Functional status is a critical index of nursing care for older adults hospitalized for major depression. Depression is accompanied by a breakdown of daily living habits to the extent that patients are unable to care for themselves or their homes. During hospitalization nurses work directly with patients, as well as manage the overall therapeutic milieu, so that daily routines can be restored. The level of improvement in performing personal (ADL) and instrumental activities of daily living (IADL) achieved during hospitalization, and ADLI/ADL status posttreatment, influence decisions about health and social services needed at discharge. Thus, reliable and valid measures of functional status and change in functional status are essential for examining the outcomes of nursing interventions. The primary aims of the proposed methodologic study are to examine the outcomes of 4 common methods of assessing ADL/IADL in the elderly to: assess their level of agreement; compare their criterion-related validity; examine their relative sensitivity for documenting change in functional status; identify factors that account for differences among outcomes; and, compare their ability to predict performance post discharge. The target population is patients 65 years of age or older hospitalized for major depression on the Geriatric Clinical Research Unit of Western Psychiatric Institute and Clinic. There will be 55 subjects with first episode depression and 55 with recurrent depression. The 4 ADL/IADL assessment methods include 2 subjective (patient self-report; caregiver report) and 2 objective (primary nurse assessment based on naturalistic observation; occupational therapy assessment based on situational performance testing conducted in the hospital) methods. Testing will be done pretreatment and posttreatment. An in-home performance test conducted after discharge serves as the criterion ADL/IADL method; a health status indicator serves as a secondary criterion measure. The measures of task disability provided by the ADL/IADL assessments will be supplemented by measures of sensory, motoric, cognitive, and affective impairment. The impairment measures will be used to examine correlates of functional disability identified through each of the 4 ADLI/ADL methods.
| Chisholm, Denise; Toto, Pamela; Raina, Ketki et al. (2014) Evaluating capacity to live independently and safely in the community: Performance Assessment of Self-care Skills. Br J Occup Ther 77:59-63 |
