Prediction of decline in activities of daily living using motor performance tests in older adults requiring long-term care.

OBJECTIVE: This study aimed to predict decline in activities of daily living (ADL) in older adults requiring long-term care, using motor performance tests. METHODS: This prospective cohort study was conducted among 3948 older adults using day care services in Japan. ADL decline was assessed using the Functional Independence Measure at the start of day care service use and 12 months later. Grip strength (GS), one-leg standing (OLS), and comfortable walking speed (CWS) were measured as baseline motor performance tests. To predict ADL decline using motor performance tests, we calculated cut-off values using receiver operating characteristics curves and odds ratios using logistic regression analysis. RESULTS: In total, 521 participants had ADL decline at 12 months of follow-up. The cut-off values for each motor performance test were as follows (for men/women): GS < 24 kg/16 kg, OLS < 2 s/3 s, and CWS < 0.77 m/s/0.71 m/s. The odds ratios based on the number of items with scores below the cut-off were 1.84 for one item, 3.19 for two items, and 5.20 for three items. CONCLUSION: Motor performance tests are effective in predicting ADL decline in older adults requiring long-term care, and combining the results of multiple items is even more effective.

Correlates of improvement in the care need levels of older adults with disabilities: a two-year follow-up study.

[Purpose] This study examined the effect of motor functioning, cognitive functioning, and activities of daily living on improvements in care need levels of older adults requiring low-level care at baseline in Japan's Long-Term Care Insurance system. We aimed to link our findings to a proposal for effective measures toward improving care need levels. [Participants and Methods] This retrospective cohort study included 11,585 individuals aged 65 years and above who received personal care and used day-care services continuously for two or more years starting from the baseline assessment. Participants showing an improvement in their care need level from baseline to two years were included in the improved group, and those who maintained or declined from the baseline level were included in the maintained/deteriorated group. [Results] The mental status questionnaire and sub-scores for the Functional Independence Measure, including those for self-care, continence, and social cognition, were significantly correlated with improvements in care need levels. [Conclusion] Conducting a detailed evaluation of these factors is important for gauging the progress of the care need levels of older adults.In addition, it is important for physiotherapists to provide non-rehabilitation professionals with advice and guidance on their assessment methods and remedies.

The effects of the employment of physical therapists and occupational therapists on the gait function of adult day service users after 1 year.

OBJECTIVE: The present study aimed to investigate the effects of the presence or absence of physical therapists (PTs) and occupational therapists (OTs) in an adult day service on the users' gait function, and to generalize the format of an effective service aimed at the preventing the exacerbation of the gait function and at promoting self-reliance in activities and participation. METHODS: The study population included 830 elderly day service users (mean age, 83.7±6.8 years; male, n=252; female, n=578) in Japan. Their normal gait speed was measured at the baseline and at 1 year. The sex, age, level of nursing care, and number of adult day service users were assessed at the baseline. The subjects were divided into 2 groups: (1) those who used services that employed PTs or OTs (the PTOT group) and (2) those who used services that did not employ PTs or OTs (the control group). We performed a univariate analysis to confirm the absence of differences between the groups in terms of all their baseline variables. Next, we performed a repeated measures analysis of variance using the presence or absence of PT or OT and time as factors. We subsequently performed a univariate analysis to examine the difference in the gait speed of the groups, as well as the differences in the gait speed between the groups at the baseline and at 1 year. RESULTS: Although the repeated measures analysis of variance did not show that time had a significant effect on the gait speed, it showed the significant effects of the presence or absence of PTs or OTs as well as the interaction between time and group. Intragroup comparisons showed a significant difference between the gait speed at baseline and that at 1 year in the PTOT group. However, there was also a significant difference in the baseline and 1-year gait speeds of the control group. The intergroup comparisons did not show a significant difference in the gait speed at baseline, but did show a significant difference in the gait speed at 1 year. CONCLUSION: The employment of PTs and OTs in adult day service controlled the exacerbation of the gait function. The gait speed in elderly individuals who require long-term care is associated with the activities of daily living and mortality rates; thus, the results of the present study indicate the need for the employment of rehabilitation specialists in adult day services.

Factors associated with the level of disability in elderly adults based on the Japanese long-term care insurance system.

AIM: The aim of this study was to identify factors associated with the level of disability in elderly adults based on the Japanese long-term care insurance system. METHODS: The participants included 3,198 frail elderly subjects (mean age: 82.0±6.45). The slightly disabled group, with a support level in the long-term care insurance system, comprised 1,129 elderly adults, and the moderately disabled group, with a care level of 1 or 2 in the long-term care insurance system, comprised 2,208 elderly adults who received day-care services. The following parameters were evaluated: grip strength, chair stand test 5-times (CST), one-leg standing with eyes open (OLS), timed "up & go" (TUG), walking speed, the mental status questionnaire (MSQ) score and functional independence measures (FIM). The participants were categorized into two groups based on the 13 motor subscales of the FIM (FIM-M): the activity of daily living (ADL) independent group, who scored 6 points or higher on all ADL measurements, and the ADL care need group, who scored 5 points or under on at least one item in all ADL measurements. A multiple logistic regression analysis was used to examine the relationships between the long-term care insurance level and the potential correlates. RESULTS: The multiple logistic regression model indicated that gender, grip strength and the MSQ and FIM-M scores were significantly associated with the long-term care insurance level (p<0.05). The FIM-M score exhibited a particularly strong correlation with the type of long-term care required (odds ratio: 2.47, 95% confidence interval: 1.89-3.24). CONCLUSIONS: The Japanese long-term care insurance level is associated with physical performance, the cognitive function and the ability to perform ADL's. These results suggest that comprehensive assessments are useful for understanding the impact of the long-term care insurance level in elderly adults.