Isabelle Gélinas

Functional Disability in Alzheimer's Disease

Functional impairment is a core symptom of Alzheimers disease. The most accurate indicator of functional impairment is the decline in performance of Activities of Daily Living (ADL). Several scales have been used to measure ADL in geriatric and Alzheimers disease (AD) populations including the Disability Assessment for Dementia (DAD). The key to making a correct differential diagnosis between benign cognitive impairment and dementia is the detection of a decline in functioning. The instrumental ADL (IADL) relevant items of the DAD could provide crucial guidance in the diagnosis of early stage AD for primary care physicians. It is anticipated that the role of primary care physicians, already essential for the management of the AD patient, will expand to include the diagnosis of earlier cases and the prescription of cholinergic drugs as treatment. ADL assessment tools such as the DAD may help their tasks.

Powered Mobility for Middle-aged and Older Adults: Systematic Review of Outcomes and Appraisal of Published Evidence

Auger C, Demers L, Gélinas I, Jutai J, Fuhrer MJ, DeRuyter F: Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence. Am J Phys Med Rehabil 2008;87:666–680. Objective:To identify the outcomes of power mobility devices for middle-aged and older adult users, and to critically appraise the research evidence. Design:Systematic review of primary source studies involving adults aged 50 and over using power mobility devices (1996–2007). Articles were (i) mapped to the Taxonomy of Assistive Technology Device Outcomes, which describes categories of impact of assistive devices from the vantages of effectiveness, social significance, and subjective well-being; and (ii) appraised using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. Results:This review retained 19 studies and identified 52 different categories of impacts of power mobility devices spanning the three vantages of the taxonomy. The coverage of outcome dimensions was not as extensive for adults age 50 and over as it was for mixed-age groups. Most of the research designs were assigned very low evidence grades. Three studies were low to moderate in quality of evidence, among which one was a randomized trial. Conclusions:A vast array of potential impacts of powered mobility devices have been described in the last decade. The level of quality of this evidence is improving, but most of these studies were not designed to verify causal relationships, and this is largely responsible for the absence of unequivocal evidence for directly attributing benefits to devices themselves and for quantifying relationships between power mobility device intervention and outcome. To raise the level of evidence about power mobility device interventions in older adults, studies are needed that use prospective designs, better-defined user groups, and well-grounded conceptual frameworks for measuring interventions and outcomes.

Comparison and correlates of participation in older adults without disabilities

This study was conducted to compare, by age group and gender, the level of participation of older adults who had no disabilities, and to determine which characteristics are most associated with participation. This study involved 350 randomly recruited community-dwelling older adults. Participation in daily activities and social roles were measured with the Assessment of Life Habits (LIFE-H). Demographic, health-related and environmental data were also collected. A decline with age was observed in four of the six daily activities domains and two of the four social roles domains of participation. However, these lower scores are mainly explained by the 85+ group, which consistently scored lower than the 65-69-year-old group. No differences were found between the 65-69, 70-74 and 75-79 years old groups. Some participation domains differed according to gender. Satisfaction with participation was high and did not differ between age groups. Characteristics most associated with participation vary according to the domains; generally, age and marital status are the best determinants of participation. This study found that most of older adults have an unrestricted level of participation which decreases only late in the aging process. This reduction in participation in very old adults was not accompanied by a decrease in satisfaction, supporting the hypothesis that they can participate satisfactorily in valued activities.

Life-Space Mobility of Middle-Aged and Older Adults at Various Stages of Usage of Power Mobility Devices

OBJECTIVE To examine whether the impact of power mobility devices (PMDs) varies as a function of stage of usage and to explore key factors associated with greater life-space mobility for middle-aged and older adults. DESIGN Multicohort study with respondents grouped as a function of stage of PMD usage (reference group with mobility impairments, n=42; initial users, 1-6mo, n=35; long-term users, 12-18mo, n=39). Cohorts were compared with respect to life-space mobility in a continuum of environments ranging from home to outside town, using analysis of variance and chi-square tests. Baseline personal, assistive device, intervention, and environmental factors associated with life-space mobility were explored with age-adjusted linear regression models. SETTING Four Canadian rehabilitation centers. PARTICIPANTS Random sample of middle-aged and older adults (N=116; 50-89y) living in the community or residential care. INTERVENTION Procurement of a powered wheelchair or scooter. MAIN OUTCOME MEASURE Life-Space Assessment composite score. RESULTS Cohort comparisons showed higher frequency of outings for PMD users in the neighborhood (P<.001) and around home (P<.05) and significantly greater Life-Space Assessment composite scores for initial and long-term users than for the reference group (P<.05). Factors such as sex, the nature of activities, and device type explained variances in Life-Space Assessment composite score ranging from 15.9% to 18.0% (P<.006). CONCLUSIONS Life-space mobility increases after PMD use and remains stable across the stages of initial and long-term use. To appreciate the impact of PMDs, clinicians should consider the environment and a combination of personal and device factors that are associated with the range of life-space mobility in the first 18 months after procurement.

Development of a French-Canadian version of the Life-Space Assessment (LSA-F): content validity, reliability and applicability for power mobility device users

Purpose. To examine the measurement properties of the French-Canadian version of the Life-Space Assessment questionnaire (LSA-F) for power mobility device (PMD) users. Methods. Content validity, test–retest reliability of telephone interviews (2-week interval) and applicability were examined with PMD users presenting neurological, orthopedic or medically complex conditions. Translation/back-translation from English to French and cultural adaptation was performed and pretested with five bilingual users. Test–retest reliability was examined with 40 French-speaking users, age 50 and over, who had been using a subsidised PMD for 2–15 months. Audio-taped interviews were coded to judge content validity and applicability. Results. Content validity results confirmed equivalent meaning for most questions. The test–retest reliability was excellent for the composite score (intra-class correlation coefficient = 0.87) and revealed moderate to substantial concordance for 18/20 items (k = 0.47–0.73; Pa > 57.5%). The applicability of the LSA-F is satisfactory considering an acceptable burden of assessment, low refusal of the telephone interview format (8%; n = 4), reasonable administration time (9.2 ± 3.9 min) and a normally distributed composite score. Conclusions. The LSA-F is a valid measure with regards to its content, stable over a period of 2 weeks and applicable for a population of middle-aged and older French-Canadian speaking adults who use PMDs.

Assessing ability to drive following an acute neurological event: are we on the right road?

Every day in Canada occupational therapists are asked to assess clients with neurological impairments and to provide recommendations to provincial licensing bureaus regarding the individuals fitness to drive. These decisions have great impact on the client and on society. In this paper we briefly review the findings that have been published regarding the assessment of — individuals with neurological conditions who wish to resume driving. In addition, a description of the tools commonly used to assess individuals is provided, along with where available, the measurement properties of each. Finally, the Driving Evaluation Service of a physical rehabilitation centre is described.

Recommendations of the Canadian Consensus Conference on Driving Evaluation in Older Drivers

SUMMARY This paper presents the results of the first Canadian Consensus Meeting focused on the structure and content of a comprehensive driving evaluation (CDE) for older individuals. The clientele of interest were individuals over 65 referred for a driving assessment primarily for cognitive reasons. The goals were: to develop recommendations on appropriate elderly clientele for referral; to identify important components of the pre- and on-road assessment; and, to delineate critical behaviors to be assessed on-road. Moderate-to-strong agreement was evident on a wide range of recommendations. These are presented along with assessment tools that have demonstrated psychometric value for driving evaluation.

Coping Strategies and Social Participation in Older Adults

Background: Social participation refers to daily activities, such as personal care and mobility, and social roles, such as interpersonal relationships and leisure. Although restrictions in participation in normal aging have been recognized, little research has been done to study the coping strategies used to alleviate those restrictions. Objective: The objective of the present study was to explore the relationships between cognitive and behavioural coping strategies and the social participation of community-dwelling older adults. Methods: The Assessment of Life Habits (LIFE-H) and the Inventory of Coping Strategies Used by the Elderly (ICSUE) were used to document social participation and coping strategies of 350 randomly recruited older adults living at home independently. Sociodemographic and health-related characteristics were also assessed. Regression analyses were performed to evaluate the relationship between social participation, coping strategies and the other variables. Results: Behavioural coping strategies were the most important factor associated with daily activities, social roles and total participation, followed by the type of living environment and age. These variables explained 33% (p = 0.04), 13% (p = 0.02), and 28% (p = 0.00) of the variance of the models, respectively. The absence of any relationship between the cognitive coping strategies and social participation was a striking result. Conclusion: Our study suggests expanding current geriatric approaches to integrate knowledge on useful, safe and appropriate behavioural changes and to help older people acquire such strategies when they are lacking.

The relationship between cognitive performance, perceptions of driving comfort and abilities, and self-reported driving restrictions among healthy older drivers

The objective of the present study was to examine the relationship between cognitive performance, driver perceptions and self-reported driving restrictions. A cross-sectional analysis was conducted on baseline data from Candrive II, a five-year prospective cohort study of 928 older drivers aged 70-94 years from seven cities. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) as well as the Trail Making Test, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort Scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales, as well as the Driving Habits and Intentions Questionnaire. The baseline data indicates this cohort is largely a cognitively intact group. Univariate regression analysis showed that longer Trails A and B completion times were significantly, but only modestly associated with reduced driving frequency and perceived driving abilities and comfort, as well as a significant tendency to avoid more difficult driving situations (all p<.05). Most of these associations persisted after adjusting for age and sex, as well as indicators of health, vision, mood and physical functioning. Exceptions were Trails A and B completion times and situational driving frequency, as well as time to complete Trails B and current driving restrictions. After adjusting for the confounding factors, the total MoCA score was not associated with any of the driving measure scores while the number of errors on Trails A was significantly associated only with situational driving frequency and number of errors on Trails B was significantly associated only with situational driving avoidance. Prospective follow-up will permit examination of whether baseline cognition or changes in cognition are associated with changes in driver perceptions, actual driving restrictions and on-road driving outcomes (e.g., crashes, violations) over time.

Reliability and Validity of the Safety Assessment Scale for People with Dementia Living at Home

Background. With the recent funding changes in health care services, more seniors with dementia are cared for in their homes and the nature of their condition puts them at higher risk for accidents and injuries. Purpose. The Safety Assessment Scale (SAS) was developed for use by community healthcare providers to evaluate and lower the risk of accidents, provide recommendations to family caregivers and enhance case management. Method. The scale was assessed in terms of the reliability as well as content, criterion and construct validity with 176 community-residing people with dementia in Quebec, Alberta and British Columbia. The Safety Assessment Scale was validated in French and English. Results. The SAS demonstrated an excellent test-retest (ICC=.91) and inter-rater (ICC=.88) reliability. Results for validity were also extremely good. Practice Implications. The scale is available in French and English. The short version of the SAS is a screening tool and the longer version provides an in-depth evaluation of safety and intervention planning. The SAS can be used by a variety of health care professionals who work with individuals who have dementia.