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Independent Living - Top 30 Publications

The OCarePlatform: A context-aware system to support independent living.

Currently, healthcare services, such as institutional care facilities, are burdened with an increasing number of elderly people and individuals with chronic illnesses and a decreasing number of competent caregivers.

New or Worsening Symptoms and Signs in Community-Dwelling Persons with Dementia: Incidence and Relation to Use of Acute Medical Services.

To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD).

Smart-home technologies were found to support some domains of independent living when ageing at home: Perspectives of older adult consumers', families, health professionals and service providers.

Helping children with serious conditions return to their families.

Eleven years ago, Linda Partridge joined the WellChild charity, with a mission to alter the care of children with complex health needs. She has done just that. As director of programmes, Ms Partridge has overseen the creation of a network of WellChild nurses to help children with serious conditions leave hospital and return to their families.

Processes of developing 'community livability' in older age.

'Community livability' is a widely used term that is still under-conceptualized. The purpose of the project was to theorize key dynamics of livability for older adults who are aging in place in their homes and communities.

Oscillating in and out of place: Experiences of older adults residing in homeless shelters in Montreal, Quebec.

Aging in place is desirable from the perspective of older adults and policy makers alike. However, the meaning of 'place' for adults experiencing homelessness has been largely overlooked. Addressing this gap, this constructivist grounded theory study discusses the meaning of place for 15 older adults residing in emergency homeless shelters in Montreal, Quebec. Findings revealed that four interrelated dimensions of place-that is, control, comfort, privacy, and security were instrumental in supporting participants' ability to feel in place across housed-homeless trajectories. Many felt out of place well before they lost their housing and some felt more in place during homelessness when shelter conditions and interpersonal relations supported these four dimensions. The empirically-driven model oscillating in and out of place extends and nuances existing understandings of aging in place and provides insights into policy and practice solutions for older adults who may not have a stable place to call home.

Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.

Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

Handgrip Strength Is Positively Associated with Mildly Elevated Serum Bilirubin Levels among Community-Dwelling Adults.

Handgrip strength (HGS) is a useful measure of health-related quality of life and general muscle strength. Serum total bilirubin (T-B) may present potential beneficial effects in preventing oxidative changes which are associated with a risk of metabolic syndrome and the development of cardiovascular disease. Limited information is available regarding whether HGS is an independent confounding factor for serum T-B. The study participants were 214 men aged 71 ± 8 (mean ± standard deviation) years and 302 women aged 71 ± 7 years that were enrolled consecutively from among paticipants aged ≥ 50 years through an annual check-up process. We evaluated the relationship between serum T-B and confounding factors within each sex. HGS related significantly with serum T-B in both men (r = 0.156, p = 0.023) and women (r = 0.173, p = 0.003). Multiple linear regression analysis showed that in men, HGS (β = 0.173) as well as smoking status (β = -0.147), exercise habit (β = 0.138), low-density lipoprotein cholesterol (β = 0.146), and hemoglobin A1c (HbA1c) (β = -0.198) were significantly and independently associated with serum T-B. In women, HGS (β = 0.159) as well as smoking status (β = -0.116), high-density lipoprotein cholesterol (β = 0.159), and HbA1c (β = -0.161) were significantly and independently associated with serum T-B. Multivariate-adjusted serum T-B levels were significantly lower in subjects with the lowest HGS level in both sexes. Increased HGS is strongly associated with increased serum T-B, independent of confounding factors in both sexes.

Meanings of balance for people with long-term illnesses.

The aim of this study was to elucidate meanings of balance in everyday life for people with long-term illnesses living at home. People living with long-term illnesses are in need of help and support to manage their daily lives. Twelve adults with extensive needs for help and support were interviewed. A phenomenological hermeneutic interpretation was used to analyse the interview texts. The findings show that balance in everyday life for people with long-term illnesses means striving for independence through care and support in their surroundings. It was also important to be able to choose how their lives would be and to be with others who listened and understood them for who they are. By building a relationship with patients at an early stage of their illnesses, nursing staff have an opportunity to understand what people who are living at home with long-term illnesses need in order to achieve balance in their everyday lives.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults.

Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention.

Association between oral health status and central obesity among Brazilian independent-living elderly.

The aim of this study was to investigate the association between oral health status and central obesity (CO) in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC) and waist-hip ratio (WHR). Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17-5.80), being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11-4.93), and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01-6.95). Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.

Loss of independence in early Parkinson disease: A 5-year population-based incident cohort study.

To determine the risk, predictors, and prognosis of independence loss and institutionalization in patients with early Parkinson disease (PD).

The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation.

The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation.

Exercise prescription to reverse frailty.

Frailty is a clinical geriatric syndrome caused by physiological deficits across multiple systems. These deficits make it challenging to sustain homeostasis required for the demands of everyday life. Exercise is likely the best therapy to reverse frailty status. Literature to date suggests that pre-frail older adults, those with 1-2 deficits on the Cardiovascular Health Study-Frailty Phenotype (CHS-frailty phenotype), should exercise 2-3 times a week, for 45-60 min. Aerobic, resistance, flexibility, and balance training components should be incorporated but resistance and balance activities should be emphasized. On the other hand, frail (CHS-frailty phenotype ≥ 3 physical deficits) older adults should exercise 3 times per week, for 30-45 min for each session with an emphasis on aerobic training. During aerobic, balance, and flexibility training, both frail and pre-frail older adults should work at an intensity equivalent to a rating of perceived exertion of 3-4 ("somewhat hard") on the Borg CR10 scale. Resistance-training intensity should be based on a percentage of 1-repetition estimated maximum (1RM). Program onset should occur at 55% of 1RM (endurance) and progress to higher intensities of 80% of 1RM (strength) to maximize functional gains. Exercise is the medicine to reverse or mitigate frailty, preserve quality of life, and restore independent functioning in older adults at risk of frailty.

The androgen receptor gene CAG repeat 
in relation to 4-year changes in 
androgen-sensitive endpoints in 
community-dwelling older European men.

The androgen receptor (AR) gene exon 1 CAG repeat length has been proposed to be a determinant of between-individual variations in androgen action in target tissues, which might regulate phenotypic differences of human ageing. However, findings on its phenotypic effects are inconclusive.

The inter-rater reliability of the Risk Instrument for Screening in the Community.

Predicting risk of adverse healthcare outcomes is important to enable targeted delivery of interventions. The Risk Instrument for Screening in the Community (RISC), designed for use by public health nurses (PHNs), measures the 1-year risk of hospitalisation, institutionalisation and death in community-dwelling older adults according to a five-point global risk score: from low (score 1,2) to medium (3) to high (4,5). We examined the inter-rater reliability (IRR) of the RISC between student PHNs (n=32) and expert raters using six cases (two low, medium and high-risk), scored before and after RISC training. Correlations increased for each adverse outcome, statistically significantly for institutionalisation (r=0.72 to 0.80, p=0.04) and hospitalisation (r=0.51 to 0.71, p<0.01) but not death. Training improved accuracy for low-risk but not all high-risk cases. Overall, the RISC showed good IRR, which increased after RISC training. That reliability fell for some high-risk cases suggests that the training programme requires adjustment to improve IRR further.

Creating a Regional Healthcare Network: People First.

Care organizations in the Dutch region Apeldoorn want to collaborate more in order to improve the care provision to elderly and psychiatric patients living independently. In order to support the collaboration they intend to create a regional digital healthcare network. The research was focused on the relevance of a regional healthcare network for care providers. Eleven semi-structured interviews based on the USE IT-model, were conducted with care providers and staff members. Results show that care providers need to tune their activities for this target group and create an agreement on integrated care. The relevance of a digital communication and collaboration platform is high. The regional healthcare network should support the collaboration between care providers by: 1. Offering a communication platform to replace the time consuming communication by telephone; 2. Making patient information available for patient and care provider at patients' homes; 3. Giving insight in who is giving what care to whom; and 4. Giving access to knowledge about the target group: elderly and psychiatric patients living independently.

Oral health-related quality of life in an aging Canadian population.

Measuring oral health-related quality of life (QOL) reflects that dentistry interventions aim to improve life rather than merely prolong life.

Association of depression and psychotropic medication on cardiac-related outcomes in a nationwide community-dwelling elderly population in Taiwan.

The objective of this study was to examine the association of depression, psychotropic medications, and mental illness with cardiovascular disease in a nationwide community-dwelling elderly population in Taiwan. A total of 5664 participants who enrolled in the Healthy Aging Longitudinal Study in Taiwan (HALST) were included in the study. Multiple logistic regression was applied to investigate the association of depression, psychotropic medication use, and mental illness, separately, with cardiovascular disease. The results suggested that cardiovascular disease was significantly associated with various definitions of depression, including: the Center for Epidemiologic Studies-Depression scale (CES-D) ≥ 16, self-reported, and physician-diagnosed for depression (adjusted odds ratio [AOR] = 1.51; 95% confidence interval (CI): 1.14-2.00 for CES-D; AOR = 3.29; 95% CI: 1.99-5.42 for self-reported; and AOR = 2.45; 95% CI: 1.51-3.97 for physician-diagnosed). Additionally, significant associations of cardiovascular disease with the use of antipsychotics (AOR = 2.04; 95% CI: 1.25-3.34), benzodiazepines (BZDs) (AOR = 1.84; 95% CI: 1.52-2.21), and Z-drugs (AOR = 1.41; 95% CI: 1.03-1.93), respectively, were also observed, but not the use of antidepressants. In addition, a significant association of cardiovascular disease with mental illness was found in this study (AOR = 2.33; 95% CI: 1.68-3.24). In line with previous reports, these findings provided supportive evidence that depression and/or mental illness were significantly associated with cardiovascular disease in a community-dwelling elderly population in Taiwan. Moreover, significant associations of cardiovascular disease with the use of antipsychotics, BZDs, and Z-drugs, individually, were found. Further investigation would be of importance to clarify the causal relationship of depression and/or psychotropic medications with cardiovascular disease, especially among elderly populations.

Proposal for a New Predictive Scale for Recurrent Risk of Fall in a Cohort of Community-Dwelling Patients with Stroke.

This study aimed to determine risk factors related to the occurrence of falls in stroke patients and to propose a new predictive scale for falls.

Assessment of Activities of Daily Living, Self-Care, and Independence.

Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.

Arthritis and associated limitations in community-dwelling Canadians living with stroke.

Residual impairments and gait deviations post-stroke may lead to secondary musculoskeletal complications such as arthritis. This study explored the prevalence of arthritis and associated functional limitations in community-dwelling Canadians with and without stroke.

Assertive community treatment: promoting engagement with care of people suffering severe addiction.

Despite the increasing number of specialized addiction services and the constant deployment of health care resources, a coordinated needs-based treatment is not always available for people with severe drugs and/or alcohol problems. Too often the involved health care professionals feel helpless and overwhelmed by the complexity of the situation. In order to promote the treatment engagement of the hard-to-reach substance users, a multidisciplinary mobile team project for addiction (SIMA) was developed in Lausanne, Switzerland, in 20174. This paper describes the model of intervention, the profile of the population followed during the first year of intervention and illustrates, through two clinical cases, the advantages of this approach.

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis.

Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.

Associations between hospital-based rehabilitation for hip fracture and two-year outcomes for mortality and independent living: An Australian database study of 1,724 elderly community-dwelling patients.

To compare rates of mortality, hospital readmissions and independent living status for 2 years following hip fracture in community-dwelling patients with and without hospital-based rehabilitation.

Maintaining Independence Through Screening.

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults.

The study purpose was to assess the effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories associated with emergency department visit only, hospitalization, and no event.

Prevalence of Inadequate Nutrient Intake in Japanese Community-Dwelling Older Adults Who Live Alone.

Dietary assessment of community-dwelling Japanese older adults who live alone using Dietary Reference Intakes (DRIs) is limited. The present study aimed to estimate the prevalence of inadequate nutrient intake among Japanese community-dwelling older adults by sex and young-old and old-old population groups to identify the most vulnerable groups that need support. A cross-sectional survey was conducted from October 2012 to October 2013 with community-dwelling adults aged 65 y or older who lived alone. Participants were drawn from six cities in four Japanese prefectures. We used two days of dietary survey data to estimate participants' usual intake. The proportion of inadequate intake was assessed using the Estimated Average Requirement (EAR) cut-point method, Tolerable Upper Intake Level, and the tentative dietary goal for preventing life-style related diseases (DG) based on DRIs for Japanese, 2015. Data for 494 participants (162 male, 332 female) over 988 d were examined to assess nutrient intake. We calculated the proportion of inadequate intake between males and females and between young-old and old-old population groups (65-74 y and ≥75 y) using chi-square or Fisher's exact tests. For six nutrients, the estimated proportion of participants with a usual intake below EAR was higher in males than females. In addition, a higher estimated proportion of female participants was within the DG range for the percentage of energy from protein, fat, and carbohydrates, and had a usual intake of two nutrients above DG than males. Our findings showed that among Japanese older adults, males were more vulnerable in terms of inadequate nutrient intake compared with females.

Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.

Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home.

Rural-urban differences in the prevalence of cognitive impairment in independent community-dwelling elderly residents of Ojiya city, Niigata Prefecture, Japan.

This study aimed to examine rural-urban differences in the prevalence of cognitive impairment in Japan.