MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency. RESULTS: A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population. CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.     

Overestimated functional dependency in older patients: Can we blame gender difference,unneeded assistance or assessment tools?

IntroductionThe population is aging in Egypt and hence functional limitation is increasing. Thus finding the best measures for its detection is mandated.ObjectivesThe aim of this study was to assess whether Katz ADL (activities of daily living) and Lawton IADL (instrumental activities of daily living) were suitable measures to represent the functional abilities of older Egyptians of both genders during hospital admission and to determine the dimensionality of both tools.MethodsFunctional status was assessed during hospital admission as a part of the comprehensive geriatric assessment for 786 older patients (aged 60 years and older). 150 of them were randomly interviewed to collect data regarding the difficulty during each task of Katz ADL and Lawton IADL performance, unnecessary and unmet needed assistance, barriers to get needed assistance and the type of care providers.ResultsThe prevalence of ADL and IADL dependency was 61.80 % and 85.87 %, respectively. Functional limitation in both scales was found to be significantly associated with increasing age, marital status other than married, cognitive impairment. Both scales showed a bi-dimensional factor structure, removing continence from Katz ADL resulted in a uni-dimensional scale. Females were more dependent than males in all tasks except household tasks of IADL.ConclusionsKatz ADL and Lawton IADL did not capture the actual dependency level among older Egyptians. The household tasks in Lawton IADL and continence in Katz ADL mislabeled dependency in the studied sample.     

长沙市城乡老年人日常生活能力调查

目的 调查长沙市城乡老年人日常生活能力损害情况,分析其影响因素.方法 采用问卷调查法,对2339名60～91岁的老年人进行日常生活能力调查,分析其性别、年龄、婚姻状况、家庭结构、教育程度、职业、常见慢性病、医疗保健意识对老年人日常生活能力的影响.结果 躯体生活自理能力中,损害率最高的是定时上厕所(18.2%),工具性日常生活能力损害率最高的是购物(26.3%).年龄、丧偶、独居、患病、医疗保健意识缺乏是影响日常生活能力的主要因素.结论 日常生活能力是反映老年人健康状况的重要指标,对高龄、丧偶、独居、患有多种慢性疾病、医疗保健意识缺乏者等老年高危人群应加强健康教育和老年保健,提高其生活质量.     

晚期血吸虫病患者生存质量及其影响因素

目的 目的 评估青浦区晚期血吸虫病 （晚血） 患者生存质量， 了解其影响因素。方法 方法 采用WHOQOL?BREF量表进行 问卷调查， 同时收集调查对象人口学特征、 家庭背景、 患病情况、 健康状况及医疗服务利用等信息。结果 结果 217例晚血患者 男女性别比为2 ∶5， 平均年龄75.33±6.94岁， 农民占89.86%， 文盲半文盲占75.58%， 巨脾型占88.94%。患者生存质量和健 康状况总体评价得分中等以上的分别为61.29%和45.16%， 两者得分差异有统计学意义 （t = 7.804， P＜0.01）； 生存质量各领 域得分均数差异有统计学意义 （χ2 =23.46， P＜0.01）。在不同诊断年份、 不同临床分型间生存质量各领域评分差异均无统 计学意义 （P均＞0.05）。Logistic回归多元分析显示定期参加体育锻炼或体力劳动对4领域评分均有影响， 近2周疾病急性 发作、 长期服用治疗性药物、 婚姻状态和年龄等因素对相应领域评分有影响。总体生存质量及生理、 心理、 社会关系和环 境4个领域评分为中等及以上水平， 但生理领域评分低于其他3个领域。结论 结论 青浦区晚血患者的生存质量尚可。为患 者提供有效的社区卫生服务和鼓励参加适度的体育、 体力活动， 是提高生存质量的重要途径。