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.

Chronic disease, mobility limitations and low physical functioning are determinants of an earlier age of retirement. Therefore, long-term population trends in these factors may have an impact on the proportion of individuals near traditional retirement age who continue to work. Our objective is to develop a projection model that accounts for trends in these factors in order to estimate the proportion of the population aged 55–74 with the capacity to participate in the labour force. We used logistic regression models to quantify how chronic disease, mobility and functional status predict labour force participation among individuals aged 55–59. Next, we obtained estimates of the population prevalence of each of these predictors for the years 2010–2050. We then used estimated coefficients from the logistic regression models to predict the age-specific probability of capacity for work up to the age of 74. We find that population capacity for work depends on trends in disability and on level of education. Future population capacity for work depends on trends in functional limitations primarily in the population with lower levels of education. Changes in functional limitations, changes in the environment, technology and social policy targeted towards individuals with lower levels of education could result in mitigation of future decreasing capacity for work in the population near retirement age.

Physical functional ability and nutritional status are two major indicators for predicting the risk of mortality in older adults. The present study examined the complementarity of the Activities of Daily Living (ADL) and the Mini-Nutritional Assessment (MNA) for predicting follow-up 4-year all-cause mortality risk in elderly Taiwanese. We analysed data of the ‘Survey of Health and Living Status of the Elderly in Taiwan’, a population-based longitudinal cohort study which involved 2872 men and women of ≥ 65 years old at baseline (1999). We rated their functional dependency with the ADL scale and nutritional status with the MNA (both the long form, LF and the short form, SF) at baseline, and analysed the complementarity of the two scales in predicting follow-up 4-year all-cause mortality with Cox regression analysis and the net reclassification improvement (NRI) to quantify the improvement. The results showed that both ADL and MNA offered improvement in predicting follow-up mortality risk beyond that predicted by either one alone according to the Akaike information criterion and the NRI. The MNA-SF was nearly as effective as the MNA-LF in improving the predictive ability of the ADL. The present study suggests that the MNA (especially the SF because of its simplicity and time-saving feature) together with the ADL scale might be of value for predicting the mortality risk of frail elderly living in various settings.

Neuropsychologists are often asked to answer questions about the effects of cognitive deficits on everyday functioning. This study examined the relationship between and the cognitive correlates of self-report, performance-based, and direct observation measures commonly used as proxy measures for everyday functioning. Participants were 88 community-dwelling, cognitively healthy older adults (age 50–86 years). Participants completed standardized neuropsychological tests and questionnaires, and performed eight activities of daily living (e.g., water plants, fill a medication dispenser) while under direct observation in a campus apartment. All proxy measures of everyday function were sensitive to the effects of healthy cognitive aging. After controlling for age, cognitive predictors explained a unique amount of the variance for only the performance-based behavioral simulation measure (i.e., Revised Observed Tasks of Daily Living). The self-report instrumental activities of daily living (IADL) and the performance-based everyday problem-solving test (i.e., EPT) did not correlate with each other; however, both were unique predictors of the direct observation measure. These findings suggest that neuropsychologists must be cautious in making predictions about the quality of everyday activity completion in cognitively healthy older adults from specific cognitive functions. The findings further suggest that a self-report of IADLs and the performance-based EPT may be useful measures for assessing everyday functional status in cognitively healthy older adults. (JINS, 2011, 17, 853–864)

Poor functional status and high rates of anxiety and depression have been reported in individuals who have sustained a traumatic brain injury (TBI). However, it is unclear whether psychiatric disorders after TBI are a cause or a consequence of functional limitations. The current study aimed to investigate the temporal relationship between anxiety, depression and functional impairment following TBI. The study has a prospective, longitudinal single-group design. Anxiety and depression, assessed using the Structured Clinical Interview for DSM-IV, and functional changes, assessed with the Glasgow Outcome Scale—Extended, were measured six and 12 months post-injury in 122 individuals who had sustained a TBI (79% male, mean age 35 years, mean duration of post-traumatic amnesia 24 days, mean Glasgow Coma Scale score 9.2). Cross-lagged analyses were conducted within a structural equation modelling framework. Functional changes six months post-injury predicted depression and anxiety one year after the injury. Anxiety and depression, in turn, were not predictive of later functional status. This study adds to our understanding of the temporal relationship between depression, anxiety and functional status after TBI. The results indicate the importance of supporting brain injured individuals in coping with the functional consequences of their injury in order promote psychological well-being. (JINS, 2011, 17, 781–787)

Background: The purpose of this study was to examine the mediating impact of executive functioning on the link between other neuropsychological domain scores and informant-based rating of functional status.

Methods: Data on 181 participants were analyzed from an ongoing epidemiological study of rural health, Project FRONTIER (mean age = 64.6 ± 13.8 years, 69% women, 42% Mexican American). Executive functioning was assessed by the EXIT25 and other neuropsychological domains were assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Informant-based rating of functional status was assessed via the Clinical Dementia Rating Scale sum of boxes scores (CDR SB).

Results: RBANS Index scores were each significantly (p < 0.05) related to CDR SB scores and EXIT25 scores. EXIT25 score was a significant partial mediator of the link between four RBANS indices (Immediate Memory, Attention, Visuospatial/Construction, Delayed Memory) and CDR SB scores, and a complete mediator of the fifth index (Language).

Conclusion: Executive functioning is a mediator of the link between other neuropsychological domains and daily functioning. Neuropsychological assessments that do not measure executive functioning will provide only a partial clinical picture with adults and elders.

Over the past 15 to 20 years there has been discussion and debate in the gerontological literature about the relative merits of self-report versus performance-based observational (PBO) measures of functional status. In 2001 the Aging in Manitoba Longitudinal Study had the opportunity to add a PBO measure of functional status and use it together with two self-report measures on a sub-sample of 138 participants. The PBO measure that was used was the Performance Assessment of Self-Care Skills, Version 3.1 (Home). Using ranks of the proportion of participants who were independent in nine different tasks, no significant correlations were found between the performance measure scores and either of the self-report measures. This finding suggests that using self-report data rather than performance data could lead program developers and policy makers to different conclusions about the extent of need for assistance among older adults.

Background: Previous studies have reported an association between executive dysfunction and the ability to perform activities of daily living (ADL)s among older adults. This study aims to examine the association between executive functions and functional status in a cross-section of older adults with varying degrees of cognitive impairment.

Methods: 89 individuals (mean age 73.8 years) were recruited at a memory clinic in São Paulo, Brazil. Subjects underwent evaluation, and were allocated into three diagnostic groups according to cognitive status: normal controls (NC, n = 32), mild cognitive impairment (MCI, n = 31) and mild Alzheimer's disease (AD, n = 26). Executive functions were assessed with the 25-item Executive Interview (EXIT25), and functional status was measured with the Direct Assessment of Functional Status test (DAFS-R).

Results: Significantly different total DAFS-R scores were observed across the three diagnostic groups. Patients with AD performed significantly worse in EXIT25 compared with subjects without dementia, and no significant differences were detected between NC and MCI patients. We found a robust negative correlation between the DAFS-R and the EXIT25 scores (r =–0.872, p < 0.001). Linear regression analyses suggested a significant influence of the EXIT-25 and the CAMCOG on the DAFS-R scores.

Conclusion: Executive dysfunction and decline in general measures of cognitive functioning are associated with a lower ability to undertake instrumental ADLs. MCI patients showed worse functional status than NC subjects. MCI patients may show subtle changes in functional status that may only be captured by objective measures of ADLs.

The major purpose of this study was to examine the effects of socio-economic status (SES) on changes in functional abilities, as measured by Activities of Daily Living (ADL) scales, among older people in Taiwan. A prospective longitudinal study design was used. A panel of 874 community-dwelling older people were followed over four years (1994 to 1998). Three SES indicators, education, having ‘extra’ money (more than required for basic necessities), and principal lifetime occupation were included in separate multiple logistic regression models of functional change in physical ADL (PADL) and in instrumental ADL (IADL). Over the four years, the study cohort experienced greater decreases in IADL functioning than in PADL functioning. Having ‘extra’ money was significantly and negatively associated with PADL decline, while level of education had a strong positive relationship with IADL functioning. In addition to SES, age was significantly associated with PADL and IADL functioning change. The paper also reports a comparison of similar findings from several eastern and western countries. This has established that among the available SES indicators, the level of education has most consistently been shown in both eastern and western population studies to be related to health and health change, and that self-perceived economic resource is also related to older people's health in Asian populations.

This study examines the environmental and psychosocial determinants of depression in older adults. Based on Lawton's environmental docility thesis, the question is posed: is the strong association between functional limitations and depressive symptomatology affected when environmental conditions, objective and subjective efficacy, and docile or proactive behaviour are taken into account. Data were used from LASA (the Longitudinal Aging Study Amsterdam), a national survey of the population between 55 and 85 years of age, stratified by age and sex. Hierarchical regression analyses were performed on the data of 2,981 respondents. Empirical support was found for the extended Lawton model, including both environmental, efficacy and behavioural factors. In particular, living in a more urbanised area, not being able to perform heavy household tasks, having a low self-efficacy, not feeling safe, receiving help from others and having few social contacts within the neighbourhood, increase depressive symptoms in general but, in particular, when combined with lower functional status. It is concluded that both being able and feeling able to influence one's environment increases proactive behaviour and decreases depressive symptomatology in older adults with low functional status.