The Cleveland Scale for Activities of Daily Living (CSADL): Its Reliability and Validity

This study evaluated the reliability and validity of the Cleveland Scale for Activities of Daily Living (CSADL), a scale designed to measure in detail specific activities of daily living in individuals with dementia. Administered to knowledgeable informants by trained examiners, the CSADL demonstrated good reliability in terms of interrater agreement and internal consistency. The validity of CSADL total scores was shown by its sensitivity to degree of cognitive impairment: All comparisons between means of the healthy elderly group and three groups of AD patients differing in severity were statistically significant. The CSADL was highly correlated with the Blessed–Roth Dementia Scale (DS-ADL) and more highly correlated with Mini-Mental State Exam scores than was the DS-ADL.     

Self-report measures among transplant candidates: the impact of evaluative situations

Experiment 1 was a between-subjects design comparing transplant candidates completing self-report measures under an evaluative versus an anonymous research condition. A cardiac disease group and a healthy community group served as controls. Transplant candidates in the anonymous research condition reported significantly more depression, anxiety, and negative affectivity as compared with transplant candidates in the evaluative condition and community controls. In contrast, the evaluative transplant group (a) did not differ from the community controls on any of the self-report measures, and (b) reported significantly less depression than cardiac disease controls. Experiment 2 was a within-subjects design with transplant candidates completing self-report measures under both an evaluative and an anonymous research condition. Significantly greater anxiety was reported under the anonymous research condition. Social desirability was significantly related to change in self-reported anxiety and depression across conditions, but was unrelated to change in endorsement of personality characteristics.     

The Relationship between Everyday Problem Solving and Inconsistency in Reaction Time in Older Adults

ABSTRACT

The purpose of the present study was to investigate whether inconsistency in reaction time (RT) is predictive of older adults' ability to solve everyday problems. A sample of 304 community dwelling non-demented older adults, ranging in age from 62 to 92, completed a measure of everyday problem solving, the Everyday Problems Test (EPT). Inconsistency in latencies across trials was assessed on four RT tasks. Performance on the EPT was found to vary according to age and cognitive status. Both mean latencies and inconsistency were significantly associated with EPT performance, such that slower and more inconsistent RTs were associated with poorer everyday problem solving abilities. Even after accounting for age, education, and mean level of performance, inconsistency in reaction time continued to account for a significant proportion of the variance in EPT scores. These findings suggest that indicators of inconsistency in RT may be of functional relevance.     

Quality of life and social support of patients being evaluated for bone marrow transplantation

A sample of 437 patients completed self-report measures of quality of life and social support while they were being evaluated for bone marrow transplantation (BMT) at The Johns Hopkins Oncology Center. Generally, the candidates showed reasonably high levels of quality of life (QOL) on the Satisfaction with Life Domains Scale (SLDS), their present ranking on the Cantril Self-Anchoring Ladder of Life, and their scores on the Bradburn Positive Affect Scale. The level of QOL of these candidates for transplant was significantly related to their level of social support. Both availability and adequacy of social support for these transplant candidates were found to be significantly related to QOL as measured by the SLDS. Availability of social support as measured by patient membership in religious and other organizations was significantly related to Positive Affect but not Negative Affect. The Family APGAR and Relational Support Scales measures of social support were significantly correlated with both Positive and Negative Affect.     

Psychological assessment of quality of life following liver transplantation

Administered measures of functional status, psychological distress, and quality of life to a consecutive series of 48 liver transplant recipients in follow-up clinic. Results showed that nearly total functional recovery was the norm. Thirty-six patients (75%) had a Karnofsky Performance Status (KPS) score of 80–100. Twelve transplant recipients had KPS scores below 80; none were employed, and most had been transplanted within 1 year. In spite of their impaired financial status, eight of these 12 reported being mostly satisfied on the self-report Quality-of-Life Scale (QLS). For the posttransplant sample as a whole, 83% were mostly satisfied with their quality of life. Pre- and posttransplant patient samples were not significantly different in reporting mild emotional distress. Results for the small subgroup with significant objective or subjective problems in achieving acceptable quality of life following liver transplantation were reviewed. Higher than normal emotional distress on the Symptom Checklist (SCL-90-R) was consistently reported by these patients. Prospective studies are needed to identify predictor variables of quality-of-life problems and to develop prevention and rehabilitation interventions.     

Psychological Distress in Caregivers of Liver and Lung Transplant Candidates

Although organ transplantation represents a stressful experience for the entire family, surprisingly little research has focused on the adjustment of caregivers. The purpose of this study was to examine what caregivers report to be the greatest benefits and stressors pretransplant, the prevalence of psychological distress and caregiver strain in pretransplant caregivers as compared to normative populations, and the physical, psychological, and demographic variables that predict distress. Fifty-two caregivers of transplant candidates (28 liver and 24 lung) completed a series of questionnaires, including the Psychosocial Adjustment to Illness Scale (PAIS-SR), SF-36 Health Survey, Caregiver Strain Index (CSI), and qualitative questions about benefits and stressors. The most commonly reported benefit of being a caregiver could be categorized as Helping the Patient, and the most common stressors were associated with Uncertainty/Waiting/Fears. Compared to normative samples of caregivers of patients with Alzheimer's disease, caregivers of liver transplant candidates reported more caregiver strain; there were no differences for lung transplant caregivers. Caregiver social functioning was found to be the only significant predictor of caregiver distress, with those caregivers who report greater distress also reporting extreme and frequent interference with normal social activities. Implications of these findings for psychological interventions are discussed.     

Meaning in the Lives of Caregivers of Individuals with Parkinson's Disease

This study explores the contribution of finding meaning in general and finding meaning specific to caregiving as potentially important explanatory variables in predicting well-being in caregivers of individuals with Parkinson's disease. Fifty-eight caregivers of individuals diagnosed with Parkinson's disease were provided self-report questionnaires to assess well-being and meaning (general and specific). Results showed a significant proportion of the variance of positive affect (PASS) and negative affect (DYS) related to well-being, as assessed by the Multiple Affect Adjective Checklist – Revised. Purpose and Existential Vacuum (two subtests of the Life Attitude Profile – Revised used to assess general meaning) predicted well-being. Purpose predicted 41.8% of the variance related to PASS; Existential Vacuum predicted 30.8% of the variance related to DYS. Meaning related specifically to caregiving (Finding Meaning Through Caregiving Scale) did not explain any additional variance. Our results suggest that finding meaning, beyond meaning specifically associated with caregiving, is the key to understanding well-being among caregivers of individuals with Parkinson's disease. The positive construct of finding meaning in general can empower researchers and professionals working with caregivers to better understand the variability in caregiver outcomes as well as assess and intervene more effectively.     

Anxiety and Depression in Patients with Amyotrophic Lateral Sclerosis and Their Caregivers

A large number of studies have investigated a variety of psychological aspects in people with Amyotrophic Lateral Sclerosis, but there is still considerable uncertainty concerning the actual morbidity, in particular for anxiety. We aim to evaluate depression levels and anxiety disposition in ALS patients and their caregivers, in comparison to healthy controls. We conducted a cross-sectional comparison between people with ALS, their caregivers and a non-clinical control group in order to evaluate anxiety and depression levels. 40 ALS patients, their caregivers and 40 healthy adult subjects completed the Beck Depression Inventory II (BDI-II) and the State-Trait Anxiety Inventory—Y2 scale (STAI). We compared overall and single item scores in order to find differences between the three groups. BDI-II scores were significantly different between groups. Depression scores were higher for patients than for healthy controls, in both somatic and psychological sub-scales. Caregivers presented higher levels of psychological depression in comparison with healthy controls, and lower scores of somatic depression in comparison to patients. No differences were found in trait anxiety levels comparing the three groups. ALS patients and their caregivers developed more depression related symptomatology than the non-clinical sample. However, susceptibility to anxiety for both patients and caregivers seemed to be at a normal level.     

Sensitive performance-based assessment of everyday action in older and younger adults

Everyday function is compromised by mild cognitive changes in aging. These changes predict risk for future decline and dementia but remain poorly characterized, largely due to a scarcity of sensitive, objective measures.Twenty-seven younger adults and 25 non-demented older adults completed the Naturalistic Action Test (NAT), a performance-based measure of everyday action involving simple and complex tasks. Performance was coded for overt errors and subtle inefficiencies. Participants also completed self-report functional measures and cognitive tests. Mixed ANOVAs revealed that older adults made more subtle NAT errors with high task demands; groups did not differ in overt errors. Correlations did not reveal significant relations between self-report and NAT errors, but NAT performance was correlated with learning and recall.The NAT provides a promising tool for detecting subtle age-related changes and examining decline across levels of impairment. Self-report may lack sensitivity to subtle changes, and episodic memory changes underlie early functional disruption.     

Posttraumatic Growth and Subjective Well-Being among Caregivers of Chronic Patients: A Preliminary Study

This preliminary study focused on positive phenomena among Israeli family caregivers (spouse, adult child, or parent) of patients with chronic illness hospitalized in a medical rehabilitation hospital. We investigated these caregivers’ posttraumatic growth (PTG) and subjective well-being (positive and negative emotions, life satisfaction), and their associations with the demographic and illness characteristics of the caregivers and patients, respectively. Participants included 74 adult primary caregivers: 28 were the patient’s spouse; 21 were the patient’s child; and 25 were the patient’s parent. Caregivers completed four self-report questionnaires. No significant association emerged between caregivers’ PTG and their negative affect or life satisfaction. Nevertheless, caregivers’ positive affect correlated with their PTG and also predicted it. Moreover, different patterns emerged for the caregiver subgroups (spouse, adult child, or parent): Patients’ children reported lower negative affect and greater life satisfaction than patients’ parents or spouses. Various explanations were discussed, alongside implications for giving recognition and assistance from the medical system to patients’ caregivers.     

Understanding the Lived Experience of Formerly Homeless Adults as They Transition to Supportive Housing

The researchers conducted in-depth interviews with formerly homeless adults who had moved to supportive housing to understand their perceived occupational needs and the factors that affected their transition. A qualitative research design with four participants who had a history of substance abuse and mental illness was used. Participant interviews that addressed categories of daily living and personal satisfaction produced data that were coded for analysis using conventional content analysis. Mega themes emerged that related to factors shaping the housing transition and maintenance experience. Occupational therapists can use these findings to create informed interventions to enhance this population's occupational performance.     

Occupational Therapists' Experience Concerning Occupational Performance in Adults With Asperger Syndrome

Persons with Asperger Syndrome often seem to have difficulty performing everyday occupations. This study aimed to describe occupational therapists' experience concerning abilities to occupational performance among adults with Asperger Syndrome. Data were collected in interviews with eight occupational therapists and analyzed using a qualitative method. Results showed that clients with Asperger Syndrome often possess abilities but seem to have difficulties knowing when, where, and how they should use them. The ability to adapt behavior in accordance with cues from the environment was identified as the core category. Environment plays a major role in how these persons interact in different situations.     

An Evaluation of Change Over Time in Everyday Cognitive Competence Among Alzheimer’s Patients

This short-term longitudinal study was designed to examine the pattern of change in everyday cognitive competence as assessed by an objective measure (i.e. the Test of Everyday Problem Solving for Cognitively Challenged Elderly; EPCCE; Willis, 1993) and by self- and caregiver reports (i.e. Instrumental Activities of Daily Living; IADL; Lawton & Brody, 1969). Patient and caregiver characteristics and clinical assessments were explored as predictors. Participants included 100 Alzheimer’s disease (AD) patients and their caregivers who were part of the Stanford Longitudinal Study. Four waves of data were examined via hierarchical linear modeling. Major findings revealed that the EPCCE and the patient IADL formed a linear pattern of decline while the caregiver IADL demonstrated a curvilinear form. Second, different sets of predictors explained the variance in the competence measures at initial status. Finally, the predictors did not account for a significant amount of variance in the instantaneous rate of change on any of the measures; however, a portion of the variance in the acceleration in the caregiver IADL was explained.     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

Psychische Betreuung von Patienten und Angehörigen in der Transplantationsmedizin

During the decision making process and waiting period before organ transplantation patients and their families often suffer from psychological distress. After transplantation a subgroup of patients keeps showing psychological symptoms and also impairments of quality of life. Psychological treatment manuals are often demanded, but are rarely achieved. This study describes the experience with a low frequent (8 sessions/year) therapeutic group for lung transplant candidates. The group, which is based on a cognitive behavioural concept, is lead by a physician (internal medicine), a psychotherapist and a physiotherapist. This therapeutic group has been continuously offered for patients and their caregivers for the past 7 years. About 50% of all patients participated in this program before transplantation, after transplantation only a few patients visited the group sessions. On average 12 patients and 8 caregivers visited each session. One problem for these patients with severe lung-disease was the long distance between patient’s homes and the hospital. This has been the reason for self-help organisations to demand better psychotherapeutic outpatient support for patients and their families before and after organ transplantation.     

Cognition,daily living,and health-related quality of life in 85-year-olds in Sweden

ABSTRACT

This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n?=?373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE.     

The factors associated with geriatric depression in rural China: stratified by household structure

Depressive symptoms and empty nest phenomenon of rural elderly people are both important public health issues, which should not be ignored. We aimed to estimate the prevalence of depressive symptoms and related factors of the empty nest elderly in rural China. We recruited 3182 eligible subjects and gathered data by face-to-face interview. Multivariate logistic regression models were used to explore the related factors of depressive symptoms. The present study showed that the prevalence of depressive symptoms significantly differed between empty nest old adults and non-empty nesters (24.1% vs. 19.0%). The elderly living alone had highest OR of depressive symptoms. Depressive symptoms of empty nest elderly was associated with sleep quality, economic status, pain, social support and ADL. While it was associated with gender, economic status, pain and PSMS in non-empty nest group. Number of chronic disease showed significant associations with depressive symptoms in the elderly living alone. Subjective support, support utilization and pain were positively associated with depressive symptoms in the elderly living with spouse. Sleep quality, economic status and ADL were common factors. Depressive symptoms obviously prevail among empty nest elderly than non-empty nesters. It reminded us that complementary social support from family and society is essential.     

Assessment of Psychopathic Traits in an Incarcerated Adolescent Sample: A Methodological Comparison

Analyses of convergent validity and group assignment using self-report, caregiver-report and interview-based measures of adolescent psychopathy were conducted in a sample of 160 incarcerated adolescents. Results reveal significant convergent validity between caregiver-report measures of adolescent psychopathy, significant convergent validity between self-report measures of adolescent psychopathy and an interviewer rating scale, but not between the caregiver-report measures and their corresponding self-report measures nor between the caregiver-report measures and the interviewer rating scale. Analyses of group assignment were also poorer than expected among all the measures with none evidencing significant agreement with the expert-rated device (Hare Psychopathy Checklist-Youth Version; PCL-YV), the most common forensic instrument used in clinical practice. Part of the poor agreement may be related to the poor psychometric performance of the callous-unemotional subscale of most of these measures and the low response rates from caregivers (N?=?35). These findings suggest that the measures do not provide an interchangeable assessment of callous-unemotional traits and suggest that further refinement of the measurement of callous-unemotional traits in youth may be warranted.     

Cognitive and functional deterioration in patients with severe COPD

The objective of this study was to examine the association among the duration of COPD, degree of hypoxemia, and neurological abnormalities including cognitive functioning. Fifty-four patients with severe COPD and 24 age- and sex-matched controls, were included in the study. All patients and controls were administered pulmonary function tests, standardized Mini-mental State Examination (MMSE), Blessed Dementia Scale (BDS), Physical Self-maintenance Scale (PSMS), Modified Activities of Daily Living scale (MADL), Instrumental Activities of Daily Living scale (IADL), Cornell Scale for Depression in Dementia (CSDD), Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR). In addition, detailed physical and neurological examinations were performed. Sixty-four percent of patients with COPD showed abnormalities in MMSE, predominantly in recent memory, construction, attention, language, and orientation domains. Functional abnormalities were correlated with cognitive abnormalities. Although COPD patients did not show significant depression compared to controls, 77.7%. of the patients showed subjective and objective cognitive disturbance and 72.2% of the patients were classified as questionable or mild dementia. In conclusion, patients with COPD show significant cognitive and functional impairments that cannot be explained just by coincidence or by depression.     

Factor Structure of Patient and Caregiver Ratings on the Dementia Quality of Life Instrument

ABSTRACT

Preliminary evidence suggests that quality of life reports from patients diagnosed with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) are as reliable and valid as data provided by caregivers. To date, no studies compared the factor structure of data provided by caregivers and patients. Factor analyses are important to conduct because they are an indicator of validity. This study compared the factor structure of patient and caregiver reports on the Dementia Quality of Life scale (DQoL). Participants (N?=?67) were patients diagnosed with amnestic MCI or mild AD and their caregivers. Principal axis factor analyses were run separately on patient and caregiver report data. The three-factor solutions for patient and caregiver data were nearly identical. Three factors corresponding to positive affect, negative affect, and aesthetics emerged reliably from analyses. Thus, data from patients demonstrated a factor structure that was highly consistent with caregiver report data and conformed to meaningful psychological constructs.