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      Independence and Caregiver Preferences Among Community-Dwelling Older People in Slovenia: A Cross-Sectional Study

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          Abstract

          Although Slovenia is becoming an aging society, very little is known about the abilities and needs of home-dwelling older people or their preferences regarding assistance. The aim of the study was to explore the need for assistance in daily activities among older Slovenian people living at home. Older adults aged between 65 and 97 years (N = 358) participated in the cross-sectional survey study. A questionnaire that assessed independence in daily activities and assistance in the home environment was developed. Data were analyzed using descriptive statistics, a nonparametric test (Wilcoxon signed rank test), and the chi-square test. The results showed that older Slovenians were more independent in activities of daily living (ADLs) than instrumental activities of daily living (IADLs). Independence was the highest for using the toilet, feeding, and mobility transfers, and the lowest for bathing. With IADLs, assistance was most often required with shopping and housework; this assistance was usually provided by family members. The provider of assistance was generally compatible with older people’s preferences concerning assistance at home. We found no differences in care preferences between urban and rural settings. Assistance in the home environment was predominantly provided by unpaid helpers, which reflects recent developments in health and social services that put an emphasis on a person’s social network. Due to demographic changes and the decrease in the number of adult children, reliance on close relatives might soon become a challenge. These findings can help policy makers understand older people’s choices and preferences better when planning long-term care.

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          Most cited references34

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          Assessment of Activities of Daily Living, Self-Care, and Independence.

          Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.
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            Executive function in daily life: Age-related influences of executive processes on instrumental activities of daily living.

            The present study of older adults used structural equation modeling (SEM) to examine the relationships between 3 executive processes underlying executive function (EF) (inhibition, task switching, updating in working memory), and 2 types of instrumental activities of daily living (IADLs) (self-report, performance based). Experimental tasks of executive attention and self-report or performance-based IADL tests were administered to create latent constructs of EF and IADLs. Confirmatory factor analysis (CFA) was used to examine the construct validity of EF and IADLs. This analysis indicated a 3-factor model of inhibition, updating, and task switching and a 2-factor model of self-report and performance-based IADLs. As predicted, when the latent variable relationships were analyzed, executive processes had a significant relationship with performance-based, but not self-report, IADLs. In addition, task switching had a strong and significant relationship with performance-based IADLs. The results of this study uniquely show a direct relationship between executive processes and performance-based IADLs, thus demonstrating the ecological utility of experimental measures of EF to predict daily function. Furthermore, these results point to areas of cognitive training that may strategically impact older adults' performance on daily life activities. (c) 2010 APA, all rights reserved
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              The hierarchy of functional loss associated with cognitive decline in older persons.

              We studied a representative cohort of community-dwelling elderly persons to (i) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses, (ii) compare the cognitive status of participants who have and have not lost independence in these functional activities, and (iii) determine whether a hierarchical scale of functional loss is associated with declining cognitive status. A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed. At baseline and 5 years later, cognitive status with the Modified Mini-Mental State Examination (3MS) and functional status with 14 Older American Resources and Services (OARS) items were measured. For each OARS functional item, the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared. For each functional item, the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent (e.g., ability to do finances), with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence. A hierarchy of functional items existed, with instrumental activities of daily living (ADLs) (e.g., shopping, banking, and cooking) being lost at higher cognitive scores than basic ADL items (e.g., eating, dressing, and walking), although there was some overlap. This is the first prospective study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks. Clear cognitive thresholds at which development of dependency in OARS functional items occurred. By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items, a natural hierarchy of functional loss associated with cognitive decline emerged. For caregivers, clinicians, and health policy makers, this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition, potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning.
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                Author and article information

                Journal
                Inquiry
                Inquiry
                INQ
                spinq
                Inquiry: A Journal of Medical Care Organization, Provision and Financing
                SAGE Publications (Sage CA: Los Angeles, CA )
                0046-9580
                1945-7243
                09 August 2019
                Jan-Dec 2019
                : 56
                : 0046958019869155
                Affiliations
                [1 ]University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
                [2 ]University of Maribor, Faculty of Organizational Sciences, Kranj, Slovenia
                Author notes
                [*]Katarina Galof, Faculty of Health Sciences, Department of Occupational Therapy, University of Ljubljana, Zdravstvena pot 5, Ljubljana 1000, Slovenia. Email: katarina.galof@ 123456zf.uni-lj.si
                Author information
                https://orcid.org/0000-0002-8644-6104
                Article
                10.1177_0046958019869155
                10.1177/0046958019869155
                6689914
                31394962
                f9420b91-c522-4c5c-9570-9124dbe09465
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 19 April 2019
                : 9 July 2019
                : 16 July 2019
                Categories
                Original Research
                Custom metadata
                January-December 2019

                older adults,activities of daily living,intergenerational support,long-term care,aging in place

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