Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults With and Without Cognitive Impairment: The Validation Study of Advanced Instrumental Activities of Daily Living Scale

Background: The capability in applying information communication technology (ICT) is crucial to the functional independence of older peoples of community living nowadays. The proper assessment of individuals' capability of ICT application is the corner stone for the future development of telemedicine in our aging population. Methods: With the recruitment of 300 participants of different functional and social background in home-living, hostel-living, and care-and-attention home living; and through assessing the ability of individuals in instrumental activities of daily living and cognitive assessments, this study aimed at capturing the content validity and construct validity of the Advanced Instrumental Activities of Daily Living (AIADL scale). In addition, this study assess the ability of older peoples in applying ICT and how the functional and social background affects their independence in aging-in-place. Results: The AIADL scale showed good test-retest reliability and good-to-excellent internal consistency. To determine if items of the AIADL scale measure various aspects of community living, exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals' capability of independent living in the community. Conclusions: The AIADL scale is a valid and reliable instrument to assess the ability of older adults in handling ICT as part of their instrumental activities in daily living. The scale can reflect capability of older peoples in applying ICT. This instrument can serve as a reference in measuring readiness of individuals in receiving telemedicine and their ability of aging-in-place

Adoption and Handling Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults

(Background) The use of information communication technology and smartphone application are crucial to individuals’ functional independence of community living. Previous studies did not reveal how older adults’ in applying the information communication technology will affect their aging-in-place in our contemporary community. (Methods) This study aimed at developing the psychometric properties of the instrument named Advanced Instrumental Activities of Daily Living (AIADL), and to explore the adoption and handling information communication technology in instrumental activities of daily living for aging-in-place of older adults. 100 home-living participants who are functionally and socially independent, 100 hostel-living participants who are functionally independent but need social assistance, and 100 care-and-attention home living participants who need environment support and assistance in daily functioning were recruited for this study. (Results) AIADL showed good test-retest reliability and good-to-excellent internal consistency. Exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals’ capability of independent living in the community. (Conclusions) AIADL is a valid and reliable instrument to assess older adults’ ability in handling contemporary instrumental activities in their daily life. This instrument can serve as a reference in measuring individuals’ ability of aging-in-place

Effects of activity intervention on cognitive and mood outcomes for participants with MCI-multiple domains deficits (Intention-to-treat method).

<p>() Standard Deviation, CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese Mini-mental state examination; ADAS-Cog—Alzheimer's Disease Assessment Scale cognitive subscale; CVFT—category verbal fluency test;. Differences between intervention programs were evaluated with three-level model with time point at level one, subjects at level two and activity groups at level three.</p><p>Effects of activity intervention on cognitive and mood outcomes for participants with MCI-multiple domains deficits (Intention-to-treat method).</p

Baseline demographic and cognitive characteristics of intervention groups.

<p>()—Standard deviation, sdMCI—Mild Cognitive Impairment, single domain deficit, mdMCI- Mild Cognitive Impairment, multiple domain deficit; CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; DAD-IADL—Instrumental activities of daily living of the Chinese Disability Assessment for Dementia; CSDD—Cornell Scale for Depression in Dementia. Group comparisons—Multi-level linear model-Baseline differences between intervention groups were evaluated with two-level model with subjects at level one and activity groups at level two. Differences between intervention groups were not significant.</p><p>Baseline demographic and cognitive characteristics of intervention groups.</p

Effects of activity intervention on cognitive and mood outcomes for all participants (Intention-to-treat method).

<p>() Standard Deviation, CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; ADAS-Cog—Alzheimer's Disease Assessment Scale cognitive subscale; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; CSDD—Cornel Scale for Depression in Dementia. Multi-level model-Differences between intervention groups were evaluated with three-level model with time point at level one, subjects at level two and activity groups at level three.</p><p>Effects of activity intervention on cognitive and mood outcomes for all participants (Intention-to-treat method).</p

Demographic and baseline cognitive profiles of sdMCI and mdMCI participants.

<p>()—Standard deviation, sdMCI—Mild Cognitive Impairment, single domain deficit, mdMCI- Mild Cognitive Impairment, multiple domain deficit; CDR-SOB—Clinical Dementia Rating sum of boxes; CMMSE—Cantonese version of Mini-mental state examination; CVFT—category verbal fluency test; SCC—Subjective Cognitive Complaints; CSDD—Cornell Scale for Depression in Dementia. Comparisons (t-tests)</p><p>Demographic and baseline cognitive profiles of sdMCI and mdMCI participants.</p

Risk Factors and Post-Resection Independent Predictive Score for the Recurrence of Hepatitis B-Related Hepatocellular Carcinoma.

Independent risk factors associated with hepatitis B (HBV)-related hepatocellular carcinoma (HCC) after resection remains unknown. An accurate risk score for HCC recurrence is lacking.We prospectively followed up 200 patients who underwent liver resection for HBV-related HCC for at least 2 years. Demographic, biochemical, tumor, virological and anti-viral treatment factors were analyzed to identify independent risk factors associated with recurrence after resection and a risk score for HCC recurrence formulated.Two hundred patients (80% male) who underwent liver resection for HBV-related HCC were recruited. The median time of recurrence was 184 weeks (IQR 52-207 weeks) for the entire cohort and 100 patients (50%) developed HCC recurrence. Stepwise Cox regression analysis identified that one-month post resection HBV DNA >20,000 IU/mL (p = 0.019; relative risk (RR) 1.67; 95% confidence interval (C.I.): 1.09-2.57), the presence of lymphovascular permeation (p100ng/mL before resection (p = 0.021; RR 1.63; 95% C.I.: 1.08-2.47) were independently associated with HCC recurrence. Antiviral treatment before resection (p = 0.024; RR 0.1; 95% C.I.: 0.01-0.74) was independently associated with reduced risk of HCC recurrence. A post-resection independent predictive score (PRIPS) was derived and validated with sensitivity of 75.3% and 60.6% and specificity of 55.7% and 79.2%, to predict the 1- and 3-year risks for the HCC recurrence respectively with the hazard ratio of 2.71 (95% C.I.: 2.12-3.48; p<0.001). The AUC for the 1- and 3-year prediction were 0.675 (95% C.I.: 0.6-0.78) and 0.746 (95% C.I.: 0.69-0.82) respectively.Several tumor, virological and biochemical factors were associated with a higher cumulative risk of HCC recurrence after resection. PRIPS was derived for more accurate risk assessment. Regardless of the HBV DNA level, antiviral treatment should be given to patients before resection to reduce the risk of recurrence

Cumulative tumor recurrence between patients with or without lymphovascular permeation.

<p>Cumulative tumor recurrence between patients with or without lymphovascular permeation.</p