scholarly journals P130: Feasibility of self-assessing functional status in older emergency department patients

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S111-S111
Author(s):  
V. Boucher ◽  
V. Boucher ◽  
M. Lamontagne ◽  
J. Lee ◽  
M. Émond
Keyword(s):  
Emergency Department ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Assessment Tool ◽  
Assessment Method ◽  
Assessment Tools ◽  
Self Assessment ◽  
Medical Reason ◽  
Significant Difference

Introduction: Geriatric Emergency Department (ED) guidelines recommend systematic screening of older patients for geriatric syndromes. However, compliance issues to this recommendation have already been observed. Self-assessment tools could be an interesting solution as self-assessed general, mental and physical health was shown to be predictive of functional decline and mortality. The Older Americans Resources and Services scale (OARS), is a simple geriatric functional assessment scale that is widely used by professionals to quantify patients’ ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL). However, its use as a self-assessment tool has never been tested. Objective: to evaluate the feasibility of the self-assessed OARS compared to its standard administration by a research assistant (RA) in older ED patients. Methods: A planned sub-analysis of a single center randomized crossover pilot study in 2018 was realized. Patients aged ≥65 who consulted to the ED for any medical reason were included. Patients were excluded if they: 1) required resuscitation (CTAS 1); 2) were unable to consent/to speak French; 3) had a physical condition preventing the use of an electronic tablet. Patients were randomized 1:1 to either 1) tablet-based functional status self-assessment or 2) the RAs questionnaire administration at first, after which they crossed-over to the other assessment method. Paired t-tests were used to assess the score differences. Results: 60 patients were included. Mean age was 74.4 ± 7.6 and 34 (56.7%) participants were women. Mean OARS score according to RA was 25.1 ± 3.3 and mean self-assessed OARS score was 26.4 ± 2.5 (p < 0.0001). There was also differences when looking at the AVQ and AIVQ separately. Mean AVQ scores were 12.5 ± 1.8 and 13.5 ± 0.9 (p < 0.0001) and mean AIVQ scores were 12.6 ± 1.8 and 12.9 ± 1.8 (p = 0.04) for RA assessment and self-assessment, respectively. Conclusion: Our results show a statistically significant difference between RA assessment and patient self-assessment of functional status, and this difference seems to be more pronounced regarding AVQ than AIVQ. The study confirms that self-assessment of functional status by older ED patients is feasible, but further testing is required in order to confirm the validity and psychometric values of this self-administered version of the OARS.

scholarly journals Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ching-Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Functional Decline ◽  
Depression Scale ◽  
Assessment Method ◽  
Functional Improvement ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients who aged over 65 years and admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation (GEE) was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. The study demonstrated that all the geriatric patients with functional decline presented gradual improvements of physical function up to 180 days after discharge. Whether depression exists did not substantially affect functional recovery after discharge, whilst either dementia or delirium could impede elder people functional status. The recovery of functional improvement in delirium or dementia was relatively irreversible when comparing with depression. Once delirium or dementia was diagnosed, poorer functional restore was expected. In brief, intensive work and strategies on modifying delirium or dementia should be put more effort as early as possible. Conclusions Old hospitalized patients with depression can recover well after adequate intervention. We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission. Comprehensive plan must be implemented timely.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

scholarly journals Structured guideline-based physiotherapy reduces difficulties in activities of daily living in Parkinson’s disease

2021 ◽  
pp. 1-10
Author(s):  
Kadri Medijainen ◽  
Mati Pääsuke ◽  
Aet Lukmann ◽  
Pille Taba
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Assessment Tool ◽  
Self Assessment ◽  
Core Areas ◽  
Conventional Physiotherapy ◽  
And Control

BACKGROUND: In the long term, Parkinson’s disease (PD) leads to the development of difficulties in daily functional tasks. There remains a paucity of evidence on the effectiveness of physiotherapy on patient-perceived difficulties regarding basic activities of daily living (ADL). OBJECTIVES: To assess an effect of a versatile physiotherapy intervention on patient-perceived difficulties in basic ADL. METHODS: The study sample included 24 patients (10 men and 14 women) with PD. Participants were randomly assigned into intervention (IG) and control groups (CG). Two assessments were performed with a gap of 10 weeks. Following first assessment, during an 8-week period, IG participants attended sixteen physiotherapy 60-minutes sessions in groups that were divided into five parts to address the core areas recommended by the European Physiotherapy Guideline for PD (EPGPD): gait, transfers, balance, physical capacity, and manual activities. The main assessment tool was the Modified Patients Specific Functional Scale (ModPSFS), which represents a self-assessment rating on difficulties perceived in 17 different commonly occurring activities. RESULTS: IG members reported a significant reduction in self-perceived difficulties as assessed by ModPSFS (effect size 1.39; 95%CI 5.1, 26.6 points, p = 0.005). CONCLUSIONS: 2-months conventional physiotherapy with incorporated core areas recommended in EPGPD for PD reduced patient-perceived difficulties in basic ADL.

scholarly journals 72 Validating MyHEARTSMAP, an emergency psychosocial self-assessment and management tool, among youth with minor traumatic brain injuries or minor orthopaedic injuries seen in the Paediatric Emergency Department

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e30-e30
Author(s):  
Erik Lamoureux ◽  
Takuro Ishikawa ◽  
Keith Yeates ◽  
Miriam Beauchamp ◽  
William Craig ◽  
...  
Keyword(s):  
Emergency Department ◽  
Convergent Validity ◽  
Assessment Tool ◽  
Social Issues ◽  
Pearson Correlation ◽  
Assessment Tools ◽  
Management Tool ◽  
Self Assessment ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

Abstract Background Fewer than 20% of the estimated 1.2 million Canadian youths living with mental health (MH) concerns receive adequate care. Paediatric emergency department (PED) visits related to MH are increasing across North America. The online self-assessment tool, MyHEARTSMAP, was developed to facilitate screening of MH concerns in the PED and general practice. MyHEARTSMAP assesses 10 psychosocial areas, mapping to four domains of MH (Psychiatry, Function, Social, and Youth Health) to provide domain-specific recommendations for patient management (Figure A). Objectives We evaluated the convergent validity of MyHEARTSMAP when compared to established psychosocial self-assessment tools: Paediatric Quality of Life (PedsQL) and Strengths and Difficulties Questionnaire (SDQ). Design/Methods We conducted a cross-sectional study among youths and parents enrolled in a larger cohort study: Advancing Concussion Assessment in Paediatrics (A-CAP). Participants were children aged 8 to 16 years old with mild traumatic brain injury or orthopaedic injury and their parents. Participants were recruited from two PEDs in Alberta and British Columbia and were asked to complete MyHEARTSMAP, in addition to the PedsQL and SDQ completed in their A-CAP study procedures. We evaluated three MH domains from MyHEARTSMAP (PSYCHIATRY FUNCTION, AND SOCIAL) to their corresponding score sections in PedsQL (EMOTIONAL, SCHOOL, and SOCIAL) and SDQ (EMOTIONAL, none, and CONDUCT and PEER). We calculated Pearson correlation coefficients between these corresponding domains and sections. Results We recruited 40 child and parent pairs from Alberta and 82 from BC. The children were on average aged 12.6 years old (SD 2.2) and 44% were female. The tools screened participants as “at-risk” for various MH concerns at a rate of 26.7% to 60.8% for MyHEARTSMAP, 2.5% to 13.9% for PedsQL, and 12.3% to 16.0% for SDQ. Overall, MyHEARTSMAP was moderately correlated with PedsQL (mean ±95% CI: r = 0.405±0.151) and SDQ (mean ±95% CI: r = 0.322±0.162). Correlations (±95% CI) by MyHEARTSMAP domain for the child and parent versions, respectively, were as follows: PSYCHIATRY PedsQL (r = 0.483±0.140 / 0.509±0.134) and SDQ (r = 0.417±0.150 / 0.598±0.116); FUNCTION PedsQL (r = 0.578±0.122 / 0.455±0.143); SOCIAL PedsQL (r = 0.249±0.170 / 0.158±0.175) and SDQ (r = 0.207±0.172 / 0.067±0.178). Conclusion In conclusion, MyHEARTSMAP PSYCHIATRY and FUNCTION domains have moderate convergent validity to PedsQL and SDQ. Unlike PedsQL and SDQ, the evaluation of social issues in MyHEARTSMAP is MH-specific, resulting in low convergent validity for the SOCIAL domain.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

scholarly journals OLDER VETERANS’ PERSPECTIVES ON MEASURING FUNCTIONAL STATUS IN VA PRIMARY CARE CLINICS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S755-S755
Author(s):  
Francesca Nicosia ◽  
Malena J Spar ◽  
Alicia Neumann ◽  
Molly C Silvestrini ◽  
Maureen Barrientos ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Functional Status ◽  
Thematic Analysis ◽  
Daily Living ◽  
Medical Center ◽  
Assessment Method ◽  
Self Assessment ◽  
Primary Care Clinics ◽  
Primary Care Settings

Abstract Little is known about older adults’ perspectives on measuring functional status (i.e., ability to perform basic and instrumental activities of daily living). This study used a qualitative design to understand older Veterans’ perspectives on measuring function in primary care settings. Thematic analysis of interviews conducted with 28 Veterans ≥65 years and 5 caregivers from one VA Medical Center identified several themes including: 1) importance and relevance of discussing function; 2) preferences for assessment method (e.g., provider- or self-assessment;) and 3) wording of questions (i.e., needing help vs. having difficultly). These findings suggest that effective approaches to measuring function must consider patient preferences on content and format and ensure that measurement is used to inform care. We applied these findings to develop an interprofessional intervention to improve functional status measurement for older Veterans in primary care.

scholarly journals Effects of Depression, Dementia and Delirium on Activities of Daily Living in Elderly Patients after Discharge

2019 ◽  
Author(s):  
Ching Fu Weng ◽  
Kun-Pei Lin ◽  
Feng-Ping Lu ◽  
Jen-Hau Chen ◽  
Chiung-Jung Wen ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Short Form ◽  
Medical Center ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
The Impact

Abstract Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients aged 65 years and older admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. There were significant lower BI scores in patients with dementia and delirium compared with those without up to 180 days after discharge, but no difference was seen in the depression group. In general, patients had delirium or dementia had worsening functional status, even though significant magnitude of improvements on BI scores after discharge. Conclusions Depression does not affect patients’ ADLs. On the other hand, dementia and delirium can persistently limit patients’ physical function. Future care should focus more on dementia and delirium to restore function.

Functional outcomes following inpatient rehabilitation of guillain-barré syndrome patients: Intravenous immunoglobulins versus plasma exchange

2021 ◽  
pp. 1-9
Author(s):  
Moshe Bondi ◽  
Einat Engel-Haber ◽  
Julie Wolff ◽  
Liza Grosman-Rimon ◽  
Ayala Bloch ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Plasma Exchange ◽  
Functional Outcomes ◽  
Daily Living ◽  
Functional Independence ◽  
Assessment Tools ◽  
Guillain Barre Syndrome ◽  
Disability Scale ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

BACKGROUND: Treatment with either Intravenous immunoglobulin (IVIg) or plasma exchange (PE) in patients with Guillain-Barré Syndrome (GBS) showed equivalent efficacy as attested by a commonly used disability scale. However, it has been suggested that this scale may not be sensitive enough to detect subtle functional changes between the two treatments since it mainly focuses on walking capability and respiratory function. OBJECTIVE: To evaluate functional outcomes following treatment with IVIg or PE using comprehensive scales that incorporate parameters of basic activities of daily living. METHODS: A retrospective cohort study was conducted between 2007 and 2013 in an inpatient neurologic rehabilitation department. The study group included 70 individuals with GBS: 39 were treated with PE and 31 with IVIg. A comparison of functional outcomes was performed using Functional Independence Measure (FIM), rehabilitation efficiency (REy), rehabilitation effectiveness (REs), and the GBS disability scale (GDS). RESULTS: Both treatments had a comparable effect on the various functional outcomes. Patients showed a significant increase in total FIM scores (30 points on average) during rehabilitation mainly as a result of an increase in motor sub-scores. A mean improvement of 1.23 (SD 0.9) in GDS was also observed. On average, individuals with GBS spent 20 days combined in the acute departments and 61 days in the rehabilitation department, with length of stay being similar for both treatments. CONCLUSIONS: IVIg and PE treatments have similar basic activities of daily living (ADL) functional outcomes. Nevertheless, due to the different mechanism of actions of these treatments and the multitude of GBS variants, it is possible that further comprehensive assessment tools may demonstrate differences in activity and participation of individuals with GBS.

scholarly journals Reliability and validity of a computer game-based tool of upper extremity assessment for object manipulation tasks in children with cerebral palsy

2021 ◽  
Vol 8 ◽  
pp. 205566832110140
Author(s):  
Anuprita Kanitkar ◽  
Sanjay T Parmar ◽  
Tony J Szturm ◽  
Gayle Restall ◽  
Gina Rempel ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Performance Measures ◽  
Assessment Tool ◽  
Computer Game ◽  
Object Manipulation ◽  
Manual Dexterity ◽  
Assessment Tools ◽  
Significant Difference ◽  
Children With Cerebral Palsy

Introduction A computer game-based upper extremity (CUE) assessment tool is developed to quantify manual dexterity of children with Cerebral Palsy (CP). The purpose of this study was to determine test-retest reliability of the CUE performance measures (success rate, movement onset time, movement error, and movement variation) and convergent validity with the Peabody Developmental Motor Scale version 2 (PDMS-2) and the Quality of Upper Extremity Skills Test (QUEST). Methods Thirty-five children with CP aged four to ten years were tested on two occasions two weeks apart. Results CUE performance measures of five chosen object manipulation tasks exhibited high to moderate intra-class correlation coefficient (ICC) values. There was no significant difference in the CUE performance measures between test periods. With few exceptions, there was no significant correlation between the CUE performance measures and the PDMS-2 or the QUEST test scores. Conclusions The high to moderate ICC values and lack of systematic errors indicate that the CUE assessment tool has the ability to repeatedly record reliable performance measures of different object manipulation tasks. The lack of a correlation between the CUE and the PDMS-2 or QUEST scores indicates that performance measures of these assessment tools represent distinct attributes of manual dexterity.

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