Episodic future thinking is defined as the ability to mentally project oneself into the future into a specific time and place. Episodic future thinking has been explored extensively in neuroscience. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study examined the relationship between episodic future thinking and instrumental activities of daily living (IADLs), which is a domain of adaptive functioning frequently assessed by neuropsychologists to examine independent living potential including the ability to handle finances, prepare food, complete household duties, and manage medications. A secondary aim was to examine whether episodic future thinking is related to IADLs over and above standard measures of cognition. 61 older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), two measures of IADLs (an informant report measure called the Everyday Cognition Scale and a performance-based measure called the Independent Living Scales), and standard measures of memory and executive functioning. Episodic future thinking was significantly associated with performance-based IADLs when accounting for age, education, gender, and depression (r=.26, p=.010). Episodic future thinking significantly predicted performance-based IADLs over and above executive functioning (R2=.025, p=.030). Episodic future thinking was not predictive of performance-based IADLs over and above memory (p=.157). Episodic future thinking was not significantly associated with informant reported IADLs when accounting for age, education, gender, and depression (p=.284). This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. Episodic future thinking may provide information about IADLs to clinical neuropsychologists so they can improve their recommendations for independent living.

Objective: The transition to long-term care (LTC) of older adults receiving home care services is preceded by declining functional independence with basic and instrumental activities of daily living (ADL and IADL, respectively). These individual, and group, level time-dependent changes occur within unique provincial and regional policy contexts across Canada, which determine the amount and types of services received by home care recipients during this transition period. It is currently unknown whether activities of daily living (ADL) or IADL (instrumental activities of daily living) exhibit accelerated decline preceding transition to LTC, and if so, whether the onset and rate of decline differs for ADL versus IADL. This dissertation sets out to determine whether such change points exist within longitudinal data gathered from home care recipients in Ontario during the years of 2008 to 2015. Methods: A profile likelihood method was employed to identify the best fitting change points at which the slopes of functional decline in ADL and IADL for those who transition to LTC from home care services depart from the normative age slope of those who remain in community. Data analyzed was collected at approximately 6-month intervals using the International Residential Assessment Instrument – Home Care (RAI-HC) in Ontario, Canada, and was obtained from the Canadian Institutes for Health Information (CIHI) for the period of 2006-2015. A policy review was conducted to determine whether changes had occurred to the amount or type of home care services provided during the data collection period, and subsequently data from 2008 to 2015 were retained. IADL was measured using the 21-point IADL Involvement Scale and ADL was measured using the 28-point ADL Long Form. Best fitting change point models were first identified for ADL and IADL scores in the full sample of participants who remained in community and those who transitioned to LTC and within subgroups stratified by sex. Two additional subgroups were also examined: 1) participants without a primary or secondary caregiver living in the home, and 2) participants with a primary caregiver living in the home. Each caregiver group was also stratified by sex, resulting in a total of 9 groups in which IADL and ADL change points were estimated and compared. Results: In all groups who remained in community with home care services, age-related decline in IADL and ADL were observed. Further, IADL impairment was higher at the time of first assessment and had a greater age-related slope than ADL for those who remained in community. Both measures had discernable change points preceding discharge to LTC and the change point for IADL preceded that of ADL in all groups. Across groups, the change point for ADL had a range of 0.5 years before LTC discharge for men without a primary or secondary caregiver living in the home to 2 years for women with a primary caregiver in the home. IADL change points ranged from 2.5 years before LTC discharge for men with a primary caregiver in the home to 3.6 years for women without a primary or secondary caregiver in the home. Within the full sample, including both men and women, the onset of accelerated IADL decline for those discharged to LTC preceded the onset of home care service by 1.49 years and the time of first assessment by 1.84 years. Women in the full sample, and in both caregiver groups, experienced an earlier IADL change point relative to the availability of home care services and assessment when compared to men. Conclusions: Both IADL and ADL have discernible change points for in the years preceding discharge from home care to LTC. The change point for IADL consistently precedes that of ADL for the entire sample, for those with or without a caregiver in the home and for both men and women. The onset of accelerated IADL decline in the presence of age normative ADL decline may be an early indicator of pending transition from home care to LTC for home care recipients identified in this study. The province of Ontario has committed to providing the right care, at the right time in the right place. This study demonstrates that home care policy in Ontario during this study period, which does not provide for IADL services until after patients first qualify for ADL services, may not be achieving the provinces commitment of ensuring IADL care is provided at the right time for recipients of home care services. Opportunities for early identification and intervention may be available through early monitoring of, and intervention with, IADL function. A stepped care model holds promise for early identification and intervention of IADL impairment in community living older adults. Future research will help to confirm if accelerating decline in IADL function in the absence of appropriate rehabilitation and support services may hasten the onset of accelerated ADL impairment and subsequent admission to LTC. / Graduate / 2022-12-16

No description available.

Research has demonstrated that everyday functional abilities are compromised in mild cognitive impairment (MCI), a transitional stage between normal cognitive aging and dementia, as well as in healthy aging. These functional changes have been shown to be strong predictors of future decline, highlighting their importance. However, early changes in everyday functioning remain poorly characterized, largely due to a scarcity of sensitive measures capable of detecting subtle disruption. Recent research suggests that eye-tracking methodology may be effective in addressing this gap. Fifty-two participants (27 younger adults and 25 non-demented older adults) completed a novel eye-tracking task involving passive viewing of a naturalistic scene and verbalization of a task goal (e.g., make coffee, pack a lunch). Participants also completed a performance-based measure of everyday action that required them to enact the same tasks (e.g., coffee, lunch) that were included in the eye-tracking paradigm, self-report measures of functional ability, and neuropsychological measures. Mixed ANOVAs were conducted to examine group (young, old) and condition (passive viewing, verbalization)/task (simple, complex) effects on eye-tracking and everyday action performance. Independent samples t-tests/Mann-Whitney U tests were conducted to examine group differences in eye-tracking and everyday action performance. Correlation analyses across all measures were conducted to evaluate the potential mechanisms of eye-tracking and everyday action results. Results showed no significant group differences in the primary eye-tracking variables, but both groups made a lower proportion of fixations to distractor (i.e., non-target) objects during task verbalization compared to passive scene viewing. Older adults made more inefficient actions during performance-based everyday task completion, particularly when task demands were high. Eye tracking and everyday action variables were related to different measures of self-reported functional ability. Finally, eye-tracking variables were primarily related to neuropsychological measures of executive functions/working memory, whereas everyday action performance was most strongly related to measures of verbal learning and memory. These findings suggest that age-related functional changes at the level of eye movements may occur after changes in behavioral performance of everyday tasks. Importantly, performance-based assessment of everyday action appears sensitive to age-related decline. Additionally, naturalistic eye movements and everyday task performance may reflect distinct components of self-reported functioning and may be driven by distinct cognitive processes. Future research with refined naturalistic eye-tracking tasks and samples with a wider range of impairment is necessary to further explore these findings and improve characterization and detection of risk for dementia. / Psychology

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.

The purpose of the present investigation was to examine whether across-trials inconsistency in reaction time (RT), in addition to level of cognitive performance, is predictive of older adults’ performance on a measure of everyday problem solving through a series of three investigations. A sample of community dwelling non-demented older adults, ranging in age from 62 to 92, completed the Everyday Problems Test (EPT), a measure of everyday problem solving that indexes instrumental activities of daily living (IADLs). Performance on the EPT varied according to age, cognitive status, and education, and was significantly predicted by measures of global cognitive status, cognitive decline, and various basic cognitive abilities (i.e., speed of processing, fluid abilities, episodic memory, crystallized abilities). Both inconsistency and mean latencies on measures of RT were found to be significantly associated with concurrent EPT performance, such that slower and more inconsistent RTs were associated with poorer everyday problem solving abilities. Finally, inconsistency in RT made a unique contribution in predicting performance on the EPT two years later, over and above age, education, and various basic cognitive abilities. Structural equation modeling analyses indicated that the relationship between inconsistency in RT and future EPT performance was mediated by fluid and crystallized abilities. Neither inconsistency nor cognitive functioning were significantly associated with changes in EPT performance across two years. Examination of the relationships between IADL functioning, as assessed through self- and informant-report, and inconsistency and basic cognitive abilities demonstrated that everyday problem solving and measures of IADLs tap into related but distinct constructs. The overall pattern of results obtained lends support to the idea that inconsistency in RT represents a behavioural marker of neurological dysfunction. In addition, the present investigation is the first to suggest a relationship between inconsistency in RT and real-world outcomes, such as everyday problem solving and IADL functioning.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-07T18:48:48Z No. of bitstreams: 1 George Luiz Alves Santos.pdf: 1872027 bytes, checksum: bdfb513690f509fc90967b7a77d1a157 (MD5) / Made available in DSpace on 2016-10-07T18:48:48Z (GMT). No. of bitstreams: 1 George Luiz Alves Santos.pdf: 1872027 bytes, checksum: bdfb513690f509fc90967b7a77d1a157 (MD5) Previous issue date: 2015 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: Para executar as Atividades Instrumentais de Vida Diária, os idosos interagem e estabelecem relações interpessoais. A comunicação é o que permite expressarem suas necessidades e desejos, contudo, no contexto da atualidade, o processo de comunicação se opera de forma rápida, informatizada, tecnológica, podendo suscitar processos comunicativos fragilizados, e resultando em ruídos na comunicação, ou mesmo em dificuldades na execução das Atividades de Vida Diária. Para tanto, formularam-se, como objetivos: discutir as implicações do processo de comunicação de idosos nas Atividades Instrumentais de Vida Diária para o cuidado de Enfermagem Gerontológica; descrever o processo de comunicação de idosos ao executar as Atividades Instrumentais de Vida Diária; e analisar os elementos constituintes, estratégias, ruídos e barreiras do processo de comunicação de idosos ao executar as Atividades Instrumentais de Vida Diária. O referencial teórico adotado neste estudo foi o Processo de Comunicação e a Teoria da Diversidade e Universalidade do Cuidado Cultural. Método: Estudo de abordagem qualitativa, do tipo etnoenfermagem. Para coleta dos dados, utilizaram-se a observação participante e a entrevista semiestruturada. Como cenário do estudo, teve-se um projeto de extensão universitária para idosos, localizado na cidade de Niterói (RJ). Participaram 35 idosos, tendo-se como critérios de inclusão frequentar há pelo menos 1 ano e de forma regular as atividades do projeto. Foram excluídos aqueles que faltaram a dois encontros agendados. Participaram do estudo sete profissionais, incluindo-se os que possuíam graduação completa e atuavam em atividades do projeto de extensão. As técnicas de coleta de dados foram a observação etnográfica (Modelo OPR); o Diário de Campo; e a entrevista de reconhecimento e aprofundamento. O período de coleta de dados foi de novembro de 2013 a agosto de 2014. Para análise dos dados, seguiram-se as quatro etapas proposta pela etnoenfermagem. O estudo teve aprovação do Comitê de Ética em Pesquisa local. Resultados: As categorias do estudo foram: comunicação nos grupos de convivência como promotora da cultura do envelhecimento ativo e saudável; Capacidade para execução das Atividades Instrumentais de Vida Diária: um conceito de saúde para os idosos; A utilização de tecnologias na execução das Atividades Instrumentais de Vida Diária: usos e possibilidades; Cenários de execução das Atividades Instrumentais de Vida Diária: fatores culturais e sociais; A comunicação no contexto de execução das Atividades Instrumentais de Vida Diária: ruídos e estratégias. Discussão: Os grupos foram espaços possíveis de problematizar a demandas dos idosos em relação à execução das Atividades de Vida Diária. As oficinas, se contextualizadas às necessidades dos idosos e fomentando a participação ativa deles nas atividades, permitem trabalhar conceitos importantes, como autonomia e independência. Diariamente, idosos executam suas atividades diárias, e a comunicação é o elo que permite a interdependência com quem eles interagem, contudo, essa necessidade está contextualizada. Assim, podem surgir ruídos na comunicação, caso o idoso não esteja adaptado; portanto, adquirir habilidades comunicadoras, como, por exemplo, o domínio da informática ou, ainda, o uso da própria linguagem de forma adequada, pode contribuir para uma comunicação efetiva. Conclusões: O treinamento das habilidades comunicadoras dos idosos nos grupos pode diminuir ruídos na comunicação quando estes executam as Atividades Instrumentais de Vida Diária, ou seja, promover a independência e a autonomia. No cuidado de enfermagem gerontológica, ao associar a promoção do envelhecimento ativo aos princípios da enfermagem transcultural, potencializa-se o cuidado congruente. / Introduction: In order to perform Instrumental Activities of Daily Living, the aged individuals interact and establish interpersonal relationships. Communication allows them to express their needs and wishes; however, nowadays, the communication process works very quick, computerized and using technology, which may cause fragile communicative processes, resulting in communication noise or even in difficulties to run the Instrumental Activities of Daily Living. Hence, the formulated objectives were: approaching the implications of the communication process of aged individuals in Instrumental Activities of Daily Living to Gerontological Nursing care; describing the communication process of aged individuals to perform Instrumental Activities of Daily Living; and analyzing the constituting elements, strategies, noises, and barriers of aged individuals’ communication process when performing Instrumental Activities of Daily Living. The theoretical referential adopted in this study was the Communication Process and the Theory of Diversity and Universality of Cultural Care. Method: This was an ethnonursing study of qualitative approach. Participant’s observation and semistructured interview were used for data collection. The study scenario was a university extension project for aged individuals, located in the city of Niterói (RJ). Thirty-five aged individuals participated, and inclusion criteria included going to the project activities at least for 1 year and in a regular basis. Participants who did not go to two scheduled meetings were excluded. Seven professionals took part in the study, including those with complete school education and those who worked in activities of the extension project. Data collection techniques included ethnographical observation (OPR Model); Field Diary; and recognition and deepening interview. Data collection period was from November 2013 to August 2014. For data analysis, the four stages proposed in ethnonursing were followed. The local Committee of Ethics Research approved the study. Results: The study categories comprised the following: Communication in groups of familiarity as a promotor of active and healthy aging culture; Capacity to perform Instrumental Activities of Daily Living: a health idea for aged individuals; The use of technologies to perform Instrumental Activities for Daily Living: uses and possibilities; Performance scenarios of Instrumental Activities for Daily Living: cultural and social factors; Communication in the performance notion of Instrumental Activities of Daily Living: noises and strategies. Discussion: Groups form spaces where it is possible to problematize the demands of aged individuals regarding the performance of Instrumental Activities of Daily Living. If the needs of aged individuals are put into context and their active participation in activities is encouraged, the workshops allow working important concepts like autonomy and independence. Every day, aged individuals run their daily activities, and communication is the link that allows interdependence with whom they interact. However, this need is contextualized. Thus, communication noises may arise if the senior is not adjusted; therefore, acquiring communicative skills, such as computing mastery or even the use of their own language appropriately, may contribute for an efficient communication. Conclusions: Practice of the communicative skills of aged individuals in groups can decrease noises in communication, when these subjects perform their Instrumental Activities of Daily Living, i.e. to promote independence and autonomy. In Gerontological Nursing care, the association of active aging promotion with transcultural nursing principles empowers the congruent care.

The purpose of the present investigation was to examine whether across-trials inconsistency in reaction time (RT), in addition to level of cognitive performance, is predictive of older adults’ performance on a measure of everyday problem solving through a series of three investigations. A sample of community dwelling non-demented older adults, ranging in age from 62 to 92, completed the Everyday Problems Test (EPT), a measure of everyday problem solving that indexes instrumental activities of daily living (IADLs). Performance on the EPT varied according to age, cognitive status, and education, and was significantly predicted by measures of global cognitive status, cognitive decline, and various basic cognitive abilities (i.e., speed of processing, fluid abilities, episodic memory, crystallized abilities). Both inconsistency and mean latencies on measures of RT were found to be significantly associated with concurrent EPT performance, such that slower and more inconsistent RTs were associated with poorer everyday problem solving abilities. Finally, inconsistency in RT made a unique contribution in predicting performance on the EPT two years later, over and above age, education, and various basic cognitive abilities. Structural equation modeling analyses indicated that the relationship between inconsistency in RT and future EPT performance was mediated by fluid and crystallized abilities. Neither inconsistency nor cognitive functioning were significantly associated with changes in EPT performance across two years. Examination of the relationships between IADL functioning, as assessed through self- and informant-report, and inconsistency and basic cognitive abilities demonstrated that everyday problem solving and measures of IADLs tap into related but distinct constructs. The overall pattern of results obtained lends support to the idea that inconsistency in RT represents a behavioural marker of neurological dysfunction. In addition, the present investigation is the first to suggest a relationship between inconsistency in RT and real-world outcomes, such as everyday problem solving and IADL functioning.

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.