Browsing by Subject "activities of daily living"
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Item Measuring Dementia of the Alzheimer Type More Precisely(2012-11-29) Lowe, Deborah AnneAlzheimer?s disease (AD) progressively impairs cognitive and functional abilities. Research on pharmacological treatment of AD is shifting to earlier forms of the disease, including preclinical stages. However, assessment methods traditionally used in clinical research may be inappropriate for these populations. The Alzheimer Disease Assessment Scale-cognitive (ADAS-cog), a commonly used cognitive battery in AD research, is most sensitive in the moderate range of cognitive impairment. It focuses on immediate recall and recognition aspects of memory rather than retention and delayed recall. As clinical trials for dementia continue to focus on prodromal stages of AD, instruments need to be retooled to focus on cognitive abilities more prone to change in the earliest stages of the disease. One such domain is delayed recall, which is differentially sensitive to decline in the earliest stages of AD. A supplemental delayed recall subtest for the ADAS-cog is commonly implemented, but we do not know precisely where along the spectrum of cognitive dysfunction this subtest yields incremental information beyond what is gained from the standard ADAS-cog. An item response theory (IRT) approach can analyze this in a psychometrically rigorous way. This study?s aims are twofold: (1) to examine where along the AD spectrum the delayed recall subtest yields optimal information about cognitive dysfunction, and (2) to determine if adding delayed recall to the ADAS-cog can improve prediction of functional outcomes, specifically patients? ability to complete basic and instrumental activities of daily living. Results revealed differential functioning of ADAS-cog subtests across the dimension of cognitive impairment. The delayed recall subtest provided optimal information and increased the ADAS-cog?s measurement precision in the relatively mild range of cognitive dysfunction. Moreover, the addition of delayed recall to the ADAS- cog, consistent with my hypothesis, increased covariation with instrumental but not basic activities of daily living. These findings provide evidence that the delayed recall subtest slightly improves the ADAS-cog?s ability to capture information about cognitive impairment in the mild range of severity and thereby improves prediction of instrumental functional deficits.Item Relationship of psychological well-being and activities of daily living in older adults following hospitalization: A secondary analysis(2008-07-09) Margaret Elizabeth Ottenbacher; Dr. Elizabeth ReifsniderThe ability to perform activities of daily living (ADLs) is fundamental to maintaining older people’s independence and quality of life. Service providers, policy makers, and researchers use ADL measures to develop predictive information about functional outcomes related to specific diseases and treatments, to describe the stages and severity of disabling chronic diseases, to plan placement decisions, to determine eligibility for long-term care services, to determine benefits, and to establish new social policies, as well as to predict admission to a nursing home, use of paid home care, use of hospital and physician services, living arrangements, insurance coverage, and mortality. Patients 65 years and older account for over one-third of hospitalizations and this trend is expected to continue in the coming decades as the number of older adults living to an advanced age increases exponentially.\r\n The purpose of this study was to examine the psychological well-being of an older, ethnically diverse patient population admitted to the Acute Care for Elders (ACE) unit at UTMB and the ability to recover ADLs post-discharge. This secondary analysis of data collected on 403 hospitalized older adults through convenience sampling was examined at baseline, and on the longitudinal three month follow-up sample of 218 older adults who had previously participated at baseline.\r\n Key findings of this study included: 1) social support was noted to be a significant predictor of higher psychological well-being scores in five out of six domains, and 2) significant predictors of recovery of ADLs at three month follow-up included length of stay, number of comorbidities, ADL summary at time of hospitalization, and the psychological domain of Environmental Mastery. \r\n Psychological well-being does have a significant relationship with recovery of ADLs and is an important contributor to quality of life in older adults.\r\n