Yes / Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence. / Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) grant ES/L001853/2; Alzheimer’s Society as a Centre of Excellence, grant number 348, AS-PR2-16-001

No description available.

THESIS ABSTRACT Name: Bc. Lenka Košnarová Supervisor: Mária Krivošíková, M.Sc. Opponent: Title of thesis: Memory disorders assessment in patients with Alzheimer's disease Abstract: Objective: The main objective of the thesis was to investigate the impact of memory disorders on self-care in patients with Alzheimer's disease (AD). Another objective of the thesis was to determine whether age of patients with AD affects occupational performance in daily living activities. Methods: The sample was consist of 50 probands (11 men, 39 women), who were diagnosed AD by physician. For data collection was used a questionnaire Bristol Activities of Daily Living scale (BADLS) evaluating self-care and Contextual Memory Test (CMT) for evaluation of memory disorders. Testing the hypothesis was performed by correlation the corrected Spearman correlation coefficient and regression analysis. Results: The thesis results confirmed a significant correlation between BADLS scores and CMT scores - immediate recall (rSp = .51; p<0.05), delay recall (rSp = .42; p<0.05), total (rSp = .48; p<0.05). Furthermore, research results suggest that memory impairment occur more with PADLS. There also was no statistically significant relationship between age and performance of activities of daily living (ADL) coefficient (rSp = .07; p<0.05)....

Many elderly patients visiting the emergency department for minor injuries are not assessed for functional status and experience functional decline 6 months post injury. Identifying such high-risk patients can allow for interventions to prevent or minimize adverse health outcomes including loss of independence. For the purpose of a planned clinical decision rule to identify elderly patients at high risk of functional decline a survey of physicians was conducted. A random sample of 534 Canadian geriatricians, emergency and family physicians was selected with half randomly selected to receive an incentive. A response rate of 57.0% was obtained with 90% of physicians considering a drop in function of at least 2 points on the 28-point OARS ADL scale as clinically significant. A sensitivity of 90% would meet or exceed 90% of physicians' requirements for a clinical decision rule to identify injured seniors at high risk of functional decline 6 months post injury.

Many elderly patients visiting the emergency department for minor injuries are not assessed for functional status and experience functional decline 6 months post injury. Identifying such high-risk patients can allow for interventions to prevent or minimize adverse health outcomes including loss of independence. For the purpose of a planned clinical decision rule to identify elderly patients at high risk of functional decline a survey of physicians was conducted. A random sample of 534 Canadian geriatricians, emergency and family physicians was selected with half randomly selected to receive an incentive. A response rate of 57.0% was obtained with 90% of physicians considering a drop in function of at least 2 points on the 28-point OARS ADL scale as clinically significant. A sensitivity of 90% would meet or exceed 90% of physicians' requirements for a clinical decision rule to identify injured seniors at high risk of functional decline 6 months post injury.

The overall aim was to improve knowledge of the consequences of cognitive dysfunction in everyday life and of instruments to make these assessments. The thesis contains four studies each of different design using different populations. In study I, the relationship between cognitive function, ability to perform activities of daily living and perceived health-related quality of life were investigated in a population of 85-year-old individuals in the community of Linköping (n = 373). The study was part of the Elderly in Linköping Screening Assessment 85 (ELSA 85). Even mild cognitive dysfunction correlated with impaired ability to perform activities of daily living and lower health-related quality of life. In study II, the diagnostic accuracy and clinical utility of Cognistat, a cognitive screening instrument, were evaluated for identifying individuals with cognitive impairment in a primary care population. Cognistat has relatively good diagnostic accuracy with a sensitivity of 0.85, a specificity of 0.79 and a Clinical Utility Index (CUI) of 0.72. The corresponding values were 0.59, 0.91 and 0.53 for the Mini Mental State Examination (MMSE), and 0.26, 0.88 and 0.20 for the Clock Drawing Test (CDT). In study III, the aim was to develop an instrument measuring self-perceived or caregiver reported ability to perform everyday life activities in persons with suspected cognitive impairment or dementia and to perform psychometric testing of this instrument, named the Cognitive Impairment in Daily Life (CID). The CID was found to have good content validity. In study IV, experiences of cognitive impairment, its consequences in everyday life and the need for support in persons with mild cognitive impairment (MCI) or mild dementia and their relatives were explored. Interviews were performed with five people with MCI, eight people with mild dementia and their relatives (n = 13). The main finding was that persons with MCI and dementia experienced cognitive changes that could be burdensome and result in changed activity patterns. In conclusion, the findings support earlier research and show that cognitive dysfunction even at mild stages has an impact on everyday life and reduces perceived quality of life. To improve interventions for persons with cognitive impairment, it is important to assess not only cognitive function but also its consequences in everyday life activities.

Chronic pain is a widespread problem, especially in the older population, and can affect various aspects of daily living. At a time when it has been acknowledged that the population is increasingly ageing, research regarding the effects of chronic pain on the daily living of older adults is essential. Furthermore, the development of innovative technology is changing the way that much research is being conducted, and can lead to the retrieval of novel information, using a fresh approach. The adoption of this technology in the field of chronic pain research has the potential to examine various aspects of the daily living of older adults living with chronic pain using a different approach to previous research. This study is underpinned by a Critical Realist ontology and Hermeneutic epistemology and follows a Generic Qualitative Research methodology (Caelli, et al., 2003). The aim of the study was not to generalise the findings but to gather a deep theoretical description of the outcomes and offer an explanation of these findings based on an analysis of the multiple research methods used within the study. This study had two main aims and was split into two sections according to the aims. Firstly, Part A of this study aimed to explore a range of day-to-day patterns and experiences of functioning in older adults suffering from chronic pain. Part B aimed to explore the usability, acceptance and experience of the technology used to measure functioning as part of the first aim of this study. Part B also aimed to look at the practicalities the participants were faced with when using the technology. A mixed methods design was used for Part A in which 15 older adults (65+) living with chronic pain (pain >3 months) took part in an in-depth study lasting seven days. As well as the 15 core participants that took part in the study, two older adults (65+) without chronic pain and two younger adults (<65) with chronic pain took part in the study in order to provide some insight into the effects of either pain, or age, on functioning. Part A used four data collection techniques to gather data upon the daily functioning of older adults with chronic pain; the Daily Reconstruction Method diary (Kahneman, Krueger, Schkade, Schwarz, Stone, 2004), the Sensecam (also known as the Vicon Revue, Vicon©), the LifeShirt (Vivometrics Inc) and a semi-structured interview. However, although the LifeShirt was validated, as part of this PhD, and used throughout the study, the gathered data was not analysed due to multiple problems with the data. The Daily Reconstruction Method, Sensecam and the semi-structured interview were each analysed separately before the results of the Daily Reconstruction Method and Sensecam were integrated into the themes derived from the semi-structured interviews. The integrated results led to the development of two themes, each with sub-themes; ‘effect on daily living’ and ‘managing pain and functioning’. The themes from Part A highlighted the way in which pain affected functioning and the modifications to daily functioning as a result of chronic pain. The way in which individuals perceived the management of their own pain and functioning, as well as strategies and assistive devices to manage pain and functioning were also discussed. This study has furthered current knowledge due to the idiographic nature of the study, as well as multiple, novel, data collection tools used, adding additional details to how tasks have been modified, reduced, or terminated. Part B of this study used the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh, et al., 2003), the Flow-State Scale (Jackson & Marsh, 1996) and semi-structured interviews to explore participants’ use of both the Sensecam and LifeShirt. The questionnaires and interviews were carried out with all of the individuals that carried out Part A of this research. From the semi-structured interviews two main themes were reported, each with sub-themes; ‘expectations and experiences’ and ‘awareness of equipment’. Two concepts developed from the themes within Part B that were specific to the participants’ experiences of wearing wearable technology in this study, as opposed to ‘typical’ non-wearable technology; specifically, the importance of design and the importance of others. Both of these overarching concepts affected the expectations of the technology, the experiences of using the technology, as well as the awareness of the technology during use. Furthermore, both concepts will remain and are long-lasting, despite the development of the technology in this field, but there are specific details that are contemporary and are specific to either the Sensecam or the LifeShirt as used in this study.

Introdução: As órteses são recursos terapêuticos auxiliares indicados para alívio da dor, melhora do padrão funcional ou aplicação de forças para correção de deformidades. Existe uma carência de estudos que analisem as alterações biomecânicas promovidas pelas órteses no padrão funcional do membro superior. O objetivo do presente estudo foi analisar os efeitos biomecânicos do ombro e do cotovelo com o uso de órteses funcionais em pacientes com disfunções decorrentes de traumas do sistema musculoesquelético. Métodos: O estudo analisou as alterações do padrão de movimento com o uso das órteses dinâmicas e estáticas por meio da análise cinemática e eletromiográfica do membro superior durante a realização de uma tarefa funcional padronizada, sendo que os controles serão os próprios pacientes. Os movimentos analisados foram flexão-extensão de ombro, abdução-adução de ombro, rotação interna-rotação externa de ombro, flexão-extensão de cotovelo, pronação-supinação. Na eletromiografia foi analisada a integral normalizada dos músculos trapézio superior, bíceps braquial e tríceps braquial. Além disso foi realizada dinamometria isométrica de preensão e pinças, bem como a aplicação do questionário QuickDASH sobre sintomatologia e funcionalidade. Foram incluídos 6 pacientes, maiores de 18 anos, com disfunções decorrentes de lesões nervosas periféricas e deformidades musculoesqueléticas decorrentes de artrite reumatóide, que tiveram indicação do uso de órtese. Resultados: embora as órteses estáticas sejam indicadas para correção de desvio ulnar e para bloqueio de garra mista, de acordo com os resultados deste estudo, não agregaram em termos de funcionalidade. Neste último modelo, um voluntário apresentou diferença clinicamente importante de 22,7 pontos, sinalizando piora da função na situação com órtese. Além disso, as órteses para bloqueio de garra mista demandaram maior recrutamento de trapézio superior e bíceps braquial. As órteses dinâmicas para lesão do nervo radial parecem favorecer a força de preensão estática, porém, promoveram compensações proximais durante a execução de tarefas dinâmicas, que envolveram elevação e deslocamento do membro superior, em termos de amplitude de movimento de abdução de ombro, flexão e pronação de cotovelo / Introduction: Orthoses are therapeutic resources that are indicated for pain relief, improvement of the functional pattern and / or to correct deformities. There is a lack of studies that analyze the biomechanical alterations promoted by the orthoses in the functional pattern of the upper limb. The aim of the present study was to analyze the biomechanical effects in shoulder and elbow promoted by orthoses in patients with upper extremity dysfunctions due to trauma of the musculoskeletal system. Methods: The range of motion and muscle activation was collected simultaneously during the performance of a standardized functional task with and witho no orthosis. The movements analyzed were shoulder flexion-extension, shoulder abduction-adduction, shoulder internal-external rotation, elbow flexion-extension, pronation-supination and the integrated electromyography signal of the upper trapezius, brachial bíceps and brachial triceps muscles were analyzed. In addition, isometric dynamometry of gripping and pinch, besides the application of the questionnaire QuickDASH about symptomatology and functionality. Were included six patients, older than 18 years, with peripheral nerve dysfunction and musculoskeletal deformities due to rheumatoid arthritis, who had indication of the use of orthosis. Results: although the static orthosis are indicated for correction of ulnar deviation and MCP extension-blocking, according to the results of this study, they did not add in terms of functionality. MCP extension-bloking orthosis promoted a clinically important difference of 22,7 points, suggesting worsing of the funtion. In addition, this model demanded greater proximal muscular recruitment of upper trapezius and brachial biceps. Dynamic orthoses for radial nerve injury seem to favor static grip strength, but they promoted proximal compensations during the execution of dynamic tasks, that involved elevation and displacement of the upper limb in terms of shoulder abduction, flexion and pronation of elbow

É de extrema importância estudar a relação entre capacidade funcional e saúde bucal relacionado à qualidade vida, para auxiliar nos fatores intervenientes tanto no cuidado odontológico como em outras áreas de atenção à saúde do idoso, além de adequar planos de tratamento as reais necessidades de cada indivíduo, proporcionando melhor qualidade de vida. O objetivo desse estudo foi investigar a capacidade funcional e saúde bucal relacionada à qualidade de vida do idoso. Foram incluídos na pesquisa idosos acima de 65 anos que residem em área de cobertura da Estratégia Saúde da Família de Bauru. Foram investigadas, através de entrevistas, as variáveis capacidade funcional (Índice de Katz), saúde bucal relacionada à qualidade de vida (OHIP-14), condições socioeconômicas e comorbidades. Foram excluídos da pesquisa idosos que apresentavam alterações de compreensão e expressão da comunicação, Para a realização da análise estatística foi utilizado o Teste de Pearson ao nível de significância de 0,05 e a Regressão Linear Multivariada, ao nível de significância de p 0,01. Participaram da pesquisa 238 idosos com 65 anos ou mais, sendo que 56,3% tinham entre 65 e 74 anos e 43,7% tinham 75 anos ou mais, a média geral de idade foi 74,5 anos. Quanto ao sexo, 55,5% eram mulheres, houve predominância da raça branca (65,1%). Quanto a variável capacidade funcional, 8,8% apresentaram incapacidade funcional intermediária ou severa. Sobre os aspectos socioeconômicos, 61,3% dos idosos apresentaram renda mensal de até dois salários mínimos, 88,2% eram aposentados ou pensionistas, 68,9% tinham algum grau de escolaridade e 57,1% eram casados ou mantinham uma união estável. Quanto a saúde bucal relacionada à qualidade de vida, 20,6% dos entrevistados se sentiram desconfortáveis para mastigar alguns tipos de alimentos. A hipertensão arterial foi a comorbidade mais relatada pelos entrevistados (75,6%). As dimensões dificuldade para mastigar (0,21; p<0,05) e necessidade de parar as refeições (0,21; p<0,05) do instrumento OHIP-14 apresentaram correlação estatisticamente significante com o Índice de Katz. Através da análise multivariada, foi observado que quanto maior a incapacidade menos o idoso se preocupa com a saúde bucal. A alimentação é um aspecto importante da vida diária de qualquer pessoa, especialmente o idoso que apresenta doenças crônicas em maior quantidade e severidade conforme o envelhecimento acontece. Além disso, a incapacidade apresentou tendência de aumento com a idade, no entanto a literatura não permite concluir que o envelhecimento em si seja causa da incapacidade funcional. A maior limitação do estudo se relaciona ao próprio desenho epidemiológico, pois o estudo transversal não permite inferências de causalidade, no entanto a amplitude do grupo etário nesta pesquisa permite observar tendências sobre a capacidade funcional e a saúde bucal relacionada à qualidade de vida em idosos. A incapacidade funcional aumentou com a idade e apresentou tendência de maior impacto negativo na saúde bucal relacionada a qualidade de vida dificultando a realização de refeições. / It is extremely important to study the relation between functional capacity and oral health related quality of life, to assist in intervening factors both in dental care as in other areas of health care for the elderly, and adequate treatment plans the real needs of each individual providing better quality of life. The aim of this study was to investigate the functional capacity and oral health related quality of life of the elderly. They were included in the survey, seniors over 65 residing in the Family Health Strategy coverage area of Bauru. Variables functional capacity (Katz Index), oral health related quality of life (OHIP-14), socioeconomic conditions and comorbidities were investigated through interviews. There were excluded from the research elders that presented understanding and communication expression changes for the statistical analysis we used the Pearson Test at the 0.05 significance level and Multivariate Linear Regression, at a significance level of p <0, 01. The participants were 238 elders aged 65 or more, wherein 56.3% were between 65 and 74 years and 43.7% were 75 years or older, the overall mean age was 74.5 years. As to gender, 55.5% were women, with predominance of Caucasians (65.1%). As for the functional capacity variable, 8.8% had intermediate or severe disability. On socio-economic aspects, 61.3% of seniors had incomes up to twice the minimum wage, 88.2% were retired or pensioners, 68.9% had some degree of schooling and 57.1% were married or maintained a stable relationship. As for oral health related quality of life, 20.6 % of respondents feel uncomfortable to chew some foods. Arterial hypertension was the most reported comorbidity by respondents (75.6 %). The dimensions \"difficulty chewing\" (0.21; p < 0.05) and \"the need to stop meals\" (0.21; p < 0.05) of the OHIP -14 instrument showed a statistically significant correlation with the Katz index. Through multivariate analysis, it was observed that the higher the inability least the elderly care about oral health. Food is an important aspect of daily life for anyone, especially the elderly people who present chronic diseases in greater quantity and severity as aging occurs. Furthermore, the inability showed increased with age, but the literature does not suggest that aging itself is the cause of disability. The major limitation of the study relates to own epidemiological design, as the cross-sectional study does not allow causal inferences; however the extent of the age group in this study allows us to observe trends on the functional status and oral health related quality of life in the elderly. Functional disability increased with age and tended to higher negative impact on oral health related quality of life hindering the realization of meals.

A neuropatia diabética é umas das principais complicações crônicas da Diabetes Mellitus que causa prejuízo nos sistemas somatossensorial e motor resultando em alterações biomecânicas nos padrões de locomoção. Atividades de locomoção da vida diária que provocam maior desafio mecânico e de estabilidade podem ser consideradas como um fator de risco para formação de ulcerações em diabéticos neuropatas. Assim, para o real entendimento da interferência da neuropatia diabética na realidade do paciente diabético, torna-se essencial avaliar a biomecânica de membro inferior durante a execução de tarefas motoras da vida real do paciente. O objetivo deste estudo foi investigar a influência da neuropatia diabética nas características discretas e das séries temporais do padrão de ativação muscular, por meio da EMG de superfície, e da cinemática sagital de membro inferior, por meio de eletrogoniômetros, de diabéticos neuropatas (GD) e não diabéticos (GC) (n=46, GC=23, GD=23). Na análise discreta foram analisadas variáveis discretas dos envoltórios lineares dos músculos VL, GM e TA e da variação angular sagital de quadril, joelho e tornozelo. Estas variáveis foram comparadas entre grupos, em cada tarefa motora, por testes t independentes (=0,05). A análise das séries temporais eletromiográficas e de variação angular sagital foi realizada por meio da correlação cruzada de cada série entre os grupos. Também se avaliou a força da relação de fase entre a atividade muscular de VL, TA e GM com a variação angular de joelho e tornozelo, em cada grupo. Os coeficientes de correlação dessas relações foram comparados entre grupos por testes t independentes (=0,05). Os resultados demonstraram que durante o subir, os diabéticos apresentaram menor extensão de tornozelo ao final do apoio e, ao se projetarem para frente na primeira metade do apoio, fletiram menos o tornozelo. Em decorrência disto, houve um prejuízo no posicionamento ideal de tornozelo, indispensável para a ação inicial eficiente de VL. A desvantagem mecânica de VL observada no GD no início do apoio no degrau desencadeou uma ativação aumentada deste músculo ao final da fase de apoio na perna contralateral. No descer, o GD apresentou menor extensão de tornozelo no início do apoio, mas não apresentou alterações na EMG. Nos resultados da análise das séries temporais das EMG houve alta similaridade entre os grupos tanto no subir quanto no descer. A correlação entre a atividade muscular e a variação angular em todas as relações avaliadas foram significativamente mais fracas para o GD no subir para o VL joelho e GM tornozelo (relações fracas em ambos os grupos), exceto para a relação TA e tornozelo, em que o GD obteve relação moderada, enquanto o GC obteve relação fraca. No descer, as correlações foram similares entre os grupos (moderada para VL - joelho e GM - tornozelo, e fraca para TA - tornozelo). Aparentemente, o subir parece exacerbar mais os déficits motores da neuropatia diabética tanto na análise discreta quanto nas séries temporais. Apesar da similaridade temporal das séries no descer escada, qualitativamente houve diferenças na forma, sugerindo uma estratégia de recrutamento motor alterada. Em resumo, diabéticos neuropatas apresentam o padrão cinemático de tornozelo e muscular de vasto lateral e tibial anterior alterados durante estas atividades cotidianas, assim como uma alterada coordenação da ativação muscular de joelho e tornozelo com o correspondente movimento articular. Estes fatos, associados aos maiores impactos verticais do subir e descer escada podem aumentar o risco de ulceração no dia-a-dia de diabéticos neuropatas / The diabetic neuropathy is one of the main chronic complications of Diabetes Mellitus which causes damage to somatosensory and motor control systems resulting in biomechanical alterations in locomotion patterns. Locomotion activities with greater mechanical and balance demands might be considered a risk factor for ulcer formation in diabetic neuropathic patients. Therefore, to have a better understanding of the diabetic neuropatic interference in the daily life of these individuals, it is essential to evaluate the biomechanics of lower limbs during real life activities. The aim of this study was to investigate the influence of the diabetic neuropathy in the discrete characteristics and in time series of muscle activation patterns, using superficial EMG, and sagittal kinematics, using electrogoniometers, of lower limbs during stair management in diabetics (n=23) and non-diabetic individuals (n=23). The discrete analyses were done by discrete variables of VL, GM and TA linear envelopes and the sagittal angular variation of hip, knee and ankle. These variables were compared between groups in each motor task, by t test for independent samples ( = 0.05). The analyses of electromyographic and sagittal angular variation time series were performed by cross-correlation of each serie between groups. Moreover, the strength of the phase relationship between muscle activity of VL, TA and GM with the angular variation of knee and ankle was assessed in each group. The correlation coefficients of these relationships were compared between groups by independent t tests ( = 0.05). The main findings showed that during the stair ascent, diabetics had lower ankle extension at the end of stance phase, and while projecting their body forward during the first half of stance, their ankle flexion angle was also smaller. Because of that, there was a worse ankle positioning in the beginning of the stance, necessary for an efficient action of VL. The mechanical disadvantage of VL observed in diabetic neuropathic patients at the beginning of the stance phase may have triggered an increased activation in the same muscle at the end of stance in the contralateral leg. In the stair descent, diabetics had lower ankle extension at the beginning of stance, but did not show significant alterations in EMG. In the time series analysis, the EMG signals of all muscles presented higher similarities in timing across time series between groups for stair ascent and descent. The correlation obtained between groups for the muscle activity and angular variation amongst all evaluated relationships were statistically lower in the diabetic group for stair ascent (for VL-knee and GM-ankle (both groups presented weak relation), except for the relation between TA and ankle joint variation, which was moderate for the diabetic individuals and weak for controls. In the stair descent, the correlations were similar between groups (moderate relation for VL- knee and GM - ankle, and a weak relation for TA - ankle). Apparently, the stair ascent explicited motor deficits caused by diabetic neuropathy in the discrete analysis and also in the time series analysis. Although the similarities in the time series in the stair descent, qualitative shape differences were observed, suggesting a impaired pattern of motor recruitment in neuropathic patients. In summary, diabetic neuropathic individuals presented an altered ankle kinematic and VL and TA muscles activities patterns during these real life activities, and also altered coordination between muscle activity of knee and ankle and adjacent joint motion. These facts, combined to higher vertical impacts of stair ascent and descent might raise the plantar ulceration risks in the daily activities of diabetic neuropathic individuals