Katz index of activities of daily living in assessing functional status of older people: Reliability and validity of Sinhala version.

Purpose: This study evaluated the reliability and validity of the Sinhala version of Katz index of activities of daily living (ADL) in assessing the functional status of older people aged >65 years. Materials and methods: The Katz index was translated to Sinhala, cross-culturally adapted and administered in two stages. In stage 01, 200 patients aged ≥65 years, selected randomly from out-patient medical clinics, were asked to fill the Sinhala version of Katz index along with the Sinhala version of the 10-item Barthel index (BI). The Katz index was re-administered after two weeks among a subgroup of 45 patients selected randomly. In stage 02, Katz index was administered among randomly selected 200 community dwelling older people, aged ≥65 years. In addition, performance-based physical functions [gait speed (GS) and short physical performance battery (SPPB)] were also measured. Results: The analysis of stage 01 data showed internal consistency measured with Cronbach's alpha of 0.82 and test-retest reliability evaluated with intra-class correlation (ICC) (95% CI) of 0.94 (0.89-0.96) (p < 0.001). Exploratory Factor Analysis with the Principal Component Analysis revealed the presence of two factors with Eigen value exceeding 01, explaining 75.9% of cumulative variance. Further, the Sinhala version of Katz index total score showed a strong correlation with the BI total score (r = 0.91, p < 0.001) indicating strong concurrent validity. The stage 02 data revealed that older people with poor perception of general health status had lower mean (SD) Katz index score (3.58 ± 1.82) compared to those with good perception of health (5.56 ± 0.79) (p < 0.001). Similarly older people with prevalent diseases had comparatively lower scores of Katz index, compared to those without, indicating the known group validity (p < 0.05). Further, moderate correlations between the Katz index and performance based physical functions were observed showing the agreement (with GS - r; -0.26, p < 0.001, with SPPB - r; 0.31, p < 0.001). Conclusions: We conclude that the Sinhala version of Katz index has satisfactory psychometric properties and it is a reliable and valid tool to assess the functional status of Sinhala conversant older people in Sri Lanka.

Age-dependent assessment thresholds to optimize patient care in a resource-limited setting: an analysis based on the Sri Lankan FRAX model.

Age-dependent upper and lower assessment thresholds help categorizing women aged 40 years or more according to their fracture risk, independent of BMD information. INTRODUCTION: Age-dependent assessment thresholds of the FRAX algorithm help stratifying men and women aged 40 years or more according to their fracture risk. This allows clinicians to decide on those who require interventions without BMD assessment and those who require BMD input for further assessment. METHODS: Intervention thresholds were defined by 10-year probabilities of a major osteoporotic fracture (MOF) and hip fracture (HF) considering a woman with a BMI of 25.0 kg/m2 having a prior fragility fracture but no other clinical risk factors. The lower assessment thresholds (LAT) were set at 0.8 times the 10-year probabilities of a MOF and HF in a woman with a BMI of 25.0 kg/m2, without previous fracture or other clinical risk factors. The upper assessment thresholds (UAT) were set at 1.2 times the intervention thresholds of MOF and HF. Fracture probabilities were estimated for the age range of 40-80 years, without BMD input. These values were applied to a group of women who underwent DXA for clinical reasons in a single center. RESULTS: The LATs of MOF and HF varied from 0.7 to 8.8% and 0.1 to 3.7%, from 40 to 80 years, respectively. The corresponding values for UATs were 2.5 to 21.6% and 0.3 to 8.4%. ITs of MOF and HF varied from 2.1 to 18% and 0.2 to 7%, respectively. When applied to a group of 315 postmenopausal women who underwent DXA for clinical indications, 22.9% of women were above the UATs (high-risk category) while 8.6% were below the LATs (low-risk category). The proportion of women in the intermediate category who require BMD for further assessment was 68.6% (95% CI 59.7 to 77.5%). CONCLUSIONS: In nearly one-third of women aged 40 years or more, the decision to treat or not to treat can be achieved without BMD estimation. The remaining two-thirds will require a BMD assessment for further evaluation.

Quality of Life and Functional Independence of Hip Fracture Patients: Data from a Single Center Follow-Up Study in Sri Lanka.

BACKGROUND: Data on the functional outcomes of hip fracture patients in Sri Lanka are limited. As this information is required for the design of long-term care plans, we assessed the physical activities (activities of daily living [ADL]) and quality of life (QoL) of hip fracture survivors in Sri Lanka. METHODS: A group of 180 consecutive patients with incident hip fractures admitted to a tertiary care center in Southern Sri Lanka were followed up for 12 months. The Sinhala versions of the Barthel Index, 36-Item Short-Form Survey, and Mini-Mental State Examination were used to assess ADL, QoL, and mental status, respectively. RESULTS: Of the 180 patients (149 women), 107 underwent surgery. An initial sharp decline and partial recovery of ADL and QoL were observed among patients with hip fractures. Furthermore, patients who underwent surgical treatment showed faster recovery of ADL and QoL than did patients who were managed conservatively. Similarly, patients who did not have complications during the hospital stay showed faster recovery of ADL and QoL than did patients with one or more complications. Conclusions: Hip fractures profoundly affected both ADL and QoL, and recovery remained incomplete at 12 months post fracture. Patients who underwent surgery had a faster recovery than did patients who did not undergo surgery; similarly, patients without complications also had a faster recovery than did those with complications.

Current incidence and future projections of fragility hip fractures in Sri Lanka.

IN SRI LANKA, THE CRUDE AND STANDARDIZED HIP FRACTURE RATES IN 2018 WERE 88.3 AND 115.5 PER 100,000 PERSON-YEARS, RESPECTIVELY. IN 2018, 3824 HIP FRACTURES WOULD HAVE OCCURRED IN THE COUNTRY AND THIS IS LIKELY TO REACH 12,068 IN 2051: PURPOSE: This study was designed to calculate the current crude, standardized, and age- and sex-specific fragility hip fracture incidence in Sri Lanka and hip fracture projection for 2051. Currently such data are not available. METHODS: New fragility hip fractures (resulting from falls from standing height or less) that occurred in the Southern province of Sri Lanka from Sep 2017 to 2018 were collected prospectively by visiting and contacting all health care centers that provide care for fracture patients. Traumatic fractures, old fractures, and fractures among residents outside Southern province were excluded. We calculated current crude, standardized (US standardized population 2000), and age- and sex-specific fragility hip fracture incidence. The number of hip fractures that would occur in 2051 was estimated based on the population projections of the country. RESULTS: There were 554 patients admitted during 1-year period from September 2017 giving crude hip fracture incidence of 88 per 100,000 person-years (95% CI 85-90). The crude hip fracture rates among women and men were 132.2 and 35.3 per 100,000 person-years, respectively. The standardized hip fracture rate was 115.5 per 100,000 person-years. According to the data, 3824 (95% CI 3200-4583) hip fractures would have occurred island-wide during the study period. This number is likely to reach 12,068 (95% CI 10405-13,990) in 2051 when the age-specific population projections are taken into consideration. CONCLUSIONS: Although the observed hip fracture rate was low when compared with other countries, the number of hip fracture would increase from the current 10 per day to around 33 in 2051.

Factors associated with one-year mortality of patients admitted with fragility hip fracture: a follow-up study in Southern Sri Lanka.

One hundred and eighty patients with incident fragility hip fracture admitted to a tertiary care center in Sri Lanka were followed up for 12 months. When compared with those survived, patients who died were older and had higher comorbidity and physical impairment, before fracture and at discharge from the hospital. INTRODUCTION: This study examined the factors that are associated with mortality within the first 12 months, of patients admitted with fragility hip fracture to a tertiary care center in Southern Sri Lanka. METHODS: One hundred and eighty consecutive patients admitted with new fragility hip fracture were followed up for 12 months post-fracture. Apart from age and gender, information related to physical dependency (prefracture and at discharge) and comorbidity were collected from all subjects. RESULTS: Of 180 patients (149women), 107 had surgery while the rest were managed conservatively. Mean (SD) age of study subjects was 76.5 (9.2 years). Thirty-three patients died within the first 12 months were older and had higher comorbidity and physical impairment before fracture and at discharge from the hospital, when compared with those survived. Relative risk (95% CI, p value) of death for being a male was 6.52 (3.18-11.5, < 0.001) and corresponding values for conservative management were 6.59 (2.86-15.2, < 0.001). In the ROC analysis, in which mortality/survival was taken as state variable, AUCs for age, Charlson index, age-adjusted Charlson index, and Barthel index before fracture and Barthel index at discharge were 0.77 (0.04), 0.79 (0.04), 0.70 (0.05), 0.67 (0.05), and 0.76 (0.04 ) (p < 0.01 for all). Age-adjusted odd ratios (95% CI) of ACCI, CCI, surgical management, and Barthel index before fracture and at discharge were 2.21 (1.37 to 3.57), 2.37 (1.46 to 3.83), 0.18 (0.06 to 0.53), 0.91 (0.85 to 0.97), and 0.93 (0.88 to 0.99), respectively (p < 0.05 for all). CONCLUSIONS: We conclude that advanced age, male gender, higher comorbidity, physical impairment before and after fracture, and conservative management lead to a higher risk of mortality in patients admitted with incident fragility hip fracture. This study can be used as a platform for future research in this area in Sri Lanka.