Losing the Ability in Activities of Daily Living in the Oldest Old: A Hierarchic Disability Scale from the Newcastle 85+ Study

Objectives: To investigate the order in which 85 year olds develop difficulty in performing a wide range of daily activities covering basic personal care, household care and mobility. Design: Cross-sectional analysis of baseline data from a cohort study. Setting: Newcastle upon Tyne and North Tyneside, UK. Participants: Individuals born in 1921, registered with participating general practices. Measurements: Detailed health assessment including 17 activities of daily living related to basic personal care, household care and mobility. Questions were of the form ‘Can you … ’ rather than ‘Do you… ’ Principal Component Analysis (PCA) was used to confirm a single underlying dimension for the items and Mokken Scaling was used to determine a subsequent hierarchy. Validity of the hierarchical scale was assessed by its associations with known predictors of disability. Results: 839 people within the Newcastle 85+ study for whom complete information was available on self-reported Activities of Daily Living (ADL). PCA confirmed a single underlying dimension; Mokken scaling confirmed a hierarchic scale where ‘Cutting toenails ’ was the first item with which participants had difficulty and ‘feeding ’ the last. The ordering of loss differed between men and women. Difficulty with ‘shopping ’ and ‘heavy housework ’ were reported earlier by women whilst men reported ‘walking 400 yards ’ earlier. Items formed clusters corresponding to strength, balance, lower and upper bod

Cognitive neuroscience of delusions in aging

Assessments and clinical understanding of late-onset delusions in the elderly are inconsistent and often incomplete. In this review, we consider the prevalence, neurobehavioral features, and neuroanatomic correlations of delusions in elderly persons – those with documented cognitive decline and those with no evidence of cognitive decline. Both groups exhibit a common phenotype: delusions are either of persecution or of misidentification. Late-onset delusions show a nearly complete absence of the grandiose, mystical, or erotomanic content typical of early onset psychoses. Absent also from both elderly populations are formal thought disorders, thought insertions, and delusions of external control. Neuroimaging and behavioral studies suggest a frontotemporal localization of delusions in the elderly, with right hemispheric lateralization in delusional misidentification and left lateralization in delusions of persecution. We propose that delusions in the elderly reflect a common neuroanatomic and functional phenotype, and we discuss applications of our proposal to diagnosis and treatment

The Well-Being Measure – dementia: A validation study

The Well-Being Measure – dementia is a digital observation instrument that assesses the well-being of persons with dementia on four domains of quality of life: Mental well-being, Physical well-being, Participation, and Living arrangements. Its goal is to assess the well-being of persons with dementia in an easy and positive way. Besides illness-related symptoms and problems, the instrument also assesses positive aspects of functioning. It visualizes the results and provides specific behavioural advice to the caregivers. The goal of the present article is to conduct a first psychometric analysis: factor structure, reliability (Cronbach’s alpha), concurrent, and convergent validity. Observations were carried out among 168 persons with dementia in eleven different small-scale psychogeriatric wards. Five existing instruments were used among 63 persons to validate the Well-Being Measure-dementia: quality of life, neuropsychiatric symptoms, care dependency, depression, and agitation. The expected factor structure was found in each of the four domains. Coefficients were high on the expected factor and low on the other factor(s). The scale means were on the positive side, but showed an adequate range and variability. Reliability was satisfactory to good. The relation with existing scales was moderate to strong. The pattern of relations was consistent with the measurement intentions of the different existing instruments. The Well-Being Measure – dementia appears to be a valid and reliable scale. Further studies should assess its test-retest reliability, sensitivity to change and relation with the course of dementia. Current experience shows that the instrument is also useful in everyday practice