The aging of population is perhaps the most important problem that developed countries must face in the near future. Dependency can be seen as a consequence of the process of gradual aging. In a health context, this contingency is defined as a lack of autonomy in performing basic activities of daily living that requires the care of another person or significant help. In Europe in general and in Spain in particular, this phenomena represents a problem with economic, political, social and demographic implications. The prevalence of dependency in the population, as well as its intensity and evolution over the course of a person’s life are issues of greatest importance that should be addressed. The aim of this work is the estimation of life expectancy free of dependency (LEFD) based on functional trajectories to enhance the regular estimation of health expectancy. Using information from the Spanish survey EDAD 2008, we estimate the number of years spent free of dependency for disabled people according to gender, dependency degree (moderate, severe, major) and the earlier or later onset of dependency compared to a central trend. The main findings are as follows: first, we show evidence that to estimate LEFD ignoring the information provided by the functional trajectories may lead to non-representative LEFD estimates; second, in general, dependency-free life expectancy is higher for women than for men. However, its intensity is higher in women with later onset on dependency; Third, the loss of autonomy is higher (and more abrupt) in men than in women. Finally, the diversity of patterns observed at later onset of dependency tends to a dependency extreme-pattern in both genders.

Background: Studies on functional capacity in community-dwelling older people have shown associations between declines in instrumental activities of daily living (IADL) and several factors. Among these, age has been the most consistently related to functional capacity independent of other variables. We aimed at evaluating the performance of a sample of healthy and cognitively intact Brazilian older people on activities of daily living and to analyze its relation to social-demographic variables.

Methods: We conducted a secondary analysis of data collected for previous epidemiological studies with community-dwelling subjects aged 60 years or more. We selected subjects who did not have dementia or depression, and with no history of neurological diseases, heart attack, HIV, hepatitis or arthritis (n = 1,111). Functional capacity was assessed using the Brazilian version of the Older American Resources and Services Questionnaire (BOMFAQ). ADL performance was analyzed according to age, gender, education, and marital status (Pearson's χ2, logistic regression).

Results: IADL difficulties were present in our sample, especially in subjects aged 80 years or more, with lower levels of education, or widowed. The logistic regression analysis results indicated that “higher age” and “lower education” (p ≤ 0.001) remained significantly associated with IADL difficulty.

Conclusions: Functional decline was present in older subjects even in the absence of medical conditions and cognitive impairment. Clinicians and researchers could benefit from knowing what to expect from older people regarding IADL performance in the absence of medical conditions.

Background: The ability to manage everyday technology (ET), such as computers and microwave ovens, is increasingly required in the performance of everyday activities and participation in society. This study aimed to identify aspects that influence the ability to manage ET among older adults with and without cognitive impairment.

Methods: Older adults with mild Alzheimer's disease and mild cognitive impairment and without known cognitive impairment were assessed as they managed their ET at home. Data were collected using the Management of Everyday Technology Assessment (META). Rasch-based measures of the person's ability to manage ET were analyzed. These measures were used as dependent variables in backward procedure ANOVA analyses. Different predefined aspects that could influence the ability to manage ET were used as independent variables.

Results: Three aspects had a significant effect upon the ability to manage ET. These were: (1) variability in intrapersonal capacities (such as “the capacity to pay attention and focus”, (2) environmental characteristics (such as “the impact of the design”) and (3) diagnostic group.

Conclusions: Variability in intrapersonal capacities seems to be of more importance than the actual level of intrapersonal capacity in relation to the ability to manage ET for this sample. This implies that investigations of ability to manage ET should also include intraperson variability. Additionally, adaptations in environmental characteristics could simplify the management of ET to support older adults as technology users.

Neuropsychologists frequently are asked to comment on everyday functioning, but the research relies mostly on questionnaire-based assessment of daily functioning. While performance-based assessment of everyday functioning has many advantages over commonly used questionnaires, there are few empirically validated comprehensive performance-based measures. We present data here on a performance-based battery of daily living skills, the Functional Impact Assessment (FIA) in 47 unilateral stroke patients and 37 matched healthy controls. The FIA was validated by comparing it to performance on the self- and informant-report version of the Functional Activities Questionnaire (FAQ). We also examined the relationship between the FIA and cognitive functioning using the Neuropsychological Assessment Battery (NAB). The stroke group's performance on the FIA, FAQ (self and informant), and NAB (total and domain scores) was significantly (d′s ≥ .80) lower than the control group. The NAB total score and all domain scores were highly correlated with the FIA in the stroke group (r's > .7), and only one NAB domain score (visuospatial) was a unique predictor. This may be due to the fact that most of the NAB domains have a statistical problem of multicollinearity, which may explain why only the spatial domain was a unique predictor. While the informant FAQ was significantly correlated with FIA total score (r = .48, p < .01), the NAB total score was a significantly better predictor (r = .83, p < .001) than the informant FAQ. NAB total scaled score of less than 86 predicted impairment on the FIA with 92% sensitivity and 84% specificity. Our findings argue that the FIA is sensitive to deficits associated with stroke and is highly associated with all neuropsychological domains (attention, executive functions, language and spatial skills, and memory). (JINS, 2011, 17, 832–840)

Many functional scales used with the elederly are inadequate because they focus solely on physical functioning and were designed for younger adults who were orthopedically or neurologically impaired (e.g. the Katz, the Kenny). An appropriate assessment of the elderly's capabilities must include other components—mental functioning, tolerance and motivation, as well as physical functioning. A new assessment tool—the Geriatric Function Score Scale (G.F.S.S.) was developed for the elderly by Lowe (1984). It is an objective tool which examines physical, cognitive and motivational components of functioning and takes only 20 minutes to administer. The results of a preliminary study revealed that the score patients received on the G.F.S.S. was able to discriminate the level of placement (chronic care setting versus nursing home versus supervised setting, etc.) they would need upon discharge from the hospital. In addition, a positive conelation was found (r = .84) when comparing the G.F.S.S. with the Folstein Mini Mental Status Examination.

Vers 2031, les personnes les plus âgées (85 ans et plus) pourraient composer 4 pourcent de la population totale du Canada. Ce document relève les changements constates dans le domaine de l'utilisation des soins de longue durée, des activités de la vie quotidienne (AVQ) et des activités instrumentales de la vie quotidienne (ATVQ) chez les participants les plus âgés du Aging in Manitoba Longitudinal Study, d'après trois éléments répartis sur 13 ans. Parmi les participants, 38,4 pour cent n'avaient pas eu recours aux soins de longue durée pendant la période examinée; entre 75 et 88 pour cent des participants pouvaient continuer à manger, à se déplacer dans leur maison et à se mettre au lit et à en sortir sans aide. En ce qui a trait aux activités instrumentales de la vie quotidienne, la proportion des gens qui n'avait pas besoin d'aide allait de 3 pour cent (réparations dans la maison) à 58 pour cent (se préparer une tasse de thé ou de café). Les résultats de ces analyses signalent l'hétérogénéité des aptitudes fonctionnelles des personnes très âgées et viennent enrichir la documentation portant sur cette tranche de la population.

Background: Assessing function is a crucial element in the diagnosis of dementia. This information is usually obtained from key informants. However, reliable informants are not always available.

Methods: A 10-item semi-structured home interview (the CHIF, or Clinician Home-based Interview to assess Function) to assess function primarily by measuring instrumental activities of daily living directly was developed and tested for inter-rater reliability and validity as part of the Indianapolis–Ibadan dementia project. The primary validity measurements were correlations between scores on the CHIF and independently gathered scores on the Blessed Dementia Scale (from informants) and the Mini-mental State Examination (MMSE). Sensitivities and specificities of scores on the CHIF and receiver operator characteristic (ROC) curves were constructed with dementia as the dependent variable.

Results: Inter-rater reliability for the CHIF was high (Pearson's correlation coefficient 0.99 in Indianapolis and 0.87 in Ibadan). Internal consistency, in both samples, was good (Cronbach's α 0.95 in Indianapolis and 0.83 in Ibadan). Scores on the CHIF correlated well with the Blessed Dementia scores at both sites (−0.71, p < 0.0001 for Indianapolis and −0.56, p < 0.0001 for Ibadan) and with the MMSE (0.75, p < 0.0001 for Indianapolis and 0.44, p < 0.0001 for Ibadan). For all items at both sites, the subjects without dementia performed significantly better than those with dementia. The area under the ROC curve for dementia diagnosis was 0.965 for Indianapolis and 0.925 for Ibadan.

Conclusion: The CHIF is a useful instrument to assess function directly in elderly participants in international studies, particularly in the absence of reliable informants.

Alzheimer's disease (AD) is characterized by deterioration in the ability to perform activities of daily living (ADL) in addition to loss of cognitive function and behavioral changes. This decline in day-to-day functioning is increasingly recognized as a source of considerable social, health, and economic costs. Inability to perform ADL results in growing caregiver burden and may lead to the eventual need for alternative care or nursing home placement. The measurement of ADL, which enables monitoring of the effectiveness of therapeutic interventions, can be performed using a number of inventories including the Progressive Deterioration Scale (PDS), the Disability Assessment for Dementia (DAD), and the Alzheimer Disease Cooperative Study ADL (ADCS/ADL) assessment scale. Clinical studies using these and other scales have indicated that cholinesterase (ChE) inhibitors offer an effective approach to treating the functional decline of AD. Donepezil, rivastigmine, and galantamine have been shown in some studies to prevent or slow decline in ADL over treatment periods of one to two years. For instance, in a 24-week study in subjects with moderate to severe AD, donepezil-treated patients remained stable compared with the placebo-treated patients. Rivastigmine has shown improvement or stabilization of PDS scores in patients with mild to moderate disease following 26 weeks of treatment and slowed deterioration in patients with more severe disease. Evidence to date suggests that these agents may not be equally effective at slowing or stabilizing loss in ADL over time and that these differences may reflect differences in pharmacology. In addition to inhibition of acetylcholinesterase (AChE), these compounds have other putative differences in mechanisms of action. Galantamine allosterically modulates the nicotinic receptor and may prevent the loss of ADL. Rivastigmine robustly inhibits butyrylcholinesterase in addition to AChE and therefore acts as a dual ChE inhibitor. Comparative studies evaluating the differential effects of these ChE inhibitors on ADL are awaited.

For almost 90 years following the original description of Alois Alzheimer's patient and the identification of Alzheimer's disease (AD) (Alzheimer, 1907), physicians faced the bleak prospect of observing the inexorable and relentless decline in cognition, function, and behavior with little or no opportunity for therapeutic intervention. In the last 5 years clinicians have finally been provided with a class of medications, the cholinesterase (ChE) inhibitors, which have passed the test of efficacy and safety in the symptomatic management of AD and related dementias. With the arrival of donepezil, rivastigmine, and galantamine as the second generation of ChE inhibitors, a renewed and sustained interest in the diagnosis and care of AD patients might have been anticipated. However, there remains residual therapeutic nihilism and skepticism over the utility of these treatments in some quarters of the medical community and among some paying authorities. In moving forward and addressing these concerns, we must reflect carefully on the question, “What have we learned about the ChE inhibitors so far?”

Findings from a recent population-based survey indicate that about 33% of patients with dementia reside alone. Because many of these patients may not have a caregiver who visits them regularly, the need for a neuropsychological (NP) test to predict patients' functional competence to live alone safely is evident. In this study, we compared the accuracy of predicting Instrumental and Basic Activities (IADLs and ADLs) of 22 patients with Alzheimer's disease using several standard NP tests and the newly developed Problems in Everyday Living (PEDL) test. Performance of IADLs and ADLs as rated by caregivers was significantly correlated with performance on the PEDL, the Mini-Mental State Exam (MMSE), and with the Shipley Institute of Living Test of Verbal Abstraction (SILS-A), but not with vocabulary or naming. The PEDL was the best predictor of IADL scores (r = 0.71), compared to the MMSE (r = 0.52) and the SILS-A (r = 0.57), while the MMSE was the best predictor of ADL performance (r = 0.69), compared to the PEDL (r = 0.58) and the SILS-A (r = 0.50). (JINS, 2002, 8, 48–57.)