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This study aimed to investigate the rate of sedentary behaviour and differences in physical outcomes and activities of daily living (ADL) based on sedentary behaviour time of hospitalized older cardiovascular disease patients undergoing phase I cardiac rehabilitation. Older cardiovascular disease patients were enrolled from October 2020 to September 2023 and were divided into the high sedentary behaviour group (≥ 480 min/day) and low sedentary behaviour group (< 480 min/day). Patients' clinical characteristics, usual gait speed, and Five Times Sit to Stand Test time were compared as indices of physical outcomes. Motor, cognitive, and total Functional Independence Measure (FIM) scores were used as indices of ADL and compared between groups using analysis of covariance. Final analysis included 402 patients (mean age: 76.7 years, female: 35.3%). The high sedentary behaviour group included 48.5% of the study patients. After adjustment for baseline characteristics, gait speed (0.80 ± 0.27 vs. 0.96 ± 0.23 m/s, p < 0.001) was lower and FTSST time (11.31 ± 4.19 vs. 9.39 ± 3.11 s, p < 0.001) was higher in the high sedentary behaviour group versus low sedentary behaviour group. Motor (85.82 ± 8.82 vs. 88.09 ± 5.04 points, p < 0.001), cognitive (33.32 ± 2.93 vs. 34.04 ± 2.24 points, p < 0.001), and total FIM scores (119.13 ± 10.66 vs. 122.02 ± 6.30 points, p < 0.001) were significantly lower in the high sedentary behaviour group versus low sedentary behaviour group after adjustment. In older cardiovascular disease patients in phase I cardiac rehabilitation, sedentary behaviour time might influence physical outcomes and ADL at discharge. It is thus important to consider the amount of sedentary behaviour time spent by these patients during daily life while hospitalized., (© 2024. The Author(s).)

Aims: Post-extubation dysphagia (PED), an often overlooked problem, is a common and serious complication associated with mortality and major morbidity after cardiovascular surgery. Dysphagia is considered an age-related disease, and evaluating its long-term effects is a pressing issue with rapidly progressing ageing worldwide. Therefore, we examined the effect of PED on functional status and long-term cardiovascular events in patients undergoing cardiovascular surgery., Methods and Results: This single-centre, retrospective cohort study included 712 patients who underwent elective cardiovascular surgery and met the inclusion criteria. Patients were divided into PED and non-PED groups based on their post-operative swallowing status. The swallowing status was assessed using the Food Intake Level Scale. Functional status was evaluated as hospital-associated disability (HAD), defined as a decrease in activities of daily living after hospital discharge compared with preoperative values. The patients were subsequently followed up to detect major adverse cardiac and cerebrovascular events (MACCEs). Post-extubation dysphagia was present in 23% of the 712 patients and was independently associated with HAD (adjusted odds ratio, 2.70). Over a 3.5-year median follow-up period, MACCE occurred in 14.1% of patients. Multivariate Cox proportional hazard analysis revealed HAD to be independently associated with an increased risk of MACCE (adjusted hazard ratio, 1.85), although PED was not significantly associated with MACCE., Conclusion: Post-extubation dysphagia was an independent HAD predictor, with the odds of HAD occurrence being increased by 2.7-fold due to PED. Hospital-associated disability accompanied by PED is a powerful predictor of poor prognosis. Perioperative evaluation and management of the swallowing status, and appropriate therapeutic interventions, are warranted., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: The aim of this study was to clarify whether worsening of independence in activities of daily living (ADL) and also difficulties in ADL are triggered by hospitalization in older patients with heart failure (HF) and whether difficulties in ADL can predict readmission for HF regardless of independence in ADL in these patients., Methods and Results: We enrolled 241 HF patients in the present multi-institutional, prospective, observational study. The patients were divided according to age into the non-older patient group (<75 years, n = 137) and the older patient group (≥75 years, n = 104). The Katz index and the Performance Measure for Activities of Daily Living-8 (PMADL-8) were used to evaluate independence and difficulties in ADL, respectively. The endpoint of this study was rehospitalization for HF. Independence as indicated by the Katz index at discharge was significantly lower than that before admission only in the older patient group, and the value of the PMADL-8 at discharge was significantly higher than that before admission (P < 0.001). In all patients, after adjusting for the Katz index and other variables, PMADL-8 score was a significant predictor of rehospitalization for HF (hazard ratio 1.50; 95% confidence interval 1.07-2.13; P = 0.021)., Conclusions: Worsening of both independence and difficulties in ADL was triggered by hospitalization in older HF patients, and difficulties in ADL were relevant factors for risk of rehospitalization regardless of independence in ADL. These findings indicate the importance of preventing not only decreased independence but also increased difficulties in ADL during and after hospitalization., Competing Interests: Conflict of interest: The authors certify that there are no conflicts of interest with any financial organizations regarding the material discussed in this manuscript., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ 2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.

This study aimed to clarify the effects of worsening renal function (WRF) during hospitalization on activities of daily living (ADL) at discharge of elderly heart failure (HF) patients. We included 323 consecutive patients hospitalized for HF who were prescribed phase I cardiac rehabilitation (CR) from November 2017 to April 2019. WRF was defined as a relative increase from baseline in serum creatinine of 25% or that in serum creatinine ≥ 0.3 mg/dL during hospitalization. The indices of ADL and physical function were the functional independence measure (FIM), short physical performance battery (SPPB) and 10-m comfortable gait speed as assessed at discharge. We compared background factors, clinical parameters, walking level before hospitalization, physical function, and FIM in two groups. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with P < 0.05 in bivariate correlation as independent variables. Ultimately, 160 patients were included and divided into the WRF group (n = 72) and non-WRF group (n = 88). FIM, SPPB, and 10-m comfortable walking speed were significantly lower in the WRF group. Moreover, even after adjustment for confounding factors (age, Hb, eGFR, CKD, GNRI, start day of standing), eGFR on admission (β = 0.12), WRF (β =  - 6.42) and walking level before hospitalization (β = - 10.00) were independent factors of ADL decline at discharge (adjusted R 2  = 0.46). WRF during hospitalization of elderly HF patients was a factor affecting ADL decline at discharge along with walking level before hospitalization and renal function at admission.

Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients., Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t -test, χ 2 test, Cox proportional hazard model, and Kaplan-Meier method., Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) ( p = 0.03), hemoglobin ( p = 0.047), GNRI ( p = 0.02) and motor-FIM ( p = 0.007) were significantly different between the readmission ( n = 31) and non-readmission ( n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study's cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower ( p = 0.002) in the group with GNRI <92 and motor FIM <75., Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.

Activities of daily living (ADL) are maintained in patients with mild cognitive impairment (MCI), but, in patients with cardiovascular disease, ADL may have already declined. MCI combined with cardiac disease may accentuate the decline of ADL in these patients. Because the relationship between MCI and ADL in patients with cardiovascular disease is unclear, we examined the associations between MCI and ADL in these patients. We conducted a cross-sectional study of 114 patients with cardiovascular disease but without probable dementia. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We classified patients into the normal cognitive group and MCI group, and compared their clinical characteristics, physical function [Short Physical Performance Battery (SPPB), gait speed, handgrip strength, and knee extensor muscle strength], and ADL [via the Functional Independence Measure (FIM)]. We used logistic regression analysis to evaluate the specific association between MCI and ADL. The incidence of MCI was 36.0%. Significant differences between the two groups were identified for age, body mass index, estimated glomerular filtration rate, albumin, dyslipidemia, educational background, SPPB, gait speed, handgrip strength, and FIM. However, after adjustment for covariates, only FIM was significantly associated with MCI (odds ratio 0.74, 95% confidence interval 0.65-0.84, p < 0.001). ADL was the only independent factor significantly associated with MCI in patients with cardiovascular disease. ADL may be hindered in these patients, even at an early stage of MCI. Therefore, early intervention is necessary to prevent ADL decline from the time of MCI onset or before.

Aims: This study aims to examine the effect of differences in nutritional status on activities of daily living (ADL) and mobility recovery of hospitalized elderly patients with heart failure (HF)., Methods and Results: From among 377 consecutive HF patients who underwent rehabilitation at one acute-care hospital from January 2013 to August 2015, those who were aged ≥ 65 years could walk with assistance before hospitalization and who were hospitalized for the first time were included in this retrospective cohort study. Exclusion criteria were pacemaker surgery during hospitalization, change to other departments, death during hospitalization, and unmeasured ADL. We investigated patient characteristics, basic attributes, Geriatric Nutritional Risk Index (GNRI), ADL [motor Functional Independence Measure (motor FIM)], and Rivermead Mobility Index (RMI). Of these 377 patients, 96 met the inclusion criteria and were divided into the low GNRI group (n = 38, 83.5 ± 8.3 years, 44.7% male) and high GNRI group (n = 58, 81.0 ± 6.6 years, 55.2%). Patient characteristics and the difference between motor ADL and motility recovery and nutrition data were analysed with unpaired t-test, χ 2 test, and two-way analysis of covariance. In comparing the two groups, the following parameters were significantly lower in the low GNRI group than in the high GNRI group: body mass index (18.7 ± 2.2 vs. 23.2 ± 2.7 kg/m 2 , P < 0.01), albumin (3.4 ± 0.4 vs. 3.8 ± 0.4 g/dL, P < 0.01), diabetes mellitus ratio (21.1% vs. 50.0%, P < 0.01), RMI at discharge (6.8 ± 2.6 vs. 8.2 ± 2.2, P = 0.01), and motor FIM at discharge (67.2 ± 19.5 vs. 75.6 ± 13.3, P = 0.02). RMI showed a significant group and term main effect and interaction effect (P < 0.05). Motor FIM showed a significant main effect of group and term (P < 0.05), and no significant interaction effect., Conclusions: Low nutritional status in hospitalized elderly HF patients affected their recovery of mobility but did not appear to affect the recovery of ADL., (© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Background and Purpose: The Functional Independence and Difficulty Scale (FIDS), a newly developed basic activities of daily living (BADL) assessment tool, assesses both independence and subjective difficulty of BADL performance. This patient-reported outcome measure has been shown to have acceptable internal consistency, concurrent validity, and reliability. However, little is known about the relationship between FIDS and objective measures of physical function among older Japanese adults using long-term care insurance services. This study aimed to reveal the relationship between FIDS and physical functions and to examine the concurrent validity of FIDS against physical functions., Methods: Participants of this cross-sectional, correlational research study included community-dwelling Japanese adults aged 65 years or older and certified as long-term care insurance service users with musculoskeletal disease, internal disease, cerebrovascular diseases without observable motor paralysis, and others. Data on physical functions, including muscle strength (grip strength and isometric knee extension muscle strength [IKEMS]), flexibility (range of motion [ROM] of hip flexion and knee flexion), balance (Modified Functional Reach Test [M-FRT]) and gait performance (timed 2.4-m walk), and BADL performance assessed by FIDS, were obtained. Associations between FIDS scores and physical functions were determined by Spearman correlation coefficient and partial correlations after controlling for subject age and sex., Results: Data were collected on 53 participants (mean age = 81.9 years; 62.3% women). Spearman partial correlation coefficients controlled for sex and age between FIDS score and grip strength, IKEMS, ROM of hip flexion, ROM of knee flexion, M-FRT, and timed 2.4-m walk were 0.47 (P = .001), 0.44 (P = .001), 0.29 (P = .04), -0.05 (P = .73), 0.51 (P < .001), and -0.64 (P < .001), respectively. The strength of association was moderate for the M-FRT and 2.4-m walk and was low for grip strength and IKEMS. However, ROM of the knee showed no significant association and hip flexion had negligible association with FIDS., Conclusions: The FIDS, a patient-reported BADL assessment tool, mainly reflected balance and gait performance and had concurrent validity as an objective measure of balance and gait performance.

Background: Renal function (RF) and activities of daily living (ADL) are risk factors for heart failure (HF) patients., Aims: We evaluated differences in motor and cognitive ADL in relation to RF in elderly hospitalized HF patients., Methods: Participants were selected from 414 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics including Functional Independence Measure (FIM) and estimated glomerular filtration rate (eGFR). Subjects were divided into three groups by RF level and analyzed with one-way ANOVA and Chi-square tests and two-way ANCOVA and multiple comparison tests., Results: Of the 414 patients, 165 met the inclusion criteria (high RF: 41, moderate RF: 84, low RF: 40). There were significant differences between the three groups in age, eGFR, hemoglobin level, mobility, cognitive function, and length of hospital stay (p < 0.05). Motor FIM showed an interaction between term and group, and cognitive FIM showed a main effect on the group (p < 0.05). In the multiple comparisons, motor FIM of all groups indicated significant recovery, but it was significantly lower after 1 week in the low RF versus moderate/high RF groups (p < 0.05). Cognitive FIM showed no significant recovery in the low RF group; the FIM score after 2 weeks was significantly lower than that in the moderate/high RF groups (p < 0.05)., Conclusions: In elderly hospitalized HF patients, the motor ADL recovery process in the low RF group was delayed compared to the high RF group. Cognitive ADL in hospitalized HF patients is difficult to recover, especially in those with low RF.

Background: The newly developed Functional Independence and Difficulty Scale is a tool for assessing the performance of basic activities of daily living in terms of both independence and difficulty. The reliability of this new scale has not been assessed., Aims: The aim of this study was to examine the relative reliability and absolute reliability of the newly developed scale in community-dwelling frail elderly people in Japan., Methods: Participants were 47 community-dwelling elderly subjects (22 for assessing test-retest reliability and 25 for assessing inter-rater reliability). As relative reliability indices, intra-class correlation coefficients were used. From an absolute reliability perspective, we conducted Bland-Altman analysis and calculated the limit of agreement or minimal detectable change to determine the acceptable range of error., Results: Intra-class correlation coefficients for test-retest and inter-rater reliability were 0.90 (P < 0.001) and 0.97 (P < 0.001), respectively. The limit of agreement for test-retest reliability was -5.2 to 1.8, representing an increase of over six points for improvement and a decrease of over two points for decline of basic activities of daily living ability. The minimal detectable change for inter-rater reliability was 3.7, indicating that a three-point difference might be existed between difference raters. The results of this study demonstrated that the FIDS appeared to be a reliable instrument for use in Japanese community-dwelling frail elderly people., Conclusions: While further research using a large and more diverse sample of participants is needed, our findings support the use of FIDS in clinical practice or clinical research targeting frail elderly Japanese people.

Aims: To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF)., Methods: This cohort study comprised 589 consecutive patients with HF aged ≥65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t- test, χ 2 test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, and Kaplan-Meier method., Results: Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission ( n = 90) and readmission groups ( n = 23). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups ( p < 0.05). The body mass index (hazard ratio [HR]: 0.87; p < 0.05) and motor FIM score (HR: 0.94; p < 0.01) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; p < 0.001)., Conclusion: The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.

Aims: To validate the Functional Independence and Difficulty Scale, a new instrument that assesses both independence and difficulty in carrying out basic activities of daily living., Methods: First, we developed an item list for our construct through a literature review. Second, an expert panel evaluated the item list using the modified Delphi method. Third, to evaluate psychometric properties, a random sample of 593 community-dwelling older adults aged ≥ 65 years from Shiki City, Japan, was surveyed by mail., Results: We developed an instrument comprising 14 items: getting up from bed, standing up from a chair, standing up from the floor, dressing, putting on pants, eating, cleaning after toileting, washing, brushing teeth, opening a PET bottle, cutting toenails, walking inside, walking outside and going up or down four to six steps. Function scores for basic activities of daily living ranged from 14-42, with higher scores representing better function. Internal consistency was acceptable (Cronbach's alpha = 0.92). Spearman's partial correlation coefficients controlled for sex and age between the new assessment tool, and the Katz Index and Tokyo Metropolitan Institute of Gerontology Index of Competence were 0.81 (P < 0.01) and 0.63 (P < 0.01), respectively., Conclusions: This new tool for assessment of the basic activities of daily living showed good internal consistency and validity. This assessment tool might be applicable in research and clinical practice to evaluate the basic activities of daily living of community-dwelling elderly Japanese people. Geriatr Gerontol Int 2016; 16: 1127-1137., (© 2015 Japan Geriatrics Society.)

Background: To prevent rehospitalization for heart failure (HF), patients need to be able to perceive physical changes that occur at the onset of HF exacerbation and seek early help. Objective: The aim of this study was to evaluate the effect of a self-monitoring intervention on patients' perceptions of physical sensations during daily activities in the context of HF via a randomized controlled trial. Methods: Participants (N = 70) were randomly assigned to the intervention (received daily activity record-based self-monitoring intervention support; group A) or control (only explained the measured results from the records; group B) group. Group A reflected on and described the physical sensations in their daily activities within 1 month after discharge. Outcome measures were assessed at 1 month after the intervention using the European Heart Failure Self-care Behavior Scale, Evaluation Scale for Self-Monitoring by patients with Heart Failure, clinical events, physical activity, and sleep. Results: There was no significant difference in the change in the "asking for help" subscale score of the European Heart Failure Self-care Behavior Scale between the groups (+0.7 vs +0.4 points, P = .716). Group A had improved score on the self-monitoring subscale related to "concern about how movements affect body" from baseline (from 12.7 to 14.0 points, P = .026). There was no significant effect of self-monitoring intervention support on the first rehospitalization related to HF and all-cause death (log-rank χ²=0.432, P = .511). A significant difference in moderate-intensity physical activity between the groups was observed (+4.6 vs -0. 5 minutes, P = .029). Conclusions: A focused strategy that enables patients to perceive their physical sensations and promotes early help-seeking behavior is needed. [ABSTRACT FROM AUTHOR]

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a critical complication associated with mortality and morbidity. This study aimed to clarify the impact of CSA-AKI on activities of daily living (ADL) at discharge in elderly cardiac surgery patients. We included 122 cardiac patients who underwent coronary artery bypass surgery, valve surgery, or combined surgery by mid-line incision followed by postoperative cardiac rehabilitation (CR) from March 2015 to May 2020. CSA-AKI was based on KDIGO criteria. The index of ADL was the Functional Independence Measure (FIM). We compared background factors, clinical parameters, activity level before hospitalization, CR progress, and FIM in patients with or without CSA-AKI. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with p < 0.01 in bivariate correlation as independent variables. Ultimately, 122 patients were divided into the non-CSA-AKI group (n = 84) and CSA-AKI group (n = 38). CR progression in the CSA-AKI group was significantly slower and FIM was lower than that in the non-CSA-AKI group. Moreover, even after adjustment for confounding factors, CSA-AKI (β = -0.18), start day of walking (β = -0.34), postoperative atrial fibrillation (β = -0.15), and activity level before hospitalization (β = -0.37) were predictive factors of ADL decline at discharge (adjusted R2 = 0.52). CSA-AKI of elderly cardiac surgery patients was a predictive factor of ADL decline at discharge. [ABSTRACT FROM AUTHOR]