Pain management among older people in need of help with activities of daily living

The aim of this study was to investigate the use of various pain relief methods among older people in chronic pain and in need of help to manage activities of daily living. People who reported pain and were in need of help to manage activities of daily living were included in the study. The Multidimensional Pain Inventory-Swedish version and a modified version of the Pain Management Inventory were used to study pain and methods of pain relief. The respondents used a variety of methods (median = 3) to relieve their pain; pharmacologic methods, rest, and distraction were the predominant strategies employed. A cluster analysis identified 2 main groups of people: people who used a few well-known methods and were significantly older and people who used a larger repertoire of methods to relieve their pain and reported higher pain severity and interference with daily life. About a third of older people reported inadequate pain relief. These findings stress the need for nurses to inform older people about available methods for pain relief and to do systematic pain assessments to evaluate the effectiveness of various pain relief methods.     

Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living

The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.     

Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living

The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73–91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.     

Single ability among activities of daily living as a predictor of agitation

Aims. The aims of this study were to investigate whether the interaction effect between restraint and functional ability, and single ability during activities of daily living can predict agitation among residents with dementia. Background. Agitated behaviour is one of the most common symptoms of dementia and might endanger the patients themselves, caregivers and institutions. However, the prevalence of problem behaviours and its associated factors at long‐term care facilities in Taiwan are less understood. Design. A direct observation was used to observe the agitated behaviours of residents with dementia in special care units. Methods. Residents of dementia special care units who were diagnosed with dementia in eight long‐term care facilities were recruited. Measurements included: demographic data, the Barthel Index, the Mini‐Mental State Examination and the Cohen‐Mansfield Agitation Inventory. Results. The number of subjects who were identified with problem behaviours was 163 (43·5%). Significant differences in sex, being restrained, restrained time, age, family visits, functional status and mental status were found between the agitated and non‐agitated groups. However, mental status, family visits, walking ability, being restrained and getting in and off toilet were five independent factors associated with agitated behaviours after controlling for all other factors. Conclusions. It is recommended that strategies be constructed to encourage the family to periodically visit older residents and to develop restraint‐free environments in long‐term care facilities. Relevance to clinical practice. Residents with dementia require significant daily living support and behaviour management as their illness progress.     

Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities

BACKGROUND AND PURPOSE: The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities. SUBJECTS: The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30). METHODS: The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS: The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97. DISCUSSION AND CONCLUSION: Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.     

日常生活能力对老年人认知功能的影响

认知功能和日常生活能力是反映老年人健康状况的重要指标,老年人认知功能的下降乃至缺损不仅意味着家庭内部护理和照料的增加,而且给家庭其他成员的生活带来不利,还意味着社会就医规模的上升、社会照料的增加,也是对社会健康资源乃至社会经济资源占有量的上升[1].     

日常生活能力对老年人认知功能的影响

认知功能和日常生活能力是反映老年人健康状况的重要指标，老年人认知功能的下降乃至缺损不仅意味着家庭内部护理和照料的增加，而且给家庭其他成员的生活带来不利，还意味着社会就医规模的上升、社会照料的增加，也是对社会健康资源乃至社会经济资源占有量的上升。认知功能的影响因素较为复杂，探讨日常生活能力对老年人认知功能的影响，为采取应对措施提供依据。     

澳门老年人社会网络与身体健康状况及日常居家活动能力的相关性分析

目的探讨澳门老年人的社会网络与身体健康状况及日常居家活动能力的相关性。方法采用整群抽样方法,抽取澳门15个老人日间活动中心的741名老年人,采用Lubben社会网络量表、身体健康状况问卷、巴氏日常活动能力评估量表、Lawton工具性日常活动能力评估量表对其进行问卷调查。结果 366名老年人的社会网络不足(49.39%);仅有25.10%的老年人觉得身体健康良好,以骨关节痛/腰背痛症状最多(63.56%),出现3种及以上症状的有413人(55.74%),患有3种及以上疾病的有379人(51.15%),以高血压病最为常见(57.76%);日常生活不能自理的有148人(19.97%),居家活动能力不足的有244人(32.93%);Pearson相关分析显示澳门老年人的社会网络与日常活动能力及居家活动能力呈正相关(P<0.01)。结论澳门老年人的身体健康状况及日常居家活动能力差,其社会网络亦不足;改善身体健康状况及日常居家活动能力与老年人的社会网络密切相关。     

社区康复改善老年脑卒中患者的日常生活活动能力

目的观察社区康复对老年脑卒中患者日常生活活动能力 (activitiesofdailyliving ,ADL)的影响。 方法在社区中选取 5 0位老年脑卒中患者 ,随机分为康复组与对照组。康复组采用运动功能训练 ,ADL训练 ;对照组仅服药治疗。治疗前后对每位患者做Barthel指数评分 ,并对治疗前后的评分进行比较。结果康复组训练后的Barthel评分较治疗前明显提高 ,对照组无明显变化 ,两者具有高度显著性差异 (P <0 0 1)。结论社区康复能明显改善老年脑卒中患者的日常生活能力。     

Predictors of instrumental activities of daily living in community-dwelling older adults

Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.     

负性情绪对股骨骨折患者关节功能、步行和日常生活能力的影响

目的研究负性情绪对股骨骨折患者的关节功能、步行和日常生活能力（ADL）的影响，寻找进行干预的可能性。方法41例股骨骨折患者发病后半年进行了步行能力、膝关节活动度（ROM）和ADL（使用改良的巴氏量表）评估，同时还使用临床精神卫生自评量表（SCL-90）测试了精神心里表现。结果41例股骨骨折患者中，步行能力≤4级者的SCL-90评分躯体化（1．25±0．53）、人际关系（1．25±0．05）、抑郁（1．38±0．47）、焦虑（1．29±0．32）、敌对（1．48±0．59）和精神病性（1．34±0．38）等因子评分明显高于步行能力5级者（t=2．136—2．363；P均〈0．05）。ROM〈120。者的躯体化、人际关系、抑郁、焦虑、恐怖和精神病性等因子评分明显高于ROM≥120。者（t=2．146～2．307；P均〈0．05）。ADL〈75分者的躯体化、强迫、人际关系、抑郁、焦虑、恐怖和偏执等因子评分明显高于ADL≥75分者（t=2．026—2．274；P〈0．05）。结论股骨骨折患者发病后的步行能力、ROM和ADL与负性情绪表现密切相关，对前者进行了有针对性的心理咨询和干预治疗是很有必要的。     

Performance-based assessment of activities of daily living (ADL) ability among women with chronic widespread pain

Functional ability, including the ability to perform activities of daily living (ADL), is considered a core outcome domain in chronic pain clinical trials and is usually assessed through generic or disease-specific self-report questionnaires. Research, however, indicates that self-report and performance-based assessment of ADL offer distinct but complementary information about ability. The present study, therefore, investigated the applicability of a performance-based measure of ADL ability, the Assessment of Motor and Process Skills (AMPS), among 50 women with chronic widespread pain. The investigated psychometric properties of the AMPS included discrimination between a sample of healthy women and those with chronic widespread pain, as well as stability when no intervention was provided and sensitivity to change following intervention. Data were obtained based on a repeated measures design performing AMPS evaluations twice pre- and twice post-rehabilitation. Results indicated that the ADL motor ability measures of the participants were significantly lower than those of healthy women of same age, the ADL motor and ADL process ability measures remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change following a 2-week interdisciplinary rehabilitation program. A weak correlation (r_s = −0.35) was found between self-reported ADL ability as measured by the physical function subscale of the Functional Impact Questionnaire (FIQ) and performance-based ADL motor measures, and no correlation (r_s = −0.02) was found between FIQ ADL measures and ADL process ability, supporting the need for both performance-based and self-reported assessment of ADL.     

The association between nutritional status,advanced activities of daily living,and cognitive function among Brazilian older adults living in care homes

Institutionalized older adults are at greater risk of malnutrition, which is associated with cognitive impairment. This study investigated the association between nutritional status, advanced activities of daily living (AADL), and cognitive function among Brazilian older adults living in care homes. This cross-sectional study was conducted on 95 older adults (73.3 ± 12.5 years). Socio-demographic variables, cognitive function (measured by Mini Mental State Examination - MMSE), AADL, Mini Nutritional Assessment (MNA), and anthropometric variables were assessed. Regarding MNA, 37.8% were malnourished, 47.3% were at risk of malnutrition, and 14.9% were well-nourished. Malnourished participants (37.8%) and those with fewer number of AADL (82.3%) showed cognitive decline (MMSE < 24) (p = 0.000 and 0.030, respectively). Inadequate waist-hip ratio was associated with cognitive decline (OR 9.3; 95% IC, 9.06 - 9.85; p = 0.03). Nutritional status and AADL were associated with cognitive function. Nutritional assessment helps to early identify malnutrition and possibly to prevent cognitive impairment.     

Characteristics and behaviours associated with difficulty in performing activities of daily living among older New Zealand women

Purpose: The objective of this cross-sectional study was to determine the prevalence of self-reported difficulty in perfoming activities of daily living (ADLs) and the associated characteristics and behaviours among older women in Auckland, New Zealand. Methods: A sample of 569 community dwelling women aged 65 years and older were studied. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the association of participant characteristics and behaviours with reported difficulty in performing 1 of five basic ADLs. Results: An age adjusted prevalence of 4.6% was found for reported ADL difficulty. Age 85 years (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.1-30.2), history of stroke (OR 9.8; 95% CI 4.1-23.3), history of 1 fall in the past year (OR 3.4; 95% CI 1.6-7.4), low body mass index (OR 2.8; 95% CI 1.2-6.4), and low grip strength (OR 2.6; 95% CI 1.2-5.5) were significantly and independently associated with ADL difficulty. Among women with ADL difficulty, the prevalence of adaptive equipment use was high (>90%). Conclusions: Several characteristics, medical conditions, and behaviours, some of which may be preventable, are associated with physical disability in older New Zealand women. Studies like this are an important step toward the development of interventions to reduce or delay disability and improve health and quality of life.     

Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability follow-back surveys.

BACKGROUND: Accurate assessments of need for disability assistance are essential for effective planning of disability support services, but there is little national data on type and acuity of need. OBJECTIVE: To more fully delineate the type and magnitude of disability assistance needs across the US population, focusing on factors associated with perceived gaps in assistance. RESEARCH DESIGN: Secondary analysis of national household survey. SUBJECTS: Twenty-five thousand eight hundred five adults identified as disabled in the 1994 and 1995 National Health Interview Surveys. MEASURES: Self-reported assistance deficits with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS : An estimated 3.2 million adults with disabilities have at least one assistance deficit, usually involving IADLs like housework. However, approximately 970 thousand adults report one or more assistance deficits with basic ADLs. Compared to adults with met ADL needs, people with ADL assistance deficits are more likely to live alone, to be in poor health, to be a member of a racial or ethnic minority, and to need help with multiple activities. DISCUSSION: These analyses suggest a relatively high rate of unmet and undermet need for disability assistance in the general population. However, only a small number of these adults report assistance deficits with basic ADLs. This group is a logical target for expanded state or federal personal assistance services programming.     

The effect of functional-task training on activities of daily living for people with Parkinson`s disease,a systematic review with meta-analysis

ObjectiveTo evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson`s Disease.MethodsWe searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in a meta-analyses and heterogeneity was explored by meta-regression analysis.ResultsOut of 2546 identified studies, 69 full texts articles were checked for eligibility, of which ten were included in the systematic review. Moderate quality of evidence indicated that exercise interventions containing functional-task training had a positive effect on ADL performance scores on the Unified Parkinson's Disease Rating Scale (UPDRS) in people with Parkinson (pwp) directly after intervention (UPDRS=-2.62(-5.34;0.10)).This effect improved, in favor of functional-task interventions, at the first follow-up (UPDRS=-4.0(-7.56;-0.4)). A post-hoc meta-regression analysis yielded a significant relationship between intensity rate (minutes/week) and the size of the (average) effect on ADL score.ConclusionExercise interventions containing functional-task training have a clinically important positive effect on ADL performance in pwp directly after intervention and at first follow-up, compared to no intervention or placebo. The intensity rate of the functional-task training should be as intense as possible, within the capabilities of the person with PD. Future research is necessary to determine the exact amount of effect that can be contributed to functional-task training.     

辅助器具在提高类风湿关节炎活动期患者日常生活活动能力中的作用

目的探讨辅助器具对提高类风湿关节炎(RA)活动期住院患者的日常生活活动能力(ADL)的作用。方法采用类实验研究方法,将49例RA患者随机分为实验组23例和对照组26例,实验组给予辅助器具,对照组按RA护理常规进行护理。分别在入院当日、住院第7天、第14天对两组进行ADL评分。结果两组入院当日ADL评分差异无明显统计学意义(P>0.05),实验组住院第7天和第14天随住院时间的延长,其ADL评分逐渐增加(P均<0.01)。两组干预前后ADL评分差值的组间比较,实验组明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。结论辅助器具的使用能显著提高类风湿关节炎活动期住院患者的日常生活活动能力。     

Characteristics and behaviours associated with difficulty in performing activities of daily living among older New Zealand women.

PURPOSE: The objective of this cross-sectional study was to determine the prevalence of self-reported difficulty in performing activities of daily living (ADLs) and the associated characteristics and behaviours among older women in Auckland, New Zealand. METHODS: A sample of 569 community dwelling women aged 65 years and older were studied. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the association of participant characteristics and behaviours with reported difficulty in performing > or = 1 of five basic ADLs. RESULTS: An age adjusted prevalence of 4.6% was found for reported ADL difficulty. Age > or = 85 years (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.1-30.2), history of stroke (OR 9.8; 95% CI 4.1-23.3), history of > or = 1 fall in the past year (OR 3.4; 95% CI 1.6-7.4), low body mass index (OR 2.8; 95% CI 1.2-6.4), and low grip strength (OR 2.6; 95% CI 1.2-5.5) were significantly and independently associated with ADL difficulty. Among women with ADL difficulty, the prevalence of adaptive equipment use was high (> 90%). CONCLUSIONS: Several characteristics, medical conditions, and behaviours, some of which may be preventable, are associated with physical disability in older New Zealand women. Studies like this are an important step toward the development of interventions to reduce or delay disability and improve health and quality of life.     

MOTOmed智能运动训练系统训练对脑卒中偏瘫患者平衡功能及日常生活活动能力的影响

目的探讨MOTOmed智能运动训练系统训练对脑卒中偏瘫患者平衡功能及日常生活活动(ADL)能力的影响。 方法将40例脑卒中患者按随机数法随机分为治疗组和对照组,每组20例。对照组患者采用常规康复训练方法,治疗组在此基础上,增加MOTOmed智能运动训练系统训练。治疗前和治疗 6 周后分别采用Berg平衡量表与Barthel指数（BI）评定患者的平衡功能和ADL能力。 结果治疗后2组患者的平衡功能和 ADL能力均有明显改善(P<0.05),治疗组效果优于对照组(P<0.05)。平衡功能与ADL呈正相关。 结论MOTOmed训练系统训练配合常规康复训练可较好的改善恢复期脑卒中偏瘫患者的平衡功能和日常生活活动能力。