Self-reported mobility and instrumental activities of daily living: test-retest reliability and criterion validity

To determine the test-retest reliability and criterion validity of self-reported function in mobility and instrumental activities of daily living (IADL) in older adults, a convenience sample of 70 subjects (72.9 ± 6.6 yr, 34 male) was split into able and disabled groups based on baseline assessment and into consistently able, consistently disabled, and inconsistent based on repeat assessments over 2 weeks. The criterion validities of the self-reported measures of mobility domain and IADL-physical subdomain were assessed with concurrent baseline measures of 4 mobility performances, and that of the self-reported measure of IADL-cognitive subdomain, with the Mini-Mental State Examination. Test-retest reliability was moderate for the mobility, IADL-physical, and IADL-cognitive subdomains (κ = .51-.66). Those who reported being able at baseline also performed better on physical- and cognitive-performance tests. Those with variable performance between test occasions tended to report inconsistently on repeat measures in mobility and IADL-cognitive, suggesting fluctuations in physical and cognitive performance.     

When do older adults become "disabled"? Social and health antecedents of perceived disability in a panel study of the oldest old

Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults 'perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health.     

Physical-performance tests to evaluate mobility disability in community-dwelling elders

The purposes of this study were to evaluate community-dwelling elderly adults with different levels of perceived mobility with 5 physical-performance tests, determine the cutoff values of the 5 tests, and identify the best tests for classifying mobility status. The community-mobility statuses of 203 community-dwelling elders were classified as able, decreased, or disabled based on their self-reported ability to walk several blocks and climb stairs. They also performed the functional reach, timed 50-ft walk, timed 5-step, timed floor transfer, and 5-min-walk endurance tests. We found in all tests that the "able" outperformed the "decreased" and that the "decreased" outperformed the "disabled," except on the floor-transfer task. The optimum cutoff values of the 5 performance tests were also reported. The 5-min walk and timed 5-step test could best separate the "able" from the "decreased," whereas the 50-ft-walk-test could best differentiate the "decreased" from the "disabled." The results suggest that community-mobility function of older adults can be captured by performance tests and that the cutoff values of the 5-min-walk, 5-step, and 50-ft-walk tests can be used in guiding intervention or prevention programs.     

Determinants of stability and changes in self-reported work disability among older working-age populations

Data from the Health and Retirement Study, 1992-1994, were used to analyze (1) the prevalence and incidence of self-reported work disability among older working-age populations over a two-year period, and (2) the effect of the stability/changes in physical and functional health conditions, controlling for socioeconomic and occupational characteristics, on the stability/changes in self-reported work ability/disability. Findings show a high rate of transitions into and out of work-disabled status over the two-year period. Findings also show that, although objective physical and functional health problems and low self-ratings of health at wave 1 were significant determinants of self-reported work disability at wave 1, most subsequent changes in objective physical and functional health conditions over the two-year period were not significantly associated with the changes in self-report of work disability between wave 1 and wave 2. Especially, improved health conditions were not significantly associated with regained work ability between the two waves. Of the demographic variables, female gender significantly increased the likelihood of reporting work disability at wave 2, and being Black or Hispanic significantly decreased the likelihood of reporting regained work ability at wave 2. Research and policy implications of the findings are discussed.     

A grounded theory of living a life with a physical disability in Taiwan

This study explores the experiences of disability for a number of Taiwanese adults with a physical disability. Using a grounded theory approach, their experiences of living a life with a physical disability were gained through in-depth interviews. The resulting grounded theory ‘it is more than just the impaired body’ presents the dynamic interactions between the participants and the context in which they were living their lives and how they managed their lives within that context. With its inclusion of the cultural dimension, a holistic way of understanding the daily lives of those who experience physical disability in Taiwan is provided.     

Leisure-time physical activity and health-care utilization in older adults

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N = 1,000, 75.32 +/- 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.     

Neighborhood-level influences on physical activity among older adults: a multilevel analysis

There is a need for greater understanding of setting-specific influences on physical activity to complement the predominant research paradigm of individual-centered influences on physical activity. In this study, the authors used a cross-sectional multilevel analysis to examine a range of neighborhood-level characteristics and the extent to which they were associated with variation in self-reported physical activity among older adults. The sample consisted of 582 community-dwelling residents age 65 years and older (M = 73.99 years, SD = 6.25) recruited from 56 neighborhoods in Portland, OR. Information collected from participants and neighborhood data from objective sources formed a two-level data structure. These hierarchical data (i.e., individuals nested within neighborhoods) were subjected to multilevel structural-equation-modeling analyses. Results showed that neighborhood social cohesion, in conjunction with other neighborhood-level factors, was significantly associated with increased levels of neighborhood physical activity. Overall, neighborhood-level variables jointly accounted for a substantial variation in neighborhood physical activity when controlling for individual-level variables.     

Visual acuity's association with levels of leisure-time physical activity in community-dwelling older adults

Little is known about the effect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision, and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross-sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations while controlling for potential confounders. In multivariate analyses, each lower step in visual acuity below 20/50 was significantly associated with reduced odds of having a higher level of physical activity, OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults.     

Poverty and disability in Eastern and Western Cape Provinces,South Africa

The impact of disability on the living conditions of people living in specifically resource‐poor areas in South Africa has not previously been addressed. This paper presents a comparison of people with a disability and their non‐disabled peers with respect to some key poverty indicators among a sample of Xhosa speaking individuals in resource‐poor areas of Eastern and Western Cape Provinces. A questionnaire on the level of living conditions (household composition and socio‐economic characteristics) and a detailed disability questionnaire that captured more specific details of the disability experience of the individual with a disability were adapted to the South African context and utilised. Despite the improved situation of households with a disabled family member in terms of financial resources (due primarily to the allocation of disability grants), other measures of poverty (education and employment) remain divisive for those with disabilities.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

Association of low serum 25-hydroxyvitamin D levels with the frailty syndrome in Mexican community-dwelling elderly

Objective: Since vitamin D is an important regulator of muscle function, the effect of vitamin D deficiency on frailty syndrome has been recently studied. This cross-sectional study aimed to determine the association between 25(OH)-vitamin D levels and frailty status in Mexican community-dwelling elderly.

Methods: Sample of 331 community-dwelling elderly aged 70 or older, a subset of those included in the “Coyoacán cohort” were included. 25(OH)-vitamin D assay and frailty status were measured.

Results: Mean age was 79.3 years and 54.1% were women. Those classified as frail were more likely to have lower Mini-Mental State Examination score (p?=?0.015), more disability for instrumental activities of daily living (p?p?p?Conclusion: These results suggest that older adults with low 25(OH)-vitamin D levels are associated with the probability to being frail compared with those with sufficient vitamin D levels.     

New Voices in Iceland. Parents and Adult Children: juggling supports and choices in time and space

This paper deals with parents' perspectives and experiences of bringing up children with a variety of impairments in Iceland, and how they impact the young disabled adults' approach to the status of adulthood. The paper is based on a qualitative study that explored perspectives and experiences of 36 young disabled adults (16-24 years old), their parents, friends and teachers. The purpose of this paper is to share themes related to patterns of parents' reactions and choices when coming to terms with parenting a disabled child, the support they found from their social network and professionals, and their sons or daughters' subsequent views of themselves and their prospects as young adults. The paper includes different perspectives on adulthood and the extent to which the young disabled people expect to reach that status or remain as 'eternal youth' enmeshed in segregated services. Findings show that the type and nature of early support for parents of disabled children is critical for the young adults' approaching adulthood in regular society or expecting to remain in the limbo of 'eternal youth' within segregated settings. Early 'betrayals' may, however, be revisited at each subsequent transition point. Furthermore, parents and their disabled children who struggled for social inclusion could obtain full active membership in society, even against social and physical barriers, and medically defined disability labels.     

‘Their families or the disability services will take care of them’: the invisible homeless and how Irish government policy is designed not to help them

Most intellectually disabled adults in Ireland continue to live with their parents. For those who want and/or are forced to move out of the parental home, the default option is to avail of the various kinds of accommodation offered by the Irish disability services. This paper critically investigates the range of housing options available to intellectually disabled adults living in Ireland – some more nominal than others – and the governmental role in facilitating members of this population to live in accommodation of their choosing. The relevant issues are given voice by a mother of an adult with Down syndrome. In her search for appropriate accommodation for her daughter, she provides important experiential knowledge regarding both the shortcomings of current Irish policy and the hidden discrimination to which intellectually disabled people are subjected on a daily basis by banks and private landlords alike.     

Systematic review of functional training on muscle strength,physical functioning,and activities of daily living in older adults

Exercise programs are often recommended for preventing or delaying late-life disability. Programs that incorporate functional training, which uses movements similar to performing activities of daily living, may be suitable for such recommendation. The purpose of this systematic review was to examine the effects of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Studies in three electronic databases (MEDLINE, CINAHL, and SPORTDiscus) were searched, screened, and appraised. Thirteen studies were included in the review. These studies vary greatly in participant recruitment criteria, functional training content, and selection of comparison groups. Mobility exercises were the most common element in functional training across studies. Results show beneficial effects on muscle strength, balance, mobility, and activities of daily living, particularly when the training content was specific to that outcome. Functional training may be used to improve functional performance in older adults.     

The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000-3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700-800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg, p < .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p < .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p = .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.     

‘Chocolate … makes you autism’: impairment,disability and childhood identities

This paper discusses perceptions and experiences of impairment and disability from the perspectives of learning disabled children, their parents and their social workers. The author reports on findings from her doctoral study that adults often fail to take into account the views and experiences of learning disabled children. As a result, these children developed their own interpretations of impairment and disability based on their experiences and interactions with others. Whilst this indicates that they are active social interpreters, it also suggests that adults should make greater efforts to inform and consult learning disabled children. The author concludes by reflecting on the relevance of these findings to contemporary theories of disability and childhood.     

Same Difference? Older People's Organisations and Disability Issues

This paper addresses some important areas of commonality in the political interests of older and disabled people. The paper reports findings from survey and interview research with local organisations representing older people, and their engagement with disability issues. We begin by reviewing similarities in the claims and mobilisation of older and disabled people, and by reviewing the groups that participated in the study. The main part of the paper identifies substantive policy issues that were perceived as important to older people. Here, there are considerable areas of overlap with the claims of disabled people's organisations (for example, in relation to information, independent living, accessible housing, transport, social support, and incomes). We review these commonalities and offer some thoughts on the potential for political alliance between the two movements. The paper concludes that, while there are considerable areas of common ground, there remain cultural barriers to the mobilisation of such alliances.     

Lighting Effects on Older Adults’ Visual and Nonvisual Performance: A Systematic Review

Lighting plays an important role in daily life: It helps people perform daily activities independently and safely, and also benefits their health. This study assesses the research evidence of lighting’s impacts on older adults in four domains: (a) performance of activities of daily living and instrumental activities of daily living; (b) circadian rhythm; (c) fall prevention and postural stability; and (d) sleep quality. A comprehensive review of lighting studies on older adults’ visual and nonvisual performance was conducted using a modified PRISMA systematic review process. For the first domain, some older adults had difficulty in using the toilet, preparing meals, and doing laundry under lower illuminance. For the second domain, brighter and bluish lighting improved older adults’ circadian rhythm. For the third domain, low-intensity LED lighting affixed on door frames can help older adults maintain postural stability and prevent falling during nighttime movement. Finally, some studies concluded that receiving outdoor daylight during exercise was beneficial to older adults’ sleep quality. This study provides several methodological, theoretical, and collaborative suggestions for developing a more conclusive evidence base for lighting standards and strategies for older adults.