Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

A Ciência dos Religiosos: Estudo Exploratório dos Usos e Sentidos que Religiosos Fazem da Ciência

Este artigo apresenta um estudo empírico exploratório das atitudes e opiniões de religiosos acerca da ciência, cujos resultados foram interpretados a partir das noções de campo psicológico/espaço vital de Lewin. Objetivo: investigar a visão que adeptos de diferentes grupos religiosos brasileiros têm da ciência, os fatores que influenciaram essa visão (como a educação familiar e escolar) e o recurso à religião ou à ciência diante do sofrimento e do mal. Método: estudo transversal quantitativo com uso da Escala de Crença na Ciência e um questionário original investigando as perspectivas dos religiosos frente à ciência. Participantes: 206 mulheres e 102 homens (N=308) com diferentes afiliações religiosas. Resultados: como tendências gerais, verificou-se: (1) maior propensão à descrença na ciência, a despeito do reconhecimento de sua importância; (2) percepção de posição favorável à ciência por parte da religião e de grupos religiosos; (3) consideração de que não há conflito irreconciliável entre ciência e religião; e (4) maior tendência a buscar recursos na ciência e na religião ao mesmo tempo (ou exclusivamente na religião) para lidar com o sofrimento e o mal. Análises mais detalhadas evidenciaram, ainda, diferenças significativas entre as afiliações religiosas em seus níveis de aproximação ou afastamento da ciência.

This article presents an exploratory empirical study of the attitudes and opinions of religious people about science, which the results were interpreted based on Lewin's notion of psychological field/life space. Objective: to investigate the views held by adherents of different Brazilian religious groups about science, the factors that influenced this view (such as family and school education) and the use of religion or science to cope with suffering and the evil. Method: a quantitative cross-sectional study using the Belief in Science Scale and an original questionnaire to investigate the perspectives of religious individuals towards science. Participants: 206 women and 102 men (N = 308) from different religious groups. Results: the following general trends were found: (1) nonbelief in science, despite considering its importance to some extent; (2) the perception that religious groups have a non-negative attitude towards science, and that religion is favorable to science; (3) the consideration that there is no irreconcilable conflict between science and religion; and (4) the use of both science and religion, or exclusively of religion, to cope with suffering and the evil. More detailed analyzes also revealed significant differences between religious affiliations in their levels of support to (or rejection of) science.

Life Space Assessment in Stroke Patients

OBJECTIVE: To evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression. METHODS: The LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression. RESULTS: Test-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01). CONCLUSION: This study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression.

Factors Related to Improving Activities of Daily Living and Life-Space Mobility through Visiting Rehabilitation Services : A Multi-Institutional Study in Ibaraki Prefecture, Japan / The Japanese Journal of Rehabilitation Medicine

Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods: Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (<i>p</i>=0.016) and from 9.9 to 12.3 (<i>p</i>=0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (<i>p</i>=0.001, <i>R</i>²=0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (<i>p</i>=0.0001, <i>R</i>²=0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.