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      Dependency in Activities of Daily Living Following Limb Trauma in Elderly Referred to Shahid Beheshti Hospital, Kashan-Iran in 2013

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          Abstract

          Background:

          Activities of daily living (ADL) are an important indicator of health and independence in elderly. It provides useful information for proper planning in the field of elderly care. Trauma in elderly population is frequent and can negatively affect the independence in ADL.

          Objectives:

          The purpose of the present study was to evaluate elderly independence in activities of daily living (ADL) following limb trauma and its related factors in patients referred to trauma emergency ward of Shahid Beheshti Hospital, Kashan, Iran, in 2013.

          Patients and Methods:

          This descriptive study was conducted on 200 traumatic patients admitted to trauma emergency ward of Shahid Beheshti Hospital in 2013. The questionnaire used in this study had three parts as demographic data, information related to trauma and ISADL (independency scale of activities of daily living). ISADL was completed in emergency ward to declare pretraumatic status; it was also completed 1 and 3 months after trauma. Statistical analysis was conducted by Chi-square test, One-way and two-factor ANOVA, and Multiple regression analysis. Data analysis was conducted using SPSS software, version 16.

          Results:

          The average age of participants was 70.57 ± 9.05 years. In total, 80.5% of the elderly were completely independent in ISADL before trauma; this decreased to 13.5% one month after trauma. Besides, 32% of the elderly were completely or relatively dependent three months after trauma. Two-factor ANOVA showed a significant association between the scores of ISADL, the time interval and the type and location of an injured organ, and having the surgery as a treatment.

          Conclusions:

          More than three-quarters of the elderly were independent in ISADL before the trauma, but trauma in elderly patients had a substantial negative effect on patients' ability and ADL function.

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          Change in disability after hospitalization or restricted activity in older persons.

          Thomas Gill, Heather Allore, Evelyne A Gahbauer … (2010)
          Disability among older persons is a complex and highly dynamic process, with high rates of recovery and frequent transitions between states of disability. The role of intervening illnesses and injuries (ie, events) on these transitions is uncertain. To evaluate the relationship between intervening events and transitions among states of no disability, mild disability, severe disability, and death and to determine the association of physical frailty with these transitions. Prospective cohort study conducted in greater New Haven, Connecticut, from March 1998 to December 2008 of 754 community-living persons aged 70 years or older who were nondisabled at baseline in 4 essential activities of daily living: bathing, dressing, walking, and transferring. Telephone interviews were completed monthly for more than 10 years to assess disability and ascertain exposure to intervening events, which included illnesses and injuries leading to either hospitalization or restricted activity. Physical frailty (defined as gait speed >10 seconds on the rapid gait test) was assessed every 18 months through 108 months. Transitions between no disability, mild disability, and severe disability and 3 transitions from each of these states to death, evaluated each month. Hospitalization was strongly associated with 8 of the 9 possible transitions, with increased multivariable hazard ratios (HRs) as high as 168 (95% confidence interval [CI], 118-239) for the transition from no disability to severe disability and decreased HRs as low as 0.41 (95% CI, 0.30-0.54) for the transition from mild disability to no disability. Restricted activity also increased the likelihood of transitioning from no disability to both mild and severe disability (HR, 2.59; 95% CI, 2.23-3.02; and HR, 8.03; 95% CI, 5.28-12.21), respectively, and from mild disability to severe disability (HR, 1.45; 95% CI, 1.14-1.84), but was not associated with recovery from mild or severe disability. For all 9 transitions, the presence of physical frailty accentuated the associations of the intervening events. For example, the absolute risk of transitioning from no disability to mild disability within 1 month after hospitalization for frail individuals was 34.9% (95% CI, 34.5%-35.3%) vs 4.9% (95% CI, 4.7%-5.1%) for nonfrail individuals. Among the possible reasons for hospitalization, fall-related injury conferred the highest likelihood of developing new or worsening disability. Among older persons, particularly those who were physically frail, intervening illnesses and injuries greatly increased the likelihood of developing new or worsening disability. Only the most potent events, ie, those leading to hospitalization, reduced the likelihood of recovery from disability.
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            Falls and their prevention in elderly people: what does the evidence show?

            Laurence Rubenstein, Karen R Josephson (2006)
            A large proportion of falls and fall injuries in older people is due to multiple risk factors, many of which probably can be modified or eliminated with targeted fall prevention interventions. These interventions must be feasible, sustainable, and cost effective to be practical for widespread use. The most promising prevention strategies involve multidimensional fall risk assessment and exercise interventions. Incorporating these intervention strategies whenever feasible into a fall prevention program seems to be the most effective means for fall prevention in older adults.
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              Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons.

              John T Murphy, Evelyne A Gahbauer, Heather Allore … (2013)
              Little is known about the deleterious effects of injurious falls relative to those of other disabling conditions or whether these effects are driven largely by hip fractures. From a cohort of 754 community-living elders of New Haven, Connecticut, we matched 122 hospitalizations for an injurious fall (59 hip-fracture and 63 other fall-related injuries) to 241 non-fall-related hospitalizations. Participants (mean age: 85.7 years) were evaluated monthly for disability in 13 activities and admission to a nursing home from 1998 to 2010. For both hip-fracture and other fall-related injuries, the disability scores were significantly greater during each of the first 6 months after hospitalization than for the non-fall-related admissions, with adjusted risk ratios at 6 months of 1.5 (95% confidence interval (CI): 1.3, 1.7) for hip fracture and 1.4 (95% CI: 1.2, 1.6) for other fall-related injuries. The likelihood of having a long-term nursing home admission was considerably greater after hospitalization for a hip fracture and other fall-related injury than for a non-fall-related reason, with adjusted odds ratios of 3.3 (95% CI: 1.3, 8.3) and 3.2 (95% CI: 1.3, 7.8), respectively. Relative to other conditions leading to hospitalization, hip-fracture and other fall-related injuries are associated with worse disability outcomes and a higher likelihood of long-term nursing home admissions.
              Article 0 comments Cited 85 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Trauma Res
                Journal ID (iso-abbrev): Arch Trauma Res
                Journal ID (doi): 10.5812/atr
                Journal ID (publisher-id): Kowsar
                Title: Archives of Trauma Research
                Publisher: Kowsar
                ISSN (Print): 2251-953X
                ISSN (Electronic): 2251-9599
                Publication date (Electronic): 15 September 2014
                Publication date Collection: September 2014
                Volume: 3
                Issue: 3
                Electronic Location Identifier: e20608
                Affiliations
                [1 ]Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
                [2 ]Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kashan, IR Iran
                [3 ]Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
                Author notes
                [* ]Corresponding author: Azade Safa, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kashan, IR Iran. Tel: +98-3615550021, Fax: +98-3615556633, E-mail: azade.fazel@ 123456yahoo.com
                Article
                DOI: 10.5812/atr.20608
                PMC ID: 4276707
                SO-VID: 22d9d234-d753-49e6-9da9-072f0a27349c
                Copyright © Copyright © 2014, Kashan University of Medical Sciences; Published by Kowsar.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                Date received : 24 May 2014
                Date revision received : 12 July 2014
                Date accepted : 16 August 2014
                Categories
                Subject: Research Article

                Keywords: activities of daily living,limb,trauma,elderly
                Data availability:
                Keywords: activities of daily living, limb, trauma, elderly

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