Secondary Health Conditions, Activity Limitations, and Life Satisfaction in Older Adults With Long-Term Spinal Cord Injury

Background: Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI. Objectives: To (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction. Design: Cross-sectional descriptive cohort study. Setting: Home and community settings. Participants: A total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years. Methods: Baseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses. Main Outcome Measurements: Bowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale. Results: Bowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury. Conclusion: Older adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI. Level of Evidence: To be determined

Inter-rater agreement of a modified and extended Swedish version of the Frenchay Activities Index (FAI).

The point of departure for this study was the need for an instrument capturing social activities updated to the living circumstances of the 21st century. Starting out from the Frenchay Activities Index (FAI), the objective was to investigate the inter-rater agreement of the scoring of a modified and extended Swedish version, capturing activity performance and participation. Thirty-one older people, living in the community post stroke, were interviewed in their homes by two raters using the Swedish FAI version, extended with items on use of mode of transport and use of telephone, and modified with additional scales. Besides the original frequency scale, the new scales captured changes in frequency, reasons for change, and performance satisfaction; inter-rater agreement was analyzed with kappa statistics. Overall, the inter-rater agreement was high or very high, with weighted ̄ Κ = 0.924 for the frequency scale and ̄ Κ = 0.784-0.940 for the new scales. As a conclusion, while further validity and reliability testing is necessary, when out-of-home activities are of interest the scoring of the modified and extended Swedish FAI version can be administered with high inter-rater agreement

ORIGINAL REPORT

Objective: To study the information gained by extending a well-established instrument of dependence/independence in activities of daily living with a self-rating of difficulty, and to illustrate the relevance and usefulness of this combined approach with cross-national data. Design and subjects: Cross-sectional survey study data collected with 1918 very old persons in 5 European countries. Methods: The "ADL staircase assessment" of dependence/independence, extended with a self-rating of difficulty, was administered at home visits. Data distribution in the 5 national samples and analyses with or without use of the self-rating data were carried out. Results: High proportions of the subjects were independent in most of the activities assessed, while substantial proportions reported difficulties. Considerable differences were identified among the national samples. In personal activities of daily living, those assessed as independent varied from 87% to 100%, while the proportion of those who rated themselves as "independent without difficulty" ranged from 53% to 98%. In instrumental activities, 33-91% were assessed as independent, while the proportions of "independent without difficulty" ranged from 24% to 77%. Analysis results differed as to whether or not self-ratings of difficulty were used. Conclusion: The combined approach to data collection gave a diversified, information-rich picture. The assessment used is easy to administer and can be used in practice contexts in different countries

Light, activity and sleep in my daily life: : Design of an online intervention targeting changes to routines and the home

Background: Older adults spend more time at home after retirement, and the home becomes a central place for activity. While research indicates that indoor lighting, exposure to daylight, physical activity and sleep interact to influence functioning, mood and daily rhythm, strategies are needed to promote behavioural changes to optimise these factors in daily life. The objective is to design an intervention delivered as a web-based course to encourage behaviour change related to outdoor physical activity, sleep patterns and changes to the home environment. The behaviour changes are intended to promote mental wellbeing and improve lighting and darkness conditions. The intervention strategy departs from the Information-Motivation-Behavioural Skills Model. Intervention components build on goal implementation theory. The Technology Acceptance Model is used as a framework to evaluate usability aspects of the course content and the learning management system. Method: Using a mixed-methods approach, qualitative and quantitative data were collected through video observations, semi-structured interviews and a 10-item Likert scale questionnaire (The System Usability Scale). Scores were averaged for each participant and converted into a usability score out of 100 (a score of 68 or above is considered above average). In a first round, three experts on pedagogy, design for older people and/or interaction design were invited to independently assess the usability of the course content on their laptops in a full-scale model of an apartment. The setting enabled manipulations of the lighting conditions (daylight mode and night mode, change of luminaires), contextual interviews and video observation to identify any problems when participants experimented with the test kit included in the course material. They participated on three occasions lasting 2 hours each. Six healthy adults (aged 70+) participated in a similar usability trial in a second round. Findings: Experts’ average usability score was 78.3, indicating “Good” usability. However, the interviews did reveal some issues (e.g. difficult or inconsistent terms, unclear instructions). Results were used to refine the course before the second usability trial with six participants. Based on the interviews and usability ratings, the participants were positive about the course, and the instructions were easy to follow. All six participants rated the overall user-friendliness of the course as 6 out of 7. The average usability score was 86.7, indicating “Excellent” usability. Based on the participants’ feedback and interactions in the apartment, changes to the course content included, e.g. clarifying terms, the different types of text links and instructions. Unexpected issues with online enrolment in the course appeared before the second trial because standard instructions developed by the university were not tailored to the participants.Conclusions: A two-step usability evaluation by experts in the first round and target users in the second proved valuable. It enabled refinement of the course content and significantly reduced the number of identified usability issues in the second trial. A learning management system seems promising for use in behaviour-change interventions. However, the time-limited lab trials restricted a complete evaluation. Therefore, the next step is to pilot the course and evaluate the feasibility in real-world homes

Playing the Wrong Game: An Experimental Analysis of Relational Complexity and Strategic Misrepresentation.

It has been suggested that players often produce simplified and/or misspecified mental models of strategic decisions [Kreps, D., 1990. Game Theory and Economic Modeling. Oxford Univ. Press, Oxford]. We submit that the relational structure of players’ preferences in a game is a source of cognitive complexity, and may be an important driver of such simplifications. We provide a classification of order structures in two- person games based on the properties of monotonicity and projectivity, and present experiments in which subjects construct representations of games of different relational complexity and subsequently play the games according to these representations. Experimental results suggest that relational complexity matters. More complex games are harder to represent, and this difficulty seems correlated with short term memory capacity. In addition, most erroneous representations are simpler than the correct ones. Finally, subjects who misrepresent the games behave consistently with such representations, suggesting that in many strategic settings individuals may act optimally on the ground of simplified and mistaken premises

Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use.

Purpose: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. Method: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. Results: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56-91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. Conclusions: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. [Box: see text]

Community Relocation in Very Old Age: Changes in Housing Accessibility.

The objective of this study was to compare environmental barriers, housing accessibility, and usability before and after relocation of very old, single-living people in the community. It also examined whether accessibility improved after relocation compared with a simulated scenario in which participants would have remained in their former dwellings

Walking Ability Is a Major Contributor to Fear of Falling in People with Parkinson's Disease: Implications for Rehabilitation

Although fear of falling (FOF) is common in people with Parkinson's disease (PD), there is a lack of research investigating potential predictors of FOF. This study explored the impact of motor, nonmotor, and demographic factors as well as complications of drug therapy on FOF among people with PD. Postal survey data (including the Falls Efficacy Scale, FES) from 154 nondemented people with PD were analyzed using multiple regression analyses. Five significant independent variables were identified explaining 74% of the variance in FES scores. The strongest contributing factor to FOF was walking difficulties (explaining 68%), followed by fatigue, turning hesitations, need for help in daily activities, and motor fluctuations. Exploring specific aspects of walking identified three significant variables explaining 59% of FOF: balance problems, limited ability to climb stairs, and turning hesitations. These results have implications for rehabilitation clinicians and suggest that walking ability is the primary target in order to reduce FOF. Specifically, balance, climbing stairs, and turning seem to be of particular importance

Psychometric properties of the Swedish version of the General Self-Efficacy Scale in stroke survivors.

The aim of this study was to assess the psychometric properties of a Swedish version of the General Self-Efficacy Scale (GSE) in stroke survivors. The GSE was administered by the same assessor on two occasions 3 weeks apart with 34 stroke survivors (21 men, 13 women; mean age=68.1 years) 6-10 months after stroke. Psychometric properties including targeting and scaling assumptions, and several reliability indices, were calculated. The mean score was well above the midpoint of the scale and the total scores spanned almost the entire scale range. Floor and ceiling effects were within the limits of 15-20% for total scores (0 and 8.8%, respectively), but not for each item individually. Total skewness was estimated at -1.02 and skewness for individual items was estimated as -1.55 to -0.33. The corrected item-total correlations were all above 0.3, except for one item. Cronbach's α was high (0.92) and the test-retest reliability was acceptable (intraclass correlation coefficient2,1=0.82). The mean difference (đ) was -0.68 (NS). The SEM was 2.97 (SEM%; 9.40). In conclusion, although targeting in relation to skewness and ceiling effects was observed in some items, the GSE was reliable for use in mobile stroke survivors 6-10 months after stroke

Perceived home is associated with psychological well-being in a cohort aged 67–70 years

Research on very old people has shown that perceived aspects of home are important for health, but research on such associations in younger cohorts of older people is lacking. The aim of this study was to investigate whether perceived aspects of home were associated with psychological well-being among community-living people aged 67–70. Interview data were collected with 371 individuals living in ordinary housing in southern Sweden. Statistical analyses revealed that depression was less common among participants who reported cognitive-emotional and social bonding to the home, and among those who felt that they had control over their housing situation. The behavioral, social and physical aspects of meaning of home as well as external control beliefs were associated with psychological well-being. Showing that perceived aspects of home are relevant for psychological well-being among people aged 67–70, this study adds to the knowledge on home and health dynamics during the ageing process