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Background The functional consequences of injurious falls are well known. However, studies of the factors that can modify trajectories of disability after an injury from a fall are scarce. Aims We aimed to investigate whether sociodemographic and health-related factors may impact this association. Methods The study population consisted of 1426 community-dwelling older adults (>= 60 years) from the SNAC-K cohort study in Stockholm, Sweden. Functional status over 12 years of follow-up was assessed using the number of limitations in basic and instrumental activities of daily living. Sex, cohabitation status, physical activity, and self-rated health were assessed at baseline. Injurious falls were defined as falls requiring healthcare and were assessed over 3 years starting at baseline. Data were analyzed using linear-mixed effects models. Results The fastest increase in the number of disabilities was observed in those who had endured an injurious fall and were living alone (beta coefficient = 0.408; p < 0.001), been physically inactive (beta coefficient = 0.587; p < 0.001), and had poor self-rated health (beta coefficient = 0.514; p < 0.001). The negative impact of these factors was more pronounced among fallers compared to non-fallers. Discussion Living alone, being physically inactive, and having poor self-rated health magnifies the negative effect of an injurious fall on functional status. Among individuals who endure an injurious fall, the heterogeneity in long-term functional status is substantial, depending on the individuals' characteristics and behaviors. Conclusions These findings emphasize the need for a person-centered approach in care provision and can guide secondary prevention within health care.

Assessing cognitive decline and everyday functioning (EvF) in older age is valuable in detecting age-related neurological disorders. In Greece, there is a lack of sensitive instruments that capture fluctuations in EvF among older persons who are cognitively healthy or have subtle cognitive impairments. The EPT 28-items test, a widely used paper-and-pencil EvF measure, was translated in Greek and adapted to the Greek culture in this study. A multi-step methodology using a sample of 139 older Greek persons was employed. The results indicate that the Greek version of the EPT 28-items (i.e., the EPT-G) was well adapted, representing everyday tasks in Greece within a good range of task difficulty. The psychometric properties of the EPT-G replicate those of the original instrument, capturing EvF fluctuations among older persons with mild cognitive impairments. It was concluded that the EPT-G is a useful measure of EvF among Greek older persons.

Introduction Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies' estimates using the Short Everyday Technology Use Questionnaire. Method In this cross-sectional study, persons with cognitive impairment (n = 21) and their proxies (n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher's exact test. The level of significance was set at p < 0.05. Results At the group level, no significant differences were found between persons with cognitive impairments' perceptions and their proxies' estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads. Conclusion The persons with cognitive impairment and their proxies verified each other's responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.

Background: Everyday technologies (ET) such as smart phones, and internet banking are increasingly incorporated into daily activities. Therefore, valid assessments are needed to identify ability in ET use and to design and evaluate interventions. Aims: To evaluate and compare the stability over time (test-retest reliability) of measures generated with the short version of the Everyday Technology Use Questionnaire (S-ETUQ) in older adults with cognitive impairment or mild dementia. Materials and Methods: Data was collected with S-ETUQ at two occasions (m = 20.9 days in between) in a sample of (n = 73) older adults with cognitive impairment of different origin (n = 38) or mild dementia (n = 35). Stability of each participant’s S-ETUQ measure was examined using standardised difference z-comparisons. The test-retest reliability coefficient of the S-ETUQ measures was determined by Intraclass Correlation Coefficients. Comparisons were performed using Mann-Whitney u-tests. Results: The S-ETUQ measures were statistically stable between the two occasions. Hence, the group of persons with cognitive impairment demonstrated slightly higher stability and fewer differences compared to the group with mild dementia. The ICCs (0.82–0.90) indicated good to excellent agreement. Conclusions: S- ETUQ can be used with older people with cognitive impairments of varying degree to gather reliable and precise information regarding their use of ET.

Alterations in the gut microbiome are associated with neurocognition and related disorders, including in the context of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, the connection between the gut microbiome and cognitive decline, gauged by increased dependence in instrumental activities of daily living (IADL), remains largely unexplored in the context of these diseases. Here we characterized the gut microbiome using 16S rRNA amplicon sequencing and untargeted metabolomics with liquid chromatography-mass spectrometry from 347 people with HIV, HIV and HCV, or neither, all of whom underwent a comprehensive neuropsychiatric assessment. We observed that IADL-dependent and -independent HIV-monoinfected (HIV-positive [HIV+]/HCV-negative [HCV-]) and coinfected (HIV+/HCV+) individuals have distinct gut microbiomes. Moreover, we found that dependent individuals with HIV or HIV and HCV were enriched in Bacteroides These results may have implications for the characterization of cognitive decline, as well as the development of potential prevention and treatment strategies for individuals infected with HIV and/or HCV. Of particular interest is the possibility that dietary interventions that are known to modify the microbiome could be used to shift the microbiome toward more favorable states for preserving independence.IMPORTANCE The microbes in the gut and the chemicals they produce by metabolism have been linked to brain function. In earlier work, we showed that infection with two viruses, HIV and HCV, changed the gut microbes and metabolism in ways that were associated with a lifetime history of major depressive disorder. Here, we extend this analysis looking at a measurement of independence in daily living. We find that in individuals with HIV, whether or not they also have HCV, those who reported reduced independence were enriched in a genus of bacteria called Bacteroides This result is interesting because Bacteroides is strongly associat

Darstellung des Themas: Menschen mit Demenz sind in ihrer Handlungsfähigkeit eingeschränkt. Kognitive Interventionen sind oft Bestandteil der Behandlung von Menschen mit Demenz. Inwiefern diese, die Handlungsfähigkeit fördern, ist jedoch unklar. Ziel: In der vorliegenden Arbeit wurde die Effektivität von drei verschiedenen kognitiven Interventionsansätzen – kognitive Rehabilitation, kognitive Stimulation und kognitives Training – bezüglich der langfristigen Handlungsfähigkeit von Menschen mit milder bis moderater Demenz und deren Anwendbarkeit in der Ergotherapie überprüft. Methode: Fünf Hauptstudien wurden nach einer Literaturrecherche in medizinischen und psychologischen Datenbanken zur Beurteilung der Fragestellung bestimmt und kritisch beurteilt. Die kognitiven Interventionsmethoden der Hauptstudien wurden ins Occupational Therapy Intervention Process Modell (Fisher, 2014) eingeordnet, um diese im zeitgenössischen Paradigma zu verorten. Relevante Ergebnisse: Insgesamt zeigte sich, dass kognitive Rehabilitation die Handlungsfähigkeit von Menschen mit Demenz fördern könnte. Die Ergebnisse der kognitiven Stimulation waren unter Einbezug von zusätzlicher Literatur widersprüchlich. Beim kognitiven Training zeigte sich kein Effekt. Schlussfolgerung: Die kognitive Rehabilitation wird als legitimer Interventionsansatz angesehen. Aufgrund der untersuchten Studien ist sie effektiv und passt wegen dem betätigungsbasierten Vorgehen in das aktuelle ergotherapeutische Paradigma.

Objective: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically. Methods: Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales. Results: Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress. Discussion: In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.

Objectives: We aimed to assess the longitudinal associations of socioeconomic status and physical functioning using a large population-based survey data in China. Method: We used four waves of the Chinese Longitudinal Healthy Longevity Survey (2002-2011). Physical functioning was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Socioeconomic status was assessed using educational attainment, occupational status, household income, financial resources, and access to health services. Latent growth curve model combined with selection model was utilized. Results: High education was not associated with the baseline level or the rate of change in ADL score but predicted better baseline IADL functioning. High income was related to better IADL functioning but had no effect on the rate of change in IADL. Inadequate financial resources and unavailability of health services were mainly associated with poorer ADL and IADL functioning at baseline. White-collar occupation was unrelated to the trajectory of physical functioning. Discussion: This study provides no support either for the cumulative disadvantage or age-as-leveler theory. Improving financial status and accessibility of health care services, especially in lower social classes, may help to improve the overall level of physical functioning of the older adults.

As context may impact everyday technology (ET) use it is relevant to study this within different contexts.

Background: In order to develop supporting interventions for people demonstrating problems ET use, a detailed level of description of strengths and deficits is needed. Aims: To explore clusters of specific performance skill required when using ET, and to evaluate if and in what way such clusters are associated with age, gender, diagnosis, and types of ETs managed. Materials and methods: A secondary analysis of 661 data records from 203 heterogeneous samples of participants using the Management of Everyday Technology Assessment (META) was used. Ward’s method and a hierarchical tree cluster analysis were used to determine and define the skill clusters. Results: Four distinct clusters of performance skill item profiles were found, across the 661 data records. These were then, based on each individuals’ cluster profiles in managing ET, categorized into two groups. The two groups were associated with, diagnosis and type of ETs managed. Conclusions and significance: The findings support a more dyadic person-ET approach in evaluation of ET management. The information from the skill clusters can be used to develop targeted intervention guides for occupational therapy and healthcare.

Background & aims: To date, studies assessing the relationship between sarcopenia and delirium, two of the most common geriatric syndromes, are lacking. We sought to explore this association by investigating the co-occurrence of these two conditions and the independent association between them in a population of hospitalized older adults. Methods: Cross-sectional multicenter analysis of older adults consecutively admitted to 12 acute geriatric units (AGUs). Sarcopenia was assessed upon admission by evaluating the presence of low skeletal mass index (kg/m2), and either low handgrip strength or low walking speed (European Working Group on Sarcopenia in Older People, EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Participants underwent a comprehensive geriatric assessment upon admission; information concerning demographics, cognition (Short Portable Status Mental Questionnaire, SPMSQ) functional (Instrumental Activities of Daily Living, IADL and Basic-Activities of Daily Living, BADL), and health status (Charlson Index and specific diseases) was evaluated. The presence of delirium upon admission was ascertained as an explicit clinical diagnosis recorded by the researcher of each centre on the data form. All association estimates were reported as Prevalence Ratios (PRs) and 95% confidence intervals (CIs), using a Cox hazard proportional regression model with robust variance and constant time. Results: Of the 588 analyzed patients (mean age = 80.9 ± 6.8, 53.2% females), 199 (33.8%) had sarcopenia upon admission to the AGU. According to a multivariable Cox regression, delirium upon admission (PR 1.66, 95% CI: 1.12-2.45), IADL total score (PR 0.93, 95% CI: 0.87-0.98), Body Mass Index values (BMI) ranging from 18.5 to 25.0 (PR 1.70, 95% CI: 1.33-2.18), BMI values >18.5 (PR 2.53, 95% CI: 1.81-3.53), previous stroke (PR 1.51, 95% CI: 1.10-2.07) and chronic heart failure (CHF) (PR 1.31, 95% CI: 1.02-1.68) were significantly and independently

OBJECTIVES: The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). DESIGN: Prospective cohort study (Sydney Memory and Ageing Study). SETTING: Eastern Suburbs, Sydney, Australia. PARTICIPANTS: 554 community-dwelling individuals (54% female) aged 76 and older with normal cognition, MCI, or dementia. MEASUREMENTS: Activities of daily living were assessed with the STAM, administered by trained psychologists, and the informant-based Bayer-Activities of Daily Living Scale (B-ADL). Depressive symptoms were measured with the Geriatric Depression Scale (15-item version). Cognitive function was assessed with a comprehensive neuropsychological test battery. Consensus diagnoses of MCI and dementia were made independently of STAM scores. RESULTS: The STAM showed high interrater reliability (r = 0.854) and test-retest reliability (r = 0.832). It discriminated significantly between the diagnostic groups of normal cognition, MCI, and dementia with areas under the curves ranging from 0.723 to 0.948. A score of 26.5 discriminated between dementia and nondementia with a sensitivity of 0.831 and a specificity of 0.864. Correlations were low with education (r = 0.230) and depressive symptoms (r = -0.179), moderate with the B-ADL (r = -0.332), and high with cognition (ranging from r = 0.511 to r = 0.594). The mean time to complete the STAM was 16 minutes. CONCLUSIONS: The STAM has good psychometric properties. It can be used to differentiate between normal cognition, MCI, and dementia and can be a helpful tool for diagnostic classification both in clinical pract

Background & aims: To date, studies assessing the relationship between sarcopenia and delirium, two of the most common geriatric syndromes, are lacking. We sought to explore this association by investigating the co-occurrence of these two conditions and the independent association between them in a population of hospitalized older adults. Methods: Cross-sectional multicenter analysis of older adults consecutively admitted to 12 acute geriatric units (AGUs). Sarcopenia was assessed upon admission by evaluating the presence of low skeletal mass index (kg/m2), and either low handgrip strength or low walking speed (European Working Group on Sarcopenia in Older People, EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis. Participants underwent a comprehensive geriatric assessment upon admission; information concerning demographics, cognition (Short Portable Status Mental Questionnaire, SPMSQ) functional (Instrumental Activities of Daily Living, IADL and Basic-Activities of Daily Living, BADL), and health status (Charlson Index and specific diseases) was evaluated. The presence of delirium upon admission was ascertained as an explicit clinical diagnosis recorded by the researcher of each centre on the data form. All association estimates were reported as Prevalence Ratios (PRs) and 95% confidence intervals (CIs), using a Cox hazard proportional regression model with robust variance and constant time. Results: Of the 588 analyzed patients (mean age = 80.9 ± 6.8, 53.2% females), 199 (33.8%) had sarcopenia upon admission to the AGU. According to a multivariable Cox regression, delirium upon admission (PR 1.66, 95% CI: 1.12-2.45), IADL total score (PR 0.93, 95% CI: 0.87-0.98), Body Mass Index values (BMI) ranging from 18.5 to 25.0 (PR 1.70, 95% CI: 1.33-2.18), BMI values >18.5 (PR 2.53, 95% CI: 1.81-3.53), previous stroke (PR 1.51, 95% CI: 1.10-2.07) and chronic heart failure (CHF) (PR 1.31, 95% CI: 1.02-1.68) were significantly and independently

Hintergrund: Für ältere Menschen ist es entscheidend, ihre zusätzlichen Lebensjahre gesund, bedeutungsvoll und würdevoll zu verbringen. Auch ist ihnen sehr wichtig, möglichst lange selbständig zu bleiben und zuhause wohnen zu können. Ziel: Evidenzbasierte ergotherapeutische Interventionen darlegen, welche die Selbständigkeit und die Lebensqualität von zuhause lebenden älteren Menschen fördern. Dies soll als Empfehlung für praktizierende Ergotherapeutinnen und Ergotherapeuten in der Schweiz dienen. Methode: Für das systematische Literarturreview wurde in den Datenbanken AMED, CINAHL, Cochrane Library, Medline, OTDBase und OTSeeker gesucht. Ergänzt durch eine Schneeballsuche wurden 137 Studien gelesen und aufgrund der Ein- und Ausschlusskriterien neun Studien inkludiert. Diese wurden zusammengefasst und kritisch gewürdigt. Die beschriebenen Interventionen wurden den vier Interventionsmodellen nach OTIPM (Fisher, 2014) zugeordnet. Ergebnisse: Die Interventionen sind sehr unterschiedlich aufgebaut. Keine der Interventionen bewirkt eine signifikante Verbesserung bezüglich Selbständigkeit und Lebensqualität, dennoch sind gewisse Trends ersichtlich. Diskussion: Kompensatorische Interventionen, wie Wohnraumanpassungen und Hilfsmittelabgaben, beeinflussen die Selbständigkeit und die Lebensqualität positiv. Mit Interventionen aus dem akquisitorischen Interventionsmodell können intrinsische Faktoren verändert, bereits aufgegebene Aktivitäten wieder aufgenommen oder neue Betätigungen entwickelt werden. Die Gruppeninterventionen haben den Vorteil, dass sie nicht nur die Motivation der Teilnehmenden positiv beeinflussen, um länger aktiv zu bleiben, sondern auch die Möglichkeit bieten, Erfahrungen auszutauschen.

Darstellung des Themas: Die Zahl der Angehörigen, welche ein Familienmitglied mit einer unheilbaren, lebensbedrohlichen Krankheit begleiten, nimmt kontinuierlich zu. Die Situation der Angehörigen in der Palliative Care ist in der Literatur gering erforscht. Ergotherapeutische Lösungsansätze zur Bewältigung der aussergewöhnlichen Lebenssituation sind wenige bekannt. Zielsetzung: Die Arbeit erfasst, wie Angehörige die Veränderungen in ihren Activi-ties of daily living (ADL) und Instrumental Activities of daily living (IADL), bedingt durch die Betreuung von erwachsenen Familienmitgliedern mit einer unheilbaren, le-bensbedrohlichen Krankheit, erleben. Die Rolle der Ergotherapie wird in Bezug dieser Thematik untersucht. Methode: Die Fragestellung wird mit Hilfe eines Literaturreviews beantwortet. Die Hauptstudien werden kritisch beurteilt. In Bezug zur Occupational Adaptation werden die kategorisierten Resultate dargestellt und mit ergänzender Literatur diskutiert. Ergebnisse: Angehörige nehmen in den Bereichen ADL und IADL Veränderungen wahr. Sie berichten beispielsweise über mehr Aufgaben im Haushalt, für welche sie weniger Zeit zur Verfügung haben. Zusätzlich werden Einschränkungen in Freizeit, Arbeit und Partizipation* wahrgenommen. Schlussfolgerung: Aufgrund fortschreitender, medizinischer Möglichkeiten und der demografischen Entwicklung besteht ein zunehmender Bedarf an Palliative Care Leistungen in der Schweiz. Welche Rolle die Ergotherapie in der Schweiz darin einnehmen wird, benötigt weitere Untersuchungen.

Objective: The study aim was to investigate how and when an evaluation of perceived difficulty in use of everyday technology (Everyday Technology Use Questionnaire, ETUQ) could be used in clinical occupational therapy. Method: Eight focus-group interviews were undertaken with a total of 42 participants (occupational therapists), and data were analysed with a constant comparative approach. Results: The findings are presented in four main categories, including (i) appropriate purposes and contexts for using ETUQ, (ii) standardization versus individual flexibility, (iii) approaching everyday technology use and occupation as one whole, and (iv) synthesizing and documentation. Conclusions: In conclusion, the participants considered ability to use technology to be an important topic for occupational therapy, particularly in investigations of clients with subtle disabilities and in connection with discharge from hospital-but not in inpatient care. They had different views on how to integrate ETUQ with evaluations of occupational performance, and new ideas on how information about clients' ability to use technology could be utilized in interventions. They held standardized evaluations in high regard, but a paradox appeared in that many of them would use ETUQ in a non-standardized way, while simultaneously asking for a standardized output to be used in clients' medical files and to guide interventions.

Everyday technology, ET (e.g. computers, TV's and vending machines) perceived as relevant and used in everyday activities change continuously. Not being able to keep up with these changes may hinder participation in activities. OBJECTIVE: To investigate stability and change in perceived relevance of ET, and in levels of perceived ET difficulty across two different occasions in time and between two similar samples of older adults with and without cognitive impairment. METHODS: Data of perceived relevance and difficulty in ET use in the samples (n = 157/118), collected with the Everyday Technology Use Questionnaire (ETUQ) was investigated. RESULTS: Thirty-three (70%) of the ETs in the ETUQ significantly increased in relevance, while the perceived levels of difficulty were statistically similar in 40/47 ETs (85%) across the two time occasions. CONCLUSIONS: The perceived relevance of ET among older adults with and without cognitive impairment was indicated to increase over time, but the levels of perceived levels of difficulty of ETs did not change as much. This knowledge could be used to support and facilitate ET use in the aging population, and in general to influence society's view of older people as active users of ET in activities at home and in public spaces.

Decline of physical function [PF] in old age might be related to oxidative damage caused by free radicals, and antioxidants may play a role in reducing the risk of physical functional limitations [PFL]. Yet little is known about the role of carotenoids in PFL. The purpose of this study was to assess the association of total and daily dietary intakes of carotenoids, fruit and vegetables [FV] and their biomarkers with PF among U.S. older adults. Data were from 2,905 men and women [≥ 60 years] in the National Health and Nutrition Examination Survey [NHANES] 2003-2006. Using logistic regression, we found that serum concentration of carotenoids was associated with limitations in PF. In the fully adjusted model, the ORs [95% CI] of having limitation in activities of daily living [ADLs], instrumental activities of daily living [IADLs] and movement difficulties [MD] were 2.03 [1.16 - 3.53], 2.34 [1.61 - 3.42], and 2.15 [1.46 - 3.18], respectively, comparing the lowest quintile of serum carotenoids to the highest. Total intake and dietary intake of carotenoids were found to be associated with limitations in IADL. However, low FV consumptions were not significantly associated with PF domains. In conclusion, elevated levels of serum carotenoids are significantly associated with better physical functional performance and may play an important role in delaying the onset of physical decline.

This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55-77% less likely to be IADL disabled, and were 54-81% less likely to be ADL disabled, and were also 59-89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased.

Background and aims: Research has shown increased prevalence rates over time in several health indicators in the older population. These increases have not been accompanied by corresponding increases in ADL and IADL disability. Given that disability and other health indicators follow different trends, the associations between them may change. Since both health and disability appear to follow different trends for men and women, we can also expect gender differences in the associations. We examined gender differences in how objective tests of function as well as self-reported health and function indicators were associated with ADL/IADL in 1992 and 2002. Methods: Data were from the Swedish Panel Study of Living Conditions among the Oldest Old (SWEOLD), a nationally representative interview survey of persons aged 77+. Results: Compared to men, women had significantly higher prevalence rates for most health indicators both survey years, but there were no significant gender differences in ADL/IADL limitations. Prevalence rates increased significantly between 1992 and 2002 for all health indicators, but not for ADL/IADL. Most of the associations between ADL/IADL and other health indicators were stronger for men than for women. The overall pattern was that associations have become weaker for women over time; for men, the picture was mixed. Conclusions: The changing associations between ADL/IADL and other health indicators may reflect a complex interplay between changes in a range of social and environmental factors, some of which may be modifiable. ADL/IADL appear to reflect different dimensions of health and different kinds of needs for men and women.

This paper is based on a survey among 435 Czech households caring for a dependent senior in the family to inquire into the conditions and circumstances of caring for seniors in the family. The concept of ‘care as a labour of love’ (Graham) is contrasted with the concept of the ‘defamilisation of care’ (Glenn) and ‘social rights for elderly care’ (Fine). The author finds that more demanding family care, measured as the level of IADL or BADL, is reflected in a growing number of hours spent on family care. The author shows the significant differences in the psychological and financial burden experienced by primary caregivers in relation to how demanding the level of care required is. The article presents evidence of the existence of ‘collective family care’ in situations where demanding personal care for a senior is required. The participation of other family members in providing care for a senior in situations of demanding personal care demonstrates some features of family cohesion.

Purpose. The ability to manage technology is important for performance and participation in everyday activities. This study compares the management of technology in everyday activities among people with mild-stage dementia or mild cognitive impairment (MCI) with older adults without known cognitive impairment (OA). Method. Persons with mild-stage dementia (n=38), MCI (n=33) and OA (n=45) were observed and interviewed when managing their everyday technology at home by using the Management of Everyday Technology Assessment (META). A computer application of a Rasch measurement model was used to generate measures of participants' ability to manage technology. These measures were compared groupwise with ANCOVA. Results. The management of everyday technology was significantly more challenging for the samples with mild-stage Alzheimer's disease (AD) or MCI compared to the OA sample (AD – OA, p<0.001; d=1.87, MCI – OA, p<0.001; d=0.66). The sample with MCI demonstrated a significantly higher ability to manage technology than the sample with mild-stage AD (AD – MCI, p<0.001; d=1.23). However, there were overlaps between the groups and decreased ability appeared in all groups. Conclusions. Persons with cognitive impairment are likely to have decreased ability to manage everyday technology. Since their decreased ability can have disabling consequences, ability to manage technology is important to consider when assessing ability to perform everyday activities., The authors first of all want to thank the participants who generously demonstrated their management of everyday technology for them. They also want to thank the professionals at the investigation units who helped them to recruit participants. Particularly, the authors would like to thank Sofia Starkhammar, Monica Pantzar, Jenny Rasmussen Tjernlund, Susanne Andersson, Lizette Mårtensson, and Maria Carlsson for data collection and management.

This study's purpose was comparing perceived relevance of and difficulty in use of everyday technology such as remote controls, cell phones, and microwave ovens, in older adults with/without cognitive deficits. Three groups included 157 participants; 34 had mild-stage dementia, 30 had mild cognitive impairment (MCI), and 93 lacked known cognitive impairments. Data were collected in structured interviews with the Everyday Technology Use Questionnaire (ETUQ). Analyses revealed that participants with no known cognitive deficits (Group 3) considered a higher proportion of technologies relevant to their life situation than participants with mild-stage dementia (Group 1) and those with MCI (Group 2). Furthermore, participants with no known cognitive deficits reported the lowest mean level of perceived difficulty in everyday technology use, followed by those with MCI and those with mild-stage dementia. All three groups differed significantly (p <0.01; p <0.001) in perceived difficulty using technology, indicating that measurement of perceived difficulty in everyday technology use may sensitively detect changes resulting from MCI/dementia. Findings indicate that perceived difficulty in using everyday technology increases in people with MCI and is accentuated in mild-stage dementia. This calls for increased attention to these issues when assessing functional ability in daily activities of older adults with possible MCI/dementia, and for further research. © 2009 Informa UK Ltd.

Resumen: Este artículo se centra en los perfiles de salud de la poblacion más madura y defiende la hipótesis de que el estado de salud de los más viejos se ha visto afectado significativamente por la evolución de la mortalidad en los países de la región. Utilizamos el SABE (Survey on Health and Well-Being of Elders) sobre una muestra representativa del tipo cross-section de 10.000 personas de 60 años y más, mediante encuestas realizadas a domicilio en siete grandes ciudades de América Latina y del Caribe. Analizamos los siguientes indicadores de salud: el estado de salud subjetivo (basándonos en la declaración de los encuestados), las limitaciones funcionales, las actividades cotidianas (Activities of Daily Living -ADL-) y las actividades instrumentales cotidianas (Instrumental Activities of Daily Living -IADL-), la obesidad (relación entre el peso en kilogramos y el cuadrado de la altura en centímetros) y las condiciones crónicas según la declaración de los encuestados (incluyéndose la diabetes). Analizamos las pautas de salud y las condiciones crónicas y de enfermedad confesadas por el entrevistado; también examinamos la relación entre las condiciones de la infancia y la salud en el adulto. En particular, pretendemos demostrar que las condiciones de salud de la infancia tienen relación con la salud en la etapa adulta. Sin embargo, las relaciones no son fuertes y la evidencia es bastante débil aún en el mejor de los casos.

Este artigo céntrase nos perfís de saúde da poboacion máis madura e defende a hipótese de que o estado de saúde dos máis vellos viuse afectado significativamente pola evolución da mortalidade nos países da rexión. Utilizamos o SABE (Survey on Health and Well-Being of Elders) sobre unha mostra representativa do tipo cross-section de 10.000 persoas de 60 anos e máis, mediante enquisas realizadas a domicilio en sete grandes cidades de América Latina e do Caribe. Analizamos os seguintes indicadores de saúde: o estado de saúde subxectivo (baseándonos na declaración dos enquisados), as limitacións funcionais, as actividades cotiás (Activities of Daily Living -ADL-) e as actividades instrumentais cotiás (Instrumental Activities of Daily Living -IADL-), a obesidade (relación entre o peso en quilogramos e o cadrado da altura en centímetros) e as condicións crónicas segundo a declaración dos enquisados (incluíndose a diabetes). Analizamos as pautas de saúde e as condicións crónicas e de enfermidade confesadas polo entrevistado; tamén examinamos a relación entre as condicións da infancia e a saúde no adulto. En particular, pretendemos demostrar que as condicións de saúde da infancia teñen relación coa saúde na etapa adulta. Con todo, as relacións non son fortes e a evidencia é bastante feble aínda no mellor dos casos, Este artículo se centra en los perfiles de salud de la poblacion más madura y defiende la hipótesis de que el estado de salud de los más viejos se ha visto afectado significativamente por la evolución de la mortalidad en los países de la región. Utilizamos el SABE (Survey on Health and Well-Being of Elders) sobre una muestra representativa del tipo cross-section de 10.000 personas de 60 años y más, mediante encuestas realizadas a domicilio en siete grandes ciudades de América Latina y del Caribe. Analizamos los siguientes indicadores de salud: el estado de salud subjetivo (basándonos en la declaración de los encuestados), las limitaciones funcionales, las actividades cotidianas (Activities of Daily Living -ADL-) y las actividades instrumentales cotidianas (Instrumental Activities of Daily Living -IADL-), la obesidad (relación entre el peso en kilogramos y el cuadrado de la altura en centímetros) y las condiciones crónicas según la declaración de los encuestados (incluyéndose la diabetes). Analizamos las pautas de salud y las condiciones crónicas y de enfermedad confesadas por el entrevistado; también examinamos la relación entre las condiciones de la infancia y la salud en el adulto. En particular, pretendemos demostrar que las condiciones de salud de la infancia tienen relación con la salud en la etapa adulta. Sin embargo, las relaciones no son fuertes y la evidencia es bastante débil aún en el mejor de los casos, This paper focuses on elderly health profiles and examines the conjecture that elderly health status has been significantly impacted by the evolution of mortality in countries of the region. We use SABE (Survey on Health and Well-Being of Elders), a cross-sectional representative sample of over 10,000 elderly aged 60 and above in private homes fielded in seven major cities in Latin America and the Caribbean. We examine the following health outcomes: self-reported health, functional limitations-Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s), obesity (ratio of weight in kilograms to the square of height in centimeters), and self reported chronic conditions (including diabetes). We examine patterns of self-reported health, self-reported chronic conditions, and disability. We also examine relations between early childhood conditions and adult health. In particular, we attempt to illustrate the idea that early childhood conditions and adult health are related. However, the relations are not strong and the evidence for it is weak at best

The improvement in cognitive performances due to cholinesterase inhibitors (ChEls) is not homogeneous among Alzheimer's disease (AD) subjects. Aim of this study is to evaluate whether a specific pattern of change in mini mental state examination (MMSE) could be observed in AD subjects after 9-month treatment with ChEls. From September 2000 to September 2002, 99 subjects enrolled in the CRONOS project. They have never been previously treated with ChEls. All of them completed both the 3- and the 9-month follow-up. The multidimensional assessment included MMSE, activity of daily living (ADL), instrumental activity of daily living (IADL), somatic health status, according to design of the CRONOS project. The MMSE was analyzed both as a total score and disaggregated in 11 items. All subjects were divided in 2 groups according to the degree of change in MMSE total score from baseline to the 9th month. Subjects with a change ≤ -1 were defined as non-responders (NR), whereas those with a change ≥0 as responders (R). At start, no statistically significant differences were found between the 2 groups. MMSE score was significantly higher in the R group both at 3 (p < 0.0001) and 9 months (p < 0.0001), while functional status (ADL and IADL) was significantly lower in NR group at 9 months (p = 0.025; p = 0.018, respectively). In MMSE qualitative analysis of 3-month, NR significantly worsened in temporal (p ≤ 0.05) and spatial orientation (p ≤ 0.001), and in delayed recall items (p ≤ 0.0005) in comparison to their counterpart. At 9-month the differences between the 2 groups were observed also for registration (p < 0.001), attention (p ≥ 0.0005), obeying oral commands (p < 0.0005), reading and obeying commands (p ≤ 0.0005), writing a sentence (p ≤ 0.0005) and copying a design (p ≤ 0.05). In a multivariate regression model, after adjustment for demographic (age, education, gender) and clinical factors (duration of disease), only the change at 3 months in 5 MMSE items (temporal and sp