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Vitamin D status of two groups of elderly in Oslo: living in old people's homes and living in own homes.

Vitamin D status of two groups of elderly was determined by measuring serum concentrations of 25-hydroxyvitamin D3 (25-OHD), and dietary and supplemental vitamin D intake. Group A consisted of 35 women (mean age 86 years), and 21 men (mean age 80 years) living in 5 different homes for elderly. Group B consisted of free-living elderly, 24 women (mean age 76 years) and 7 men (mean age 79 years). There was no or little seasonal variation in serum 25-OHD concentrations in either group. Of those who did not use vitamin D supplements, 83% of the women and 77% of the men in group A, and 40% of the women and none of the men in group B had 25-OHD concentrations below 20 ng/ml in the winter serum samples. Of the 49 individuals who used supplements, only 2 had values below 20 ng/ml. In the institutionalized elderly, 14-15 micrograms vitamin D per day as supplement was associated with a mean increase in 25-OHD concentration in winter serum samples of 25 ng/ml. Dietary intakes of vitamin D were low for both groups, especially for the women (less than 3 micrograms). It is concluded that elderly Norwegians, in particular those living in institutions, ought to improve their vitamin D status by increasing their exposure to sunshine and by including more oily fish in their diet. If this is difficult to achieve, vitamin D supplement (10 micrograms/day) should be used.

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Laboratory survival, growth, and digestive gland histologic features of squids reared on living and non-living fish diets.

The effects of non-living diets on the survival, growth, and digestive gland histologic features of the bigfin reef squid (Sepioteuthis lessoniana Lesson, 1830) cultured in the laboratory were evaluated during one-half of their life cycle (95 days). Two groups of squids (n = 16 per group) were held in closed seawater systems with similar water volume, temperature, salinity, water filtration, and water flow velocities. Food for the control group consisted of live, freely swimming fish (Cyprinodon variagatus); the test group was trained to grab freshly dead fish (days 1 to 45) and then thawed, frozen fish (days 46 to 95). The two groups were evaluated for differences in (1) food intake, (2) survival, (3) growth (wet weight, mantle length, instantaneous growth rate), (4) morphologic (mantle thickness in four locations, digestive gland weight), and (5) digestive gland histologic features (indices for nuclear density and relative vacuolar density). Unexpectedly, no significant differences were found between the two groups. Mean wet weight increased from 32.1 g to 342.9 g for the control group and from 58.6 g to 372.0 g for the group fed dead food. The results demonstrate that laboratory-cultured squids can survive and grow when fed dead fish (fresh or frozen) as well as live fish without adverse effects on growth, survival, or digestive gland histologic features.

Animals↗

Correlates of caregiver-rated quality of life in assisted living: the Maryland Assisted Living study.

We used a cross-sectional study to examine the correlates of caregiver-rated quality of life (QOL) in 198 randomly selected residents from a stratified random sample of 22 assisted living facilities in central Maryland. We measured QOL by using the Alzheimer's Disease-Related Quality of Life Questionnaire. In general, despite cognitive impairment, residents in assisted living were rated as having a high QOL. In a multivariate regression, we found that nonmood neuropsychiatric symptoms were the strongest correlate of QOL, explaining 37% of the variance. Depressive symptoms, functional dependence, marital status, and cognition also contributed to the model, but only minimally. Because of the strong association of neuropsychiatric symptoms with QOL, special attention should be given to their recognition and amelioration.

Activities of Daily Living↗

Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study.

INTRODUCTION: A majority of the elderly suffer from some sort of sleep disturbance. Common sleep disturbances are insomnia and excessive daytime sleepiness. There are no published studies on the prevalence of sleep disturbance in the assisted living (AL) setting. OBJECTIVE: To estimate the prevalence, types, and associations of sleep disturbance in a stratified random sample of AL residents, and to explore the effect of sleep disturbance on cognitive and physical functioning, as assessed by the Mini- Mental State Exam (MMSE) and the Psychogeriatric Dependency Rating Scale (PGDRS). METHODS: Participants were 198 randomly selected assisted living residents in 22 Maryland facilities. Participants were rated on an 11-item sleep questionnaire regarding insomnia and daytime sleepiness. RESULTS: Sleep disturbance was present in 69% of residents, insomnia (IN) in 42% and excessive daytime sleepiness (DS) in 34.6%. IN and DS scores were not significantly correlated(r = 0.10, p = 0.19). Use of hypnotics, sedating antidepressants, and depression were associated with insomnia. Depression and poor general medical health were associated with daytime sleepiness. On a cognitive task (Mini Mental State Examination) participants with insomnia only out-performed participants with no sleep disturbance and daytime sleepiness; on a measure of physical function (PsychoGeriatric Dependency Rating Scale- physical domain), participants with insomnia fared better than those with daytime sleepiness only and those with both insomnia and daytime sleepiness. Participants with DS only performed worse on both measures compared to those with no sleep disturbance, those with insomnia only, and those with both insomnia and daytime sleepiness. CONCLUSION: The prevalence of sleep disturbance in AL is similar to that reported in nursing homes. Daytime sleepiness is associated with poorer cognitive and day-to-day functioning, while insomnia is associated with better outcomes. Effective management of DS may lead to improved functioning in the AL residents.

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Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo.

In 1993, the Shinshu Group performed the first successful adult-to-adult living donor liver transplantation (LDLT). During the first 10 years of LDLT, many technical innovations have been reported. The major limitation of LDLT for adult recipients is the size of the graft. To overcome the problem, several graft types were designed, including left liver graft with caudate lobe, right liver, modified right liver, and right lateral sector and dual grafts. The necessity and criteria of reconstruction of middle hepatic vein is still on debate in right liver graft without trunk of middle hepatic vein. Biliary reconstruction remains a significant source of morbidity in LDLT. Donor safety must always be the primary consideration in LDLT and the selection criteria and management of the living donor must continue to be refined. On February 21, 2004, the 10(th) anniversary of the adult-to-adult LDLT meeting was held in Tokyo to review the accumulated experience and the presented information is summarized.

Biopsy↗

Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging.

OBJECTIVE: The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home). STUDY DESIGN AND SETTING: The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home). RESULTS: The rating scale worked best when dichotomized into "received no assistance" and "receives assistance." Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings. CONCLUSION: The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.

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Kidney transplantation from living-unrelated donors: comparison of outcome with living-related and cadaveric transplants under current immunosuppressive protocols.

OBJECTIVES: Living-unrelated donors may become an additional organ source for patients on the kidney waiting list. We studied the impact of a combination of calcineurin inhibitors and mycophenolate-mofetil together with steroids on the outcomes of living-related (LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September 1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49) kidney transplantation, and another 173 patients received a cadaveric kidney. Immunosuppressive protocols consisted of mycophenolate-mofetil with cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the patient and graft survival data, rejection rate, and graft functional parameters. RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8 years) and cadaver (43.7 years) donor recipients (P <0.001). HLA matching was higher in LRD patients (P <0.001). Acute rejection developed in 28.6% of LUR versus 27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P = not significant). The creatinine level at 1, 2, and 3 years after transplant was 1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not significant), respectively. No difference in patient survival rates was found among the groups. The 1, 2, and 3-year graft survival rates were significantly better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS: Despite HLA disparity, the rejection and survival rates of LUR transplants under current immunosuppressive protocols are comparable to those of LRD and better than those of cadaveric transplants.

Adult↗

The role of change in physical performance in determining risk for dependence in activities of daily living among nondisabled community-living elderly persons.

Among community-living elderly persons, a single assessment of physical performance is a powerful predictor of dependence in activities of daily living (ADLs). The aim of this study was to determine whether an assessment of change in physical performance provides useful prognostic information beyond that available from a single assessment. Among a large representative cohort of elderly persons, we evaluated the 586 participants who were ADL independent at both the baseline and the one year interviews. For each of the three timed tests, participants who had a large decline in physical performance were significantly more likely to develop ADL dependence at three years than those who improved or showed no change. After adjusting for 1-year scores, however, change in physical performance was no longer associated with ADL dependence. However, among the 775 participants who were ADL independent at the baseline interview, change in physical performance was significantly associated with the onset of ADL dependence at one year, even after adjusting for baseline performance. When determining risk for ADL dependence, an assessment of change in physical performance over one year does not provide useful prognostic information beyond that available from a single assessment. Nevertheless, change in physical performance is independently associated with concurrent ADL dependence and may be useful in predicting future disability if measured over shorter intervals.

Activities of Daily Living↗

Psychosocial outcome of living donors after living donor liver transplantation: a pilot study.

In view of the scarcity of organ resources available for transplantation, living donor liver transplantation (LDLT) is gaining growing importance in the treatment of chronically terminal liver diseases. In the period between December 1999 and October 2000, 47 potential living liver donors were evaluated and 24 right hepatic lobes and two left lateral segments were transplanted at the Virchow-Klinikum of the Charité Hospital in Berlin. The present study looks into biomedical and psychosocial parameters of 23 donors before and 6 months after LDLT. Our aims were to investigate the development of psychosocial parameters after donation and the relationship between psychosocial findings and post-operative complications. Most donors showed an improved quality of life (QoL) after LDLT when compared with pre-operative results. Twenty-six percent of donors show high values for 'tiredness', 'fatigue' and 'limb pain' following donation. The post-operative complications had no influence on the psychosocial outcome. In this pilot study the resection of the right hepatic lobe amounts to a safe operation for donors and holds promise of a good psychosocial outcome for most donors, irrespective of donation-related complications. The pronounced complaints appears to indicate psychological tension and distress in some donors following donation.

Adult↗

Predictors of recovery in activities of daily living among disabled older persons living in the community.

OBJECTIVE: To identify the factors that predict recovery in activities of daily living (ADLs) among disabled older persons living in the community. DESIGN: Prospective cohort study with 2-year follow-up. SETTING: General community. PARTICIPANTS: 213 men and women 72 years or older, who reported dependence in one or more ADLs. MEASUREMENTS AND MAIN RESULTS: All participants underwent a comprehensive home assessment and were followed for recovery of ADL function, defined as requiring no personal assistance in any of the ADLs within 2 years. Fifty-nine participants (28%) recovered independent ADL function. Compared with those older than 85 years, participants aged 85 years or younger were more than 8 times as likely to recover their ADL function (relative risk [RR] 8.4; 95% confidence interval [CI] 2.7, 26). Several factors besides age were associated with ADL recovery in bivariate analysis, including disability in only one ADL, self-efficacy score greater than 75, Folstein Mini-Mental State Examination (MMSE) score of 28 or better, high mobility, score in the best third of timed physical performance, fewer than five medications, and good nutritional status. In multivariable analysis, four factors were independently associated with ADL recovery-age 85 years or younger (adjusted RR 4.1; 95% CI 1.3, 13), MMSE score of 28 or better (RR 1.7; 95% CI 1.2, 2.3), high mobility (RR 1.7; 95% CI 1.0, 2.9), and good nutritional status (RR 1.6; 95% CI 1.0, 2.5). CONCLUSIONS: Once disabled, few persons older than 85 years recover independent ADL function. Intact cognitive function, high mobility, and good nutritional status each improve the likelihood of ADL recovery and may serve as markers of resiliency in this population.

Activities of Daily Living↗

Apheresis therapy for living-donor liver transplantation: experience for apheresis use for living-donor liver transplantation at Kyoto University.

Liver transplantation is a fundamental treatment for patients with end-stage hepatic failure. In order to perform living-donor liver transplantations under safer conditions, apheresis plays a major role in Japan due to the prevalence of living-donor liver transplantation wherein later retransplantation is difficult. In our department, the roles of apheresis in liver transplantation are as follows: as bridge therapy to liver transplantation (n = 45); as a supplement to the graft liver until the recovery of hepatic function (n = 77); as treatment for multiple organ failure including posttransplantation renal failure (n = 15); and as a means with which to reduce antibody titers for antibodies such as anti-A or anti-B in persons with ABO blood type = incompatible liver transplantation (n = 23). In our department, we have performed 822 liver transplantations at present. Of those cases, 183 were selected wherein apheresis was performed around the time of the operation. In all cases, transplantation with sufficient apheresis was performed before the surgical operation, however, 22 patients (48.9%) died after undergoing surgery. Among the patients who underwent the postoperative apheresis, those in the nonsurvivor group had lower grafted liver weights compared to those of the survivor group. The kidney was the organ that most frequently failed due to postoperative complications. In cases of ABO blood type-incompatible liver transplantations, patients with high preoperative anti-A/B IgM antibody titers sustained bile duct complications, patients with high preoperative anti-IgG antibody titers sustained hepatic necrosis, and patients with high postoperative anti-A/B IgM and anti-IgG antibody titers sustained hepatic necrosis most frequently.

Adult↗

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study.

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN: Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING: Home-based interviews and examinations in Jerusalem. PARTICIPANTS: Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS: Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1). CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.

Activities of Daily Living↗

Impact of electronic aids to daily living on the lives of persons with cervical spinal cord injuries.

Structured interviews were used to evaluate the impact of electronic aids to daily living (EADL) on functional abilities and psychosocial well-being. The participants included 32 adults (26 men, 6 women; mean age of 39 years) with cervical spinal cord injuries. The experiences of 16 EADL users were compared with a control group of 16 nonusers, using the Functional Autonomy Measuring Scale, the Lincoln Outcome Measures for Environmental Controls, and the Psychosocial Impact of Assistive Devices Scale. Results show EADL users had significantly better performance (p < .05) than nonusers for instrumental activities of daily living and for 75% of 12 daily tasks. Many non-users had hands-free control of phones only, whereas EADL users had control over many other household devices, which optimized their independence. The psychosocial impact of this technology was very positive for competence, adaptability, and self-esteem. In conclusion, functional abilities were greater for a variety of daily tasks, and psychosocial impact was positive when EADLs were used.

Activities of Daily Living↗

An empirical basis for domains in the analysis of dependency in the activities of daily living (ADL): results of a confirmatory factor analysis of the Cleveland Scale for Activities of Daily Living (CSADL).

This study examines the empirical basis for dividing activities of daily living (ADLs) into broad behavioral domains. Following an exploratory factor analysis of results from the Cleveland Scale for Activities of Daily Living (CSADL), a two-factor model of ADLs was tested in a confirmatory factor analysis using two groups of demented patients. The model, which included a Basic and an Instrumental factor, was confirmed. Comparison of the item composition of the CSADL factors with a priori domains used by other ADL scales suggested that the results of the present study are broadly generalizable. The two factors are correlated, and cautions were raised concerning the likelihood that many ADL items may reflect both basic and instrumental domains.

Activities of Daily Living↗

Analysis of activities of daily living in elderly people living alone: single-subject feasibility study.

We have developed an automatic remote system for use in monitoring the health of independent elderly people living in conventional homes. In this study, a monitoring system was installed and evaluated in the house of one subject to test the feasibility of determining activities from sensor outputs. Over a period of 6 months, it was found that total counts from all sensor outputs matched the concurrently acquired data on physical activity obtained from a pedometer. Performance of each basic activity of daily living could be confirmed from the sensor output records.

Activities of Daily Living↗

Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale.

A new assessment of Activities of Daily Living has been developed specifically for use with people with dementia. The assessment is a carer rated instrument consisting of 20 daily-living abilities. The scale has 'face validity', assessing items rated as important by and using levels of ability generated by carers. It has 'construct' validity as demonstrated by principal components analysis. It has 'concurrent' validity in that it correlates well with observed task performance. It has good 'test-retest' reliability as measured by Cohen's Kappa and it correlates well with the Mini-Mental State Examination. Carers report that it is easy to use and it is relatively short. The authors believe the scale will be useful when assessing demented patients in the community or as part of clinical research trials.

Activities of Daily Living↗

Combining activities of daily living with instrumental activities of daily living to measure functional disability.

Measures of functional disability typically contain items that reflect limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Combining IADL and ADL items together in the same scale would provide enhanced range and sensitivity of measurement. This article presents psychometric justification for a combined ADL/IADL scale. Data come from 2,977 disabled respondents in the 1989 National Long-Term Care Survey. Respondents indicated whether they received human help on 7 ADL items; they also indicated whether they were unable to perform each of 9 IADL items due to health reasons. Factor analyses using tetrachoric correlations demonstrated that 15 of the 16 items reflected one major dimension. Item response theory (IRT) methods were used to calibrate the items; a one-parameter IRT model fit the data. Item calibrations showed that ADL and IADL items were not hierarchically related. Analyses showed that a simple sum of item responses could be used to derive a measure of functional disability. Implications of using a 15-item ADL/IADL scale for eligibility determination and for comparing groups are discussed.

Activities of Daily Living↗

Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: the Maryland Assisted Living Study.

OBJECTIVE: Assisted living (AL) is a rapidly expanding residential option for the senior population. With increased utilization, it becomes important to understand the detection and treatment of dementia in this setting, but little is known. The objective of this study was to identify and evaluate factors associated with caregiver unawareness of dementia and failure to treat dementia in AL. METHODS: The setting was a cross-sectional study of a random sample of AL facilities in central Maryland (The Maryland Assisted Living Study). Geriatric psychiatrists evaluated 198 participants and assigned dementia diagnoses to 134 residents (67.7%). The extent to which dementia was recognized and treated in these facilities was estimated on the basis of caregiver interview and chart review data. Using logistic regression models, demographic, cognitive, and functional measures were evaluated as predictors of caregiver unawareness and nontreatment of dementia. RESULTS: Severity of cognitive and functional impairment, number of neuropsychiatric symptoms, and male gender were all independent predictors of caregiver unawareness of dementia. Family and caregiver unawareness of dementia and female gender were predictors of failure to treat dementia. Detection and treatment were not associated with race, age, or overall medical health. CONCLUSIONS: Caregivers were more likely to be unaware of dementia in residents who did not have severe cognitive impairment or obvious behavioral and functional problems. Caregiver and family unawareness were in turn associated with nontreatment. Observed gender differences in detection and treatment will require replication and further study. These observations suggest that systematic educational interventions for caregivers and families may improve detection and hence treatment in the AL setting.

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