Entrenamiento de la memoria de trabajo en la enfermedad vascular cerebral: revisión sistemática / Working Memory Training after cerebrovascular disease: a systematic review / Treinamento Da Memória Operacional Na Doença Cerebrovascular: Revisão Sistemática

Objetivo: mejorar la independencia funcional de los pacientes con enfermedad vascular cerebral (EVC) es uno de los objetivos que se plantean los equipos de rehabilitación física y cognitiva. Uno de los modelos que podría dar respuesta a este objetivo es el entrenamiento cognitivo de la memoria de trabajo (MT). Aunque esta estrategia se viene estudiando desde hace 20 años, aún es necesario realizar un estudio de revisión sistemática que permita conocer con claridad los efectos del entrenamiento cognitivo computarizado de la MT en el funcionamiento de la vida diaria en pacientes con EVC isquémica. Metodología: para ello, se creó una ecuación de búsqueda para aplicar en la base de datos Web of Science (WoS), en el rango temporal desde enero de 2010 a enero de 2019. Posteriormente, se realiza un análisis bibliométrico con el objetivo de identificar los autores y revistas más importantes sobre el tema de investigación. Finalmente, el reporte cronológico identifica la evolución y avances del impacto de los entrenamientos de la memoria de trabajo en la EVC. Resultados: se encontraron tres enfoques relacionados con: efectos de un programa de realidad virtual en las actividades de la vida diaria, efectos del entrenamiento de la MT en la plasticidad cerebral y efectos del entrenamiento cognitivo de la MT en las actividades de la vida diaria. Conclusión: se ha propuesto el desempeño cognitivo como uno de los componentes más importantes del funcionamiento en la vida diaria, particularmente la MT como mediador entre los programas de entrenamiento cognitivo y las habilidades funcionales. Los entrenamientos cognitivos reducen el deterioro cognitivo y el riesgo de demencia. Sin embargo, los beneficios de un entrenamiento cognitivo se limitan a dominios muy similares a los entrenados (transferencia cercana, más que lejana).

Objective: improving functional independence of patients with cerebrovascular disease has become one of the main goals for physical and cognitive rehabilitation teams. A well-known framework that addresses this issue is Working Memory Training. Although this model has been studied for more than twenty years, a systematic review on the effects of Working Memory Training after ischemic stroke and its impact on everyday functioning is still needed. Methodology: thus, a search equation has been proposed on Web of Science database from January 2010 to January 2019. Then, a bibliometric analysis presents the most important authors and journals in the research topic. Finally, a chronological report shows advanced research lines and effects of Working Memory Training in patients with cerebrovascular disease. Results:these findings showed 3 approaches related to the following: effects of virtual reality-based programs on everyday functioning, effects of Working Memory Training on brain plasticity, and effects of Working Memory Training on everyday life. Conclusion: cognitive performance has been proposed to be one of the most important components of functioning in daily life. Working Memory has been shown to strongly mediate between cognitive training and functional abilities. Cognitive training is asso-ciated with less cognitive decline and reduced risk of dementia. However, the benefits from cognitive training may be limited to highly similar domains (close transfer rather than far transfer).

Introdução: melhorar a independência funcional do paciente com doença cerebrovas-cular (DCV) é um dos objetivos traçados pelas equipes de reabilitação física e cognitiva. Um dos modelos que poderia responder a esse objetivo é o treinamento cognitivo da memória de trabalho (MT).Objetivo: embora essa estratégia seja estudada há 20 anos, ainda é necessário realizar um estudo de revisão sistemática que nos permita conhecer claramente os efeitos do treinamento cognitivo computadorizado da MT no funcionamento da vida diária em pacientes com DCV isquêmica.Metodologia: para isso, foi criada uma equação de busca a ser aplicada na base de dados Web of Science (WoS), no período de janeiro de 2010 a janeiro de 2019. Pos-teriormente, é realizada uma análise bibliométrica a fim de identificar os autores mais importantes e periódicos sobre o tema de pesquisa. Por fim, o relatório cronológico identifica a evolução e a evolução do impacto do treino da memória de trabalho no CVS.Resultados: foram encontradas três abordagens relacionadas a: efeitos de um programa de realidade virtual nas atividades da vida diária, efeitos do treinamento da MT na plas-ticidade cerebral e efeitos do treinamento cognitivo da MT nas atividades da vida diária.Conclusão: o desempenho cognitivo tem sido proposto como um dos componentes mais importantes do funcionamento na vida diária, particularmente a MT como media-dor entre programas de treinamento cognitivo e habilidades funcionais. O treinamento cognitivo reduz o declínio cognitivo e o risco de demência. No entanto, os benefícios do treinamento cognitivo são limitados a domínios muito semelhantes aos treinados (transferência próxima, em vez de distante).

Daily functioning and dementia / Atividades da vida diária e demência

Abstract. Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person's ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.

Resumo. Demência é caracterizada por declínio na memória, linguagem, resolução de problemas e de outros domínios cognitivos que afetam a capacidade de realização de atividades cotidianas e atividades sociais. É consensual que o comprometimento cognitivo é um importante fator de risco para o desenvolvimento de incapacidades funcionais em pacientes com demência. O status funcional pode ser conceituado como a capacidade de realizar autocuidado, automanutenção e atividade física. Uma pessoa com demência geralmente requer ajuda para tarefas mais complexas, como gerenciar contas e finanças, ou simplesmente realizar atividades domésticas. Um bom desempenho funcional é fundamental para que os idosos mantenham a independência e evitem a institucionalização. O objetivo desta revisão é delinear alterações funcionais em pacientes com demência, valorizando os subgrupos variados de demências.

Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults / Associação entre baixa escolaridade, desempenho cognitivo reduzido, incapacidade funcional e fragilidade em idosos

ABSTRACT. Limited formal education is still common in ageing populations. Although limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no studies have examined whether the gradient of limited formal education has an impact on health in later life. Objective: to examine the relationship of limited formal education with cognitive status, functional abilities, and frailty status. Methods: a cross-sectional study was conducted involving 540 older adults stratified into groups: no formal education, 12-24 months of education, and 25-48 months of education. Cognitive screening (MMSE), functional abilities (Lawton Index), and frailty (CHS criteria) were measured. Regression analyses were performed. Results: 27% had no formal education, 21% had 12-24 months of formal education, and 55% had 25-48 months of formal education. Limited formal education has a clear gradient of negative impact: No formal education was associated with scoring below MMSE cut-off scores (OR = 7.9), being totally/partially dependent for IADLs (OR = 2.5) and frail (OR = 2.0). Having 12-24 months of education was associated with scoring below MMSE cut-off scores (OR = 5.2) and with being frail (OR = 2.0). The No formal education group was 10.1 times more likely to have worse cognitive scores, worse functional abilities and frailty/pre-frailty status concomitantly (CCoFF), while older adults who had 12-24 months of education had a 4.6 times greater chance of having CCoFF. Conclusion: limited education had a gradient association with cognitive performance, functional disability and frailty. These findings clearly emphasize the importance of prevention through education from childhood to older age.

RESUMO. A baixa escolaridade ainda é comum na população idosa. Embora a limitação na educação formal pareça estar independentemente e negativamente associada à cognição, habilidades funcionais e fragilidade no envelhecimento, nenhum estudo examinou a associação entre baixa escolaridade e um impacto futuro na saúde. Objetivo: esse estudo examinou a relação entre baixa escolaridade e o status cognitivo, habilidades funcionais e fragilidade. Métodos: estudo transversal com 540 idosos divididos em grupos: sem educação formal, 12-24 meses de escolaridade e 25-48 meses de escolaridade. Informações da triagem cognitiva (MEEM), habilidades funcionais (Índice de Lawton); a fragilidade (critérios do CHS) foram coletadas. Análises de regressão foram realizadas. Resultados: 27% não tinham educação formal, 21% tinham entre 12-24 meses de educação formal e 55% tinham entre 25-48 meses de educação formal. Baixa escolaridade apresentou um impacto negativo e gradiente: nenhuma educação formal foi associada à pontuação abaixo do escore do MEEM (OR = 7,9), à dependência total/parcialmente em AIVD (OR = 2,5) e fragilidade (OR = 2,0). Ter 12-24 meses de escolaridade foi associado à pontuação abaixo do escore do MEEM (OR = 5,2) e a ser frágil (OR = 2,0). O grupo sem educação formal foi 10,1 vezes mais provável de apresentar piores escores cognitivos, pior capacidade funcional e fragilidade/pré-fragilidade concomitante (CCoFF), enquanto adultos idosos que tinham entre 12-24 meses de escolaridade tiveram 4,6 vezes maior chance de apresentar CCoFF. Conclusão: a baixa escolaridade apresentou associação com desempenho cognitivo, limitações funcionais e fragilidade. Os achados enfatizam claramente a importância da prevenção através da educação desde a infância à velhice.

Mental health, functional ability, and health-related quality of life in elderly patients attending a tertiary hospital of Patna

With changing socioeconomic, demographic, and development scenario, there is a cultural shift in looking after the elderly population which may lead to depression in this age group. Materials and Methods: The study was a hospital-based cross-sectional study conducted in the orthopedic department of a tertiary care setting on 157 elderly individuals. This study was conducted with objectives to estimate the proportion of depression using the Geriatric Depression Scale Short Form (GDS-SF) questionnaire along with its associated factors in geriatric population coming to the orthopedic department of the institute. The study tools were GDS-SF, Katz Index of Independence in activities of daily living (ADL), the Lawton instrumental ADL, and health-related quality of life by the Centers for Disease Control. Results: The proportion of depressed individuals was 70/157 (44.6%) using GDS as a tool. The maximum number was in the age group of 60–74 years. Women outnumbered men (51.3% vs. 38.31%) for depression. The depression using GDS score was more prevalent in rural elderly, illiterate, and elderly who were economically dependent on their children and who belonged to lower middle socioeconomic status. Approximately 98% of the study participants were found to be independent using ADL. Approximately 60% males and 68% females were dependent for the instrumental ADL using Lawton score. Most of the study participants had arthritis as a major impairment sharing almost equal proportion among males and females. Conclusion: The current study concludes that there is a very high proportion of elderly subjects who are experiencing depression using the GDS-SF tool. There should be regular screening for this disease in this age group even in a tertiary care setting.

Funcionalidad y factores asociados en el adulto mayor de la ciudad San Juan de Pasto, Colombia / Functionality and Associated Factors in the Older Adult of the City of San Juan de Pasto, Colombia / Funcionalidade e fatores associados em idosos de San Juan de Pasto, na Colômbia

Resumen Introducción: la capacidad funcional es uno de los determinantes del estado de salud del adulto mayor. En esta población se presenta una mayor dependencia que conlleva a cambios significativos en los estilos de vida, y en la interacción social y familiar. El presente estudio analiza la relación de factores sociodemográficos y condiciones de salud con el estado funcional en una muestra de adultos mayores de la ciudad de Pasto, Colombia. Materiales y métodos: estudio de corte transversal en una muestra de 391 adultos mayores a quienes se les evaluó su estado funcional con la escala de actividades instrumentales de la vida diaria de Lawton y Brody. Se estudiaron las características demográficas, los antecedentes médicos, el nivel cognitivo global y la sintomatología depresiva. Se calculó como medida de asociación la razón de disparidad (RD) cruda y ajustada con sus respectivos intervalos de confianza del 95%, mediante modelos de regresión logística binaria. Resultados: un 26,3% de los adultos mayores se encontró en un nivel de dependencia funcional, asociado al género masculino (RD = 2,72; IC95% 1,51-4,93), dependencia económica (OR = 1,41; IC95% 1,26-4,40), antecedentes de enfermedad cerebrovascular (or = 3,41; IC95% 1,21-9,61), artritis (OR = 2,24; IC95% 1,27-3,98), síntomas depresivos (OR = 3,07; IC95% 1,54-6,123) y deterioro cognitivo (OR = 2,04; IC95% 1,15-3,64). Conclusión: los resultados del presente estudio determinaron que, con el proceso de envejecimiento, la capacidad funcional se ve condicionada a múltiples factores, lo cual lleva a que el adulto mayor pierda paulatinamente su nivel de independencia, lo que puede impactar en su calidad de vida y, por ende, en el contexto donde interactúa.

Abstract Introduction: Functional dependence is one of the determinants of health status in older adults. Increasing dependence lead to significant changes in lifestyles, social and family interaction. This study analyzes the relationship of socio-demographic and health conditions with functional dependency in a sample of elderly from Pasto city-Colombia. Materials and methods: A cross-sectional study in a sample of 391 older adults were done. Functional status was assessed with instrumental activities of daily living (Lawton and Brody scale). Demographic characteristics, medical history, overall cognitive level, and depressive symptoms were evaluated. As a measure of association, the odds ratio (OR) crude and adjusted with confidence intervals were calculated using binary logistic regression. Results: 26,3% of older adults were found with functional dependence. Male gender (RD = 2.72, 95% CI 1.51 to 4.93), economic dependence (OR = 1, 41, 95% CI 1.26 to 4.40), history of cerebrovascular disease (or = 3.41, 95% CI 1.21 to 9.61), arthritis (OR = 2.24; 95% CI 1,27- 3,98), depressive symptoms (OR = 3.07, 95% CI 1.54 to 6.123), and cognitive impairment (OR = 2.04, 95% CI 1.15 to 3.64) were related with functional dependence. Conclussion: With the aging process, functional capacity in elderly is a multifactorial problem. The results support the evidence that elderly gradually lose their level of independence, which can impact their quality of life and therefore in the context in which it interacts.

Resumo Introdução: a capacidade funcional é um dos determinantes do estado de saúde dos idosos. Nesta população crescente dependência levando a mudanças significativas no estilo de vida, interação social e familiar é apresentada. Este estudo analisa a relação dos fatores sociodemográficos e condições de saúde, com estado funcional em uma amostra de adultos sobre a cidade de Pasto Colômbia. Materiais e métodos: estudo transversal em uma amostra de 391 adultos, sobre os quais o seu estado funcional foi avaliada com a escala de atividades instrumentais de vida diária Lawton e Brody. características demográficas, história médica, nível cognitivo global, e os sintomas depressivos foram avaliados. Foi calculada como uma medida de associação a razão de chances (RD) bruta e ajustada com intervalos de confiança respetivos 95% em modelos de regressão logística binária. Resultados: 26,3% dos adultos mais velhos foram encontrados em um nível de dependência funcional, está associado ao sexo masculino (RD = 2,72, 95% CI 1,51-4,93), dependência económica (OR = 1, 41; 95% CI 1,26-4,40), história de doença cerebrovascular (OR = 3,41, 95% CI 1,21-9,61), artrite (OR = 2,24, 95% CI 1,27-3, 98), sintomas depressivos (OR = 3,07, 95% CI 1,54-6,123) e cognitivo impairment (OR = 2,04, 95% CI 1,15-3,64). Conclussão: Os resultados deste estudo constatou que, com o processo de envelhecimento, a capacidade funcional é sujeita a muitos fatores, as ligações acima para os idosos perdem gradualmente o seu nível de independência, o que pode afetar sua qualidade de vida e, por conseguinte, no contexto no qual ele interage.

The Factors Associated With Older Adults Receiving Care in Jamaica / Factores Asociados con los Adultos Mayores que Reciben Cuidados en Jamaica

ABSTRACT Objective: To ascertain the level of care and the predisposing, enabling and need factors associated with care received by older adults using Andersen's framework. Methods: The 2012 Jamaica Survey of Living Conditions was used to conduct descriptive, bivariate and binary logistic analyses for the receipt of care among older adults defined by activities of daily living (ADL) and the instrumental activities of daily living (IADL) measures. The ADL sample comprised 3152 older adults and the IADL sample comprised 3141 older adults. Results: Approximately 16% of older adults received ADL care and significant binary logistic associations with age, area of residence, living arrangements, source of financial support, disability, and perceived health status were found. Approximately 69% received IADL care and significant binary logistic associations with gender, age, employed, living arrangements, wealth status, source of financial support, satisfaction with life accomplishments, disability and perceived health status were found for those receiving IADL care. Conclusion: Predisposing, enabling and need factors of the Andersen framework predict ADL and IADL care. Therefore, plans for care of older adults must address those 70 years or older who live alone, have a disability, a chronic illness and rate their health poorly.

RESUMEN Objetivo: Determinar el nivel de cuidados y los factores predisponentes, capacitantes y de necesidad asociados con el cuidado recibido por los adultos mayores, usando el modelo de Andersen. Métodos: La Encuesta de Condiciones de Vida en Jamaica 2012 fue utilizada para realizar análisis descriptivos, bivariantes y logísticos binarios en relación con el recibimiento de cuidados entre los adultos mayores, definidos por las medidas de las actividades de la vida diaria (AVD) y las actividades instrumentales de la vida diaria (AIVD). La muestra de AVD abarcó 3152 adultos mayores y la muestra de AIVD abarcó 3141 adultos mayores. Resultados: Aproximadamente el 16% de los adultos mayores recibieron cuidados de AVD, y en su análisis se hallaron asociaciones logísticas binarias significativas con la edad, el área de residencia, la situación de vivienda, la fuente de apoyo financiero, la discapacidad y el estado de salud percibido. Aproximadamente el 69% recibió cuidados de AIVD, y en su análisis se hallaron asociaciones logísticas binarias con el género, la edad, los empleados, la situación de vivienda, la situación económica, la fuente de apoyo financiero, la satisfacción con los logros de vida, la discapacidad, y el estado de salud percibido. Conclusión: Los factores predisponentes, capacitantes y de necesidad del modelo de Andersen predicen los cuidados de AVD y AIVD. Por lo tanto, los planes para el cuidado de adultos mayores tienen que abarcar a aquellas personas de 70 años o más que viven solas, tienen una discapacidad, una enfermedad crónica, y valoran su salud como pobre.

Modified Criteria for Diagnosing “Cognitive Frailty”

The concept of cognitive frailty has recently been proposed by an International Consensus Group as the presence of physical frailty and cognitive impairment [defined using the Clinical Dementia Ratings (CDR)=0.5], without concurrent dementia. However, CDR is difficult to implement and not often available in epidemiologic studies or busy clinical settings, and an alternative to CDR is required. We suggest an alternative definition of cognitive frailty as: 1) physical frailty, 2) more than 1.5 standard deviation below the mean for age-, gender-, and education-adjusted norms on any cognitive function test (e.g., the Montreal Cognitive assessment test, the Alzheimer’s disease assessment scale-cognitive subscale, verbal learning test, Digit Span, Boston Naming Test, Trail Making Test, and Frontal Assessment Battery), and 3) no dependency in instrumental activities of daily living. The redefined criteria for cognitive frailty would be more feasible to implement and thus more applicable in epidemiologic studies and busy clinical settings.

Clinical features and prognosis of 93 elderly patients with multiple myeloma / 中华血液学杂志

Objective@#To explore the clinical features and prognostic factors of elderly MM patients.@*Methods@#A retrospectively analysis of clinical characteristics in 93 newly diagnosed MM patients with more than 70 years of old between August 2011 and August 2016. Based on age, basic activities of daily living scale, instrumental activities of daily living scale, Charlson comorbidity index at diagnosis, patients were divided into three groups: Fit (score=0, n=15) , Intermediate fitness (score=1, n=31) , Frail (score≥2, n=47) according to a geriatric assessment system proposed by Antonio Palumbo et al. The treatment response rate, progression free survival time (PFS) and overall survival (OS) of the three groups were analyzed.@*Results@#Complete remission was 60.0% in Fit, 22.6% in Intermediate fitness and 12.8% in Frail (Fisher χ2=12.398, P=0.002) . The median PFS for the three groups were 31 months, 24 months and 13 months (χ2=17.832, P<0.001) . The median OS was not reached for Fit, 58 months for Intermediate fitness and 25 months for Frail (χ2=40.678, P<0.001) . In 47 Frail cases, patients who received chemotherapy containing new drugs (proteasome inhibitor or immune-modulator) had a longer PFS (17 months vs 9 months, χ2=6.454, P=0.011) and patients who achieved CR had prolonged PFS and OS than non-CR (PFS: 24 months vs 12 months, χ2=4.117, P=0.042; OS: 37 months vs 25 months, χ2= 6.507, P=0.011) .@*Conclusion@#The health status of the elderly MM patients was associated with better response and longer PFS and OS. Given on those with poor health status, new drugs may have better PFS and prolonged OS.

Análisis de instrumento para evaluación del desempeño en actividades de la vida diaria instrumentales Lawton y Brody / Analysis of the Lawton and Brody instrumental activities of daily living assessment instrument

El propósito fue analizar el Índice de Lawton y Brody (ILB), determinando si los factores género, desempeño previo y nivel socioeconómico afectan las conclusiones relacionadas con la dependencia en AVDI. La metodología es analítica, exploratoria y transversal. En primera instancia se aplicó una encuesta de percepción de ILB a 22 terapeutas ocupacionales (TTOO) pertenecientes a servicios públicos de Valparaíso, Viña del Mar, Concón y Quilpué. En segunda instancia se aplicó ILB más un cuestionario complementario a 36 usuarios del Centro Comunitario de Rehabilitación de Miraflores, Instituto deNeurorehabilitación Luis Krebs y Centro de Rehabilitación Integral Siloe; paralelamente, el terapeuta ocupacional (TO) completó una encuesta con su impresión sobre la capacidad de realizar las AVDI de sus usuarios, para determinar diferencias significativas entre ambos. Resultados: Los resultados indican que los TO están en desacuerdo con las características del instrumento. En los resultados de su aplicación, el ILB permite identificar el nivel de dependencia en AVDI en los ítems que evalúa. Se condujó que el factor género no es determinante de la dependencia, pero sí es determinante el factor socioeconómico; el nivel de desempeño previo tiene una correlación positiva con el desempeño actual de las personas. Conclusiones: La percepción de los TO está en desacuerdo con ILB. Los resultados de la aplicación de ILB y la contrastación con la impresión del TO tratante permite confirmar que efectivamente el instrumento logra el objetivo para el cual fue diseñado, destacando que el género no es un factor determinante en la realización de AVDI, mientras el factor socioeconómico es considerado como relevante para su realización.

The aim was to analyze the Lawton and Brody index (LBI), to determine if factors such as gender, previous performance and socio-economic level affect the conclusions related to the IADL dependency. The methodology is analytic, exploratory and cross-sectional. An opinion survey about IADL was applied to 22 OTs belonging to public services in Valparaíso, Viña del Mar, Concón and Quilpué. The LBI plus a 36-question complementary questionnaire were applied to Rehabilitation Community Center in Miraflores, Luis Krebs Neuro-rehabilitation Institute and Comprehensive Rehabilitation Center. Besides, the OTs filled in a survey about his views on the users’ abilities to perform IADL in order to establish meaningful differences between both. Results: The results show that occupational therapists don’t agree with the instrument features. In the results application, the LBI allows to identify the dependency level in IADL in the assessed items. It was shown that the gender factor is not decisive in dependency, however, the socio-economic factor is decisive; the level of previous performance has a positive correlation with the people’s current performance. Conclusions: The OT’s perception shows disagreement with the BLI. The results of the application of LBI and the contrast with the OTs opinion allows to confirm that the instrument actually fulfills the objective for which it was designed, pointing out that gender is not a decisive factor in IADL while socio economic factor is considered relevant in its application.

A Study on the Predictors of Functional Status and the Overuse of OTC Medications among Elderly Population in a Sub-Urban Region of North Bengal.

Background: Functional status can be conceptualized as an individual’s ability to manage activities related to personal self-care and self-maintenance. Functional status assessment is fundamental aspect of geriatric examination especially in the context of over the counter (OTC) medications. This assessment helps clinicians and policymakers to design and implement interventions that help elderly to live safely and independently. The primary objective was to assess the prevalence of limitation in activities of daily living (ADL) and instrumental ADL (IADL) among elderly population. The secondary objective was to identify the use of OTC medications according to the therapeutic indications among them. Methods: A total of 200 community dwelling elderly persons residing in Sushrutanagar of North Bengal were interviewed using valid and reliable functional assessment scales namely Katz ADL and Lawton and Brody IADL. Statistical procedures for the analyses included descriptive ADL and IADL activity limitation was 15 % (30/200) and 85 % (170/200), respectively. Results: The results of logistic regression analysis revealed that advancing age (70 years and above), poor self-rated health and ailments namely musculoskeletal problems, cardiovascular diseases and cataract significantly predict functional limitation. 70% of the subjects consumed analgesics and 60% the antacids as OTC medications. Conclusion: With advancing age, various co-morbidities starts creeping up and the study subjects used the OTC medications to counteract the associated functional limitations as evident from this study. Cataract surgeries patients should be identified and operated upon so as to improve visual functioning and thus their functional ability. Further, factors affecting the use of OTC drugs in elderly subjects need further research.

Influence of Cognitive Function and Depressive Symptoms on Instrumental Activities of Daily Living in Community-dwelling Older Adults / 재활간호학회지

PURPOSE: The purpose of this study was to explore the influence of cognitive function and depressive symptoms on instrumental activities of daily living (IADL) in addition to identify the factors associated with IADL in community-dwelling older adults. METHODS: This was a descriptive study with cross-sectional design. Data were collected from July 2013 to June 2014. A total of 143 participants without dementia, depression and disability were enrolled in this study. Cognitive function was measured using Seoul verbal learning test (SVLT), digital span (forward/backward) and fist-edge-palm test. The Korean-IADL and Short Geriatric Depression Scale (S-GDS) were used. Data analysis was performed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and hierarchical regression. RESULTS: Overall, a multiple regression model revealed that approximately 27.4% of total variability in IADL in the sample of community-dwelling older adults could be explained by the significant 12 variables in this model (R²=0.274, F=5.467, p<.001). Age, having religion and cognitive function were the predictors of IADL in community-dwelling older adults. CONCLUSION: This study suggest that we need to monitor cognitive function in older to maintain the ability for IADL in older adults. Also, individualized program for improving older adults' IADL should be included in nursing intervention.

Effectiveness of Cognitive Training to Instrumental Activities of Daily Living in Community-Dwelling Elderly

OBJECTIVE: This study was aimed to investigate the effectiveness of cognitive training to Instrumental Activities of Daily Living (IADL) in community-dwelling elderly. METHODS: The participant were 786 elders who were aged over 59 years visiting local rest area from February 2015 to November 2015. The demographic data was collected. IADL were evaluated by Seoul-Instrumental Activities of Daily Living (S-IADL). Cognitive functions were evaluated by Korean Version of Mini Mental Status Examination for Dementia Screening (MMSE-DS). Before and after cognitive training, we analysed these data. RESULTS: In all 15 items of S-IADL, 4 items (using the telephone, grooming, managing belongings, talking recent events) were specially improved (p<0.05). CONCLUSION: After cognitive training, indoor activities of S-IADL were improved but some items, especially outside activities were not improved for community dwelling elderly. In future, other programs to increase outside activities or social activities should be included in cognitive training programs for community dwelling elderly.

O questionário de atividades funcionais de Pfeffer: revisão integrativa da literatura brasileira / Pfeffer’s functional activities questionnaire: an integrative review of the brazilian literature

O Questionário de Atividades Funcionais (Functional Activities Questionnaire – FAQ) tem grande importância clínica em razão da sua capacidade de identificar perdas funcionais em indivíduos com suspeita de demência. O presente estudo tem o objetivo de: 1) Identificar os grupos clínicos com os quais o instrumento é utilizado no Brasil; 2) Identificar qual versão do questionário é usada nos estudos brasileiros; 3) Avaliar o instrumento quanto ao estágio de validação, à confiabilidade e à adaptação para o contexto brasileiro, identificando as lacunas existentes e as necessidades de aprimoramento; e 4) Identificar o método de administração e o ponto de corte mais formal desse instrumento no Brasil. Realizou-se uma revisão integrativa da literatura a partir de busca nas bases de dados Lilacs, SCIELO Brasil e PUBMED, sendo que 45 estudos compuseram a amostra. Constatou-se que diferentes versões baseadas no FAQ são usadas no Brasil, não sendo possível concluir se a versão original é a mais utilizada. Esses questionários são amplamente empregados em idosos com alterações cognitivas. Foram encontrados 18 estudos de validade de construto, 15 de validade de critério e um de confiabilidade. Não foram encontrados estudos sobre a validade ecológica do FAQ. O ponto de corte utilizado com maior frequência como indicador de incapacidade funcional é o de 5 pontos. A entrevista com informante é a forma de aplicação mais utilizada. Em razão da diversidade de versões do FAQ no contexto nacional, é fundamental que o profissional tenha clareza sobre as evidências de validade da versão que utiliza para a prática clínica e de pesquisa.

Among the different assessment tools employed to measure functional capacity, the Functional Activities Questionnaire (FAQ) stands out due to its capacity for identifying functional damages in individuals with suspected dementia. The aims of the present study were: 1) identify clinical groups for which the FAQ is used in Brazil; 2) identify what version of the questionnaire is used in Brazilian studies; 3) evaluate the FAQ with regard to the stage of validation, reliability and adaptation to Brazilian culture; and 4) identify the most frequent administration method and cutoff point used for the FAQ in Brazil. An integrative review of the literature was performed based on a search of the Lilacs, SCIELO Brazil and PUBMED databases. Forty-five studies were selected to compose the sample. Different versions of the FAQ are used in Brazil and it was not possible to conclude whether the original version is the most employed. These questionnaires are widely used for older adults with cognitive impairment. Eighteen studies on construct validity, 15 on criterion validity and one on reliability were found. No study was found addressing the ecological validity of the FAQ. The most frequent cutoff point used as an indicator of functional disability was 5 points. An interview with the informant was the most frequent form of administering the questionnaire. Considering the diversity of versions of the FAQ in the national context, it is essential that the professional has clarity about the evidence of validity of the version which uses for clinical practice and research.

Processo de comunicação de idosos na execução das atividades instrumentais de vida diária: estudo etnográfico / Process of communication of the elderly in the execution of the instrumental activities of daily life: ethnographic study

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 semi-estruturada. 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

Introducción: Para realizar las Actividades Instrumentales de la Vida Diaria, los ancianos interaccionan y establecen relaciones interpersonales. La comunicación es lo que permite que ellos expresen sus necesidades y deseos, pero en la actualidad, el proceso de comunicación trabaja rápidamente, con informatización y tecnología, lo que puede causar procesos de comunicación frágiles y resultar en ruidos en la comunicación o hasta mismo en dificultades para ejecutar las Actividades Instrumentales de la Vida Diaria. Para eso, los objetivos formulados fueron: discutir las implicaciones del proceso de comunicación de los ancianos en las Actividades Instrumentales de la Vida Diaria al cuidado de Enfermería Gerontológica; describir el proceso de comunicación de los ancianos cuando realizan las Actividades Instrumentales de la Vida Diaria y analizar los elementos que constituyen, las estrategias, los ruidos y las barreras del proceso de comunicación de ancianos cuando se realizan las Actividades Instrumentales de la Vida Diaria. El referencial teórico adoptado en eso estudio fue el Proceso de la Comunicación y la Teoría de la Diversidad y Universalidad del Cuidado Cultural. Método: Estudio de abordaje cualitativo, del tipo etnoenfermería. Para la recolección de datos, se utilizó la observación participante y también la entrevista semiestructurada. El escenario del estudio fue un proyecto de extensión universitaria para ancianos, que fue centralizado en la ciudad de Niterói (Rio de Janeiro, Brasil). Un total de 35 ancianos participó del estudio, teniéndose como criterios de inclusión frecuentar por el mínimum un año y regularmente las actividades del proyecto. Se excluyeron los sujetos que no estuvieron presentes en dos encuentros agendados. Siete profesionales participaran del estudio, incluyéndose aquellos que tenían formación completa y actuaban en actividades del proyecto de extensión. Las técnicas para la recolección de datos fueron la observación etnográfica (Modelo OPR); el Diario del Campo y la entrevista de reconocimiento y profundización. La recolección de datos fue hecha en el periodo desde noviembre del 2013 hasta agosto del 2014. Para el análisis de los datos, las cuatro etapas propuestas por la etnoenfermería fueron seguidas. El estudio fue aprobado por el Comité de Ética en Pesquisa local. Resultados: Las categorías del estudio incluyeron: comunicación en los grupos de convivencia como una promoción de la cultura para envejecimiento activo y saludable; Capacidad para ejecutar las Actividades Instrumentales de la Vida Diaria: un concepto de salud para los ancianos; La utilización de tecnologías para realizar las Actividades Instrumentales de la Vida Diaria: usos y posibilidades; Locales para ejecutar las Actividades Instrumentales de la Vida Diaria: factores culturales y sociales; y La comunicación en el contexto de la realización de las Actividades Instrumentales de la Vida Diaria: ruidos y estrategias. Discusión: Los grupos fueron espacios posibles para problematizar las demandas de los ancianos cuanto a la realización de las Actividades Instrumentales de la Vida Diaria. Las oficinas, si contextualizadas a las necesidades de los ancianos y promoviendo la participación activa de ellos en las actividades, permiten trabajar importantes conceptos como autonomía e independencia. Todos los días, ancianos realizan sus actividades diarias y la comunicación es la conexión que permite la interdependencia con aquellos que ellos interaccionan, pero esa necesidad es contextualizada. Así, pueden surgir ruidos en la comunicación si el anciano no estas adaptado; por lo tanto, adquirir habilidades comunicadoras como el dominio de computación o mismo el uso de la propia lenguaje adecuadamente, puede contribuir para una comunicación eficaz. Conclusiones: El entrenamiento de las habilidades comunicadoras de ancianos en grupos puede disminuir los ruidos en la comunicación, cuando ellos realizan las Actividades Instrumentales de la Vida Diaria, o sea hay la posibilidad de la promoción de independencia y autonomía. En el cuidado de enfermería gerontológica, asociar la promoción del envejecimiento activo a los principios de la enfermería transcultural potencializa el cuidado congruente

A funcionalidade dos mais idosos (>75 anos): conceitos, perfis e oportunidades de um grupo heterogêneo / The functioning of the oldest old (>75 years): concepts, profiles and opportunities of a heterogeneous group

OBJETIVOS: Conhecer a funcionalidade de dois grupos de idosos (75-84 anos e >85 anos) e sua associação com idade e gênero. MÉTODOS: Trata-se de estudo observacional do tipo analítico e transversal, cuja amostra foi constituída por indivíduos de ambos os sexos com idade >75 anos. Foi recolhida informação relativa a condição de saúde e funcionalidade pré-morbilidade. Os instrumentos de coleta de dados foram um questionário de caracterização sociodemográfica e o Método de Avaliação Biopsicossocial. RESULTADOS: A amostra foi constituída por 262 idosos com média de idade de 82,9 ± 4,86 anos, dos quais 161 (61,5%) eram mulheres. Os mais velhos (>85 anos) viviam mais isolados (p=0,020) e tinham menores habilitações literárias (p=0,027), apresentando mais limitações em utilizar escadas (p=0,015), no banho (p=0,008), na continência fecal (p=0,015) e em todas as atividades instrumentais (p<0,031). As mulheres apresentavam maior vulnerabilidade no estado civil (p<0,001) e no status econômico (p=0,009), enquanto os homens tinham piores resultados nas quedas (p=0,003) e nos comportamentos de risco (p<0,001). O desempenho na locomoção e nas atividades básicas e instrumentais era semelhante entre os sexos. CONCLUSÕES: As variáveis de natureza social apresentaram-se diferentes quanto à idade e ao gênero. As componentes da funcionalidade -locomoção, atividades diárias básicas e atividades instrumentais - apresentaram maiores limitações nos idosos com idade > 85 anos, sobretudo as instrumentais. Não se encontraram diferenças na funcionalidade em relação ao gênero.

OBJECTIVES: To know the functioning of two groups of seniors (75-84 and >85 years) and its association with age and gender. METHODOLOGY: This is an observational, analytical and transversal study, with sample composed by elderly individuals with 75 years or older. Data concerned health condition and functioning pre morbidity status. Data collection instruments were a social and demographic characterization questionnaire and the Biopsychosocial Assessment Method. RESULTS: The study sample was composed of 262 elderly, with a mean age of 82,9 ± 4,86 years, and 161 individuals (61,5%) were women. The oldest old (>85 years) lived more isolated (p=0,020) and had fewer educational qualifications (p=0,027), showed greater limitations in climbing stairs (p=0,015), personal hygiene (p=0,008), and faecal continence (p=0,015) and in all instrumental activities (p<0,031). Women were more vulnerable at marital (p<0,001) and economic status (p=0,009), while men had worse results in falls (p=0,003) and risk factors (p<0,001). The functional status in mobility and daily activities was similar between the sexes. CONCLUSIONS: The oldest old studied had different social state variables vulnerability related to age and gender. However, the difference in functional variables vulnerability was only related to age. The oldest old had more difficulties in some activities, especially those that are instrumental.

Validation of the Dementia Care Assessment Packet-Instrumental Activities of Daily Living

OBJECTIVE: We aimed to evaluate the psychometric properties of the IADL measure included in the Dementia Care Assessment Packet (DCAP-IADL) in dementia patients. METHODS: The study involved 112 dementia patients and 546 controls. The DCAP-IADL was scored in two ways: observed score (OS) and predicted score (PS). The reliability of the DCAP-IADL was evaluated by testing its internal consistency, inter-rater reliability and test-retest reliability. Discriminant validity was evaluated by comparing the mean OS and PS between dementia patients and controls by ANCOVA. Pearson or Spearman correlation analysis was performed with other instruments to assess concurrent validity. Receiver operating characteristics curve analysis was performed to examine diagnostic accuracy. RESULTS: Chronbach's alpha coefficients of the DCAP-IADL were above 0.7. The values in dementia patients were much higher (OS=0.917, PS=0.927), indicating excellent degrees of internal consistency. Inter-rater reliabilities and test-retest reliabilities were statistically significant (p<0.05). PS exhibited higher reliabilities than OS. The mean OS and PS of dementia patients were significantly higher than those of the non-demented group after controlling for age, sex and education level. The DCAP-IADL was significantly correlated with other IADL instruments and MMSE-KC (p<0.001). Areas under the curves of the DCAP-IADL were above 0.9. CONCLUSION: The DCAP-IADL is a reliable and valid instrument for evaluating instrumental ability of daily living for the elderly, and may also be useful for screening dementia. Moreover, administering PS may enable the DCAP-IADL to overcome the differences in gender, culture and life style that hinders accurate evaluation of the elderly in previous IADL instruments.

Results of determining some needs of rehabilitation care requirred to elderly of Mongolia / Монголын Анагаах Ухаан

Introduction: The issue of meeting need of rehabilitation care service required to elders is one of determinants which influences in enabling quality of life of elderly people. In our country, we lack of survey on determining current need of long term care and one of its form rehabilitation care service for the elderly, so it became the background of the research. Goal: Reveal some needs of rehabilitation care service through determining the Activities of daily living and Instrumental Activities of daily living of Mongolian elderly people Materials and Method: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The research was conducted by using ADL and IADL tests as well as questionnaire to determine the needs of rehabilitation care service. Results: Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women, and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 473 elderly were from Ulaanbaatar city, 734 of them were from 4 regions of countryside. Among survey involved elderly, the mean of ADL ability was 87.4 percent, of which, the following abilities were better such as: continence (92.5%), toileting (91.3%), dressing (87.9%), while bathing ability was impaired mostly or 18.2 percent. Subsequently, the mean of IADL ability among survey involved elderly was found to be 29.9 percent. The health needs of elderly were differed. Due to extensive indicator, 24.8 percent of elderly wanted to admit in a hospital, 20.8 percent - home nursing care and 32.6 percent -involvement in rehabilitation care service. In terms of amount, the maximum needs were eight, while most of elderly requested 1-3 kinds of needs. Conclusions: 1. The impairment of Activity of Daily Living was found to be approximately 22.6 percent, while Instrumental Activity of Daily Living was 29.9 percent among Mongolian elderly people. 2. The impairment level of Activities of Daily Living and Instrumental Activities of Daily Living indicated the requirement of occupational and physical therapy in health care service for the elderly.

Validity of Frenchay Activities Index on Chinese Stroke Patients / 中国康复理论与实践

@#ObjectiveTo explore the validity of Frenchay Activities Index on Chinese stroke patients.MethodsThe 39 stroke patients as stroke group and 39 healthy subjects as control group were assessed by the same rater using Frenchay Activities Index twice. In the first assessment, Barthel index was addititionally used to measure the activities of daily living for the stroke group. The Spearman's correlation coefficient was used to analyse the concurrent validity of the Barthel Index and Frenchay Activities Index in the stroke group. The paired t test was used to compare the scores of Frenchay Activities Index between two groups.ResultsThe correlation coefficient of Frenchay Activities Index and Barthel Index was 0.727 in the stroke group(P<0.001). The scores of each items and the total scores of the Frenchay Activities Index in the stroke group were significantly lower than that of the control group(P<0.01).ConclusionFrenchay Activities Index is acceptable for stroke.

Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment

OBJECTIVE: This study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls. METHODS: This study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning. RESULTS: The total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%). CONCLUSION: The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.

Factors Associated with ADL and IADL from the Third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005 / 가정의학회지

BACKGROUND: It is important to evaluate the functional ability of the elderly for optimal care. This study was conducted to identify factors associated with dependence for activities of daily living (ADL) and instrumental activities of daily living (IADL) in elderly adults in Korea. METHODS: A cross-sectional study of data from the third Korea National Health and Nutrition Examination Survey (KNHANES III) 2005 was undertaken. The sample consisted of 3,656 participants, 65 years of age or older. Multifactorial regression analysis was used to identify associations between ADL and IADL dependence and sociodemographics, lifestyle, and health history. RESULTS: Among the 629 (17.2%) ADL-dependent and significantly and independently associated factors were age, lower education level, health assistance or no-insurance, stroke, urinary incontinence, diabetes, arthritis, and lung cancer. Among the 1,674 (55.7%) IADL-dependent and significantly and independently associated factors were age, lower education level, single or widowed, male, stroke, arthritis, glaucoma and/or cataract. CONCLUSION: Functional dependence in older adults was directly related to aging and had multiple determinants. Awareness of these determinants should help design health programs that can identify individuals who are at high risk of losing their independence, and implement interventions for slowing or reversing the process.