Original Article
RELATIONSHIP OF EXECUTIVE FUNCTION, EDUCATIONAL STATUS
AND QUALITY OF LIFE W ITH THE FUNCTIONAL BALANCE IN OLDER
ADULTS
Rushikesh K. Joshi
Lect urer, BITS Inst it ute of Physiot herapy, Vadodara-mumbai NH#8, Varnama, Vadodara, Gujarat , India.
Background:Balance is a com plex const ruct w hich is affect ed by cognit ion. It is necessary t o know t he cognit ive cor relat es of funct ional balance t o design necessary int ervent ions for t he individuals w it h balance problem s.
Objectives:To det er m ine t he relat ionship of execut ive funct ion, educat ional stat us and qualit y of life w it h t he funct ional balance in older adult s.
M et hodology:120 healt hy elder ly subject s w ere t aken f or t he st udy based on t he inclusion cr it eria. Follow ing t he init ial screening, t he execut ive funct ion, educat ional st at us and qualit y of life of t he subject s w ere m easured. Execut ive funct ion perform ance t est w as used for m easuring execut ive funct ion. The qualit y of life w as m easured using SF36 quest ionnaire. The funct ional balance w as m easured using t he ber g balance scale and t im ed up and go t est . The relat ionship am ong t he out com e m easure w as found out using t he Pearson correlat ion coef ficient .
Results:The result s of t he present st udy show ed t hat EFPT and BBS are negat ively correlat ed t o each ot her w it h r-value -0.271. The educat ional st at us score show ed a low posit ive cor relat ion w it h f unct ional balance w it h r-value 0.358. The qualit y of life did not show any significant correlat ion w it h funct ional balance.
Int erpretation & Conclusion:Execut ive funct ion and funct ional balance show ed a low correlat ion. This m eans t hat higher t he execut ive funct ion, bett er w ill be t he funct ional balance of t he individual. M oreover, educat ional st at us also affect s t he funct ional balance of t he individual.
KEY W ORDS: Elderly populat ion, execut ive f unct ion perfor m ance t est , short form healt h sur vey, Berg Balance Scale, Tim ed Up and Go Test .
ABSTRACT
INTRODUCTION
Address for correspondence: Dr. Rushikesh K. Joshi (M PT Neurology & Psychosomat ic disorders), Lect urer, BITS Inst it ute of Physiot herapy, Vadodara-mumbai NH#8, Varnama, Vadodara, Gujarat , India. Contact- +91-8141633941, +91-8460142742. E-M ail: [email protected]
DOI: ht t p:/ / dx.doi.org/10.16965/ ijpr.2015.156
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International Journal of Physiotherapy and Research ISSN 2321- 1822
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DOI: 10.16965/ ijpr.2015.156
Received: 08-06-2015 Peer Review : 08-06-2015 Revised: 01-07-2015
Accept ed : 30-07-2015 Published (O): 11-08-2015 Published (P): 11-08-2015
Aging is a com plex pr ocess involving m any variables such as genet ics, lifest yle fact or s, chronic diseases, t hat interact w it h one anot her, great er influencing t he manner in w hich w e age [1]. Wit h Aging t here is det eriorat ion of various p h ysi o lo gi cal cap aci t i es su ch as m u scl e st rengt h, aerobic capacit y, neuro–m uscular coordinat ion and flexibilit y w hich can lead t o impaired physical performance [2]. These age
Balance is a complex const ruct in older adult s w it h signs and sympt oms of balance disorders. Decreased balance in perform ing funct ional act ivit ies is associat ed w it h act ual balance performance, general healt h-relat ed qualit y of life, and t he presence of co-morbid psychological impairment s [4]. Also, various fact ors contribut e t o t he balance of a person [5]. These fact ors ult im at ely det ermine t he funct ional balance, w hich is needed t o carry out daily act ivit ies. Alt erat ions in t hese fact ors result s int o falls. As w e know t hat falls are one of t he commonest problems in geriatric population. They impair the healt h st at us of t he elderly persons. Falls are t he leading cause of bot h fat al and ot her injuries for adult s aged e” 65 years [6].
Id en t i f y i n g an d co m par i ng cogn i t i v e component s, including t he execut ive funct ion correlat es of funct ional balance, is part icularly import ant in order t o design int ervent ions t o promot e independence and prevent funct ional disabilit y. By know ing t his relat ionship w it h funct ional balance, w e can predict t he funct ional balance of an elderly person. Thus, w e can t ailor necessary int ervent ions for t hem being a healt h professional.
Therefore t he aim of t his st udy is t o det ermine t he relat ionship of executive funct ion, educat ion st at us and qualit y of life w it h t he funct ional balance in older adult s. Underst anding t hese r el at io n shi p s can p o t en t i al l y i m p r o v e management of older adult s w ho present w it h balance disorders.
M ATERIALS AND M ETHODS
120 subjects w ere taken in the st udy ageing from 60-80yrs. Among t hese included bot h male and female gender older adult s from old age homes. The st udy w as a cross-sect ional st udy design. Convenient sampling w as done and t he subject s w ere informed about t he goal of t he st udy. Also, informed consents w ere taken from the subject s. They underw ent general screening and t hen follow ed by t he t est s for inclusion cr it er ia. Inclusion crit eria included M M SE (mini ment al scale examinat ion) and TUG (t imed up and go) t est . The subject s w ho scored >24 in M M SE and t hose w ho w ere able t o perform TUG t est w ere included in t he st udy [7] [8]. Exclusion crit eria of t he st udy w as t o exclude t he individuals w it h
cogn i t i v e i m p ai r m en t (M M SE scor e<24). Individuals w it h balance pr oblem s and had hist ory of falls w ere excluded from t he st udy. Execut ive funct ion of t he subject w as assessed using execut ive funct ion performance t est [9]. The t est included four t asks t o be performed by t he subject . It included cooking, t elephoning, medicat ion and billing tasks (Figure 1). For each of t hese t asks, t he EF (execut ive f unct ion) component s of t he t ask w ere measured. The EF component s included init iat ion, organizat ion, sequencing, judgment & safet y, complet ion. The t est result s int o 3 scores: t he EF component score for all 4t asks (range 0-20), t he t ot al t ask score (range 0-25), and a t ot al overall score (range 0-100). The EF com ponent score can range from 0 t o 5.
Fig. 1: Execut ive funct ion perform ance t est .
Educat ional st at us w as document ed based on t he number of years of formal educat ion of t he subject . This included t he number of years of schooling and higher educat ion.
Qualit y of life of t he subject w as assessed using t he SF36 quest ionnair e (Shor t f or m healt h quest ionnaire) [10] .All t he quest ions are scored on a scale from 0 t o 100, w it h 100 represent ing t he highest level of funct ioning possible. Furt her, Funct ional balance of t he subject s was measured using Berg Balance Scale (Figure 2) and Timed Up and Go Test (TUG) [11] [12].
Fig. 2: Berg Balance Scale.
RESULTS AND TABLES
The mean score of age is 70.22 and SD is 5.262. The m ean score of gender is 1.44 and SD is 0.499. The mean score of M M SE is 27.18 and SD is 1.290.
Relat ionship bet w een t he execut ive funct ion, educat ional st at us and qualit y of life w it h t he funct ional balance w as correlat ed using t he Pearson’s correlat ion.
Tab le 1 : Th e t ab l e b el o w sh o w s t h e r - val u es f o r cor relat ions found in t he st udy.
Sr. No Correlation between No. of
subjects (N) r- value 1 EFPT and BBS 120 -0.271* * 2 QOL1 and BBS 120 -0.236* * 3 QOL2 and BBS 120 -0.193* 4 QOL3 and BBS 120 -0.239* * 5 QOL4 and BBS 120 0.003 6 QOL5 and BBS 120 -0.217* * 7 QOL6 and BBS 120 -0.069 8 QOL7 and BBS 120 -0.037 9 QOL8 and BBS 120 0.06 10 EDUSTATUS and BBS 120 0.358* *
* * Cor r elat ion is signif icant at 0.01 Level (2-t ailed)
EFPT- Execut ive Funct ion Perform ance Test , BBS- Berg Balance Scale, QOL (1,2…8)- Qualit y of life component s.
Graph 3: Show s correlat ion of educat ional st at us and BBS scor es of t he subject s.
Result s clear ly show t hat only educat ional st at us show ed a moderat e posit ive correlat ion betw een the berg balance scores of t he subject s. (Graph 3.1)
Th e o t her co r r elat ion s d one bet w een t he execut ive funct ion and qualit y of life did not show any significant correlat ions.
DISCUSSION
In t hi s st ud y, w e used execu t i ve f un ct io n performance t est (EFPT) for t he measurement of execut ive function of t he subject . SF36 healt h survey quest ionnaire w as used t o assess t he qualit y of life of t he subject s. To assess t he funct ional balance of t he subject s, w e used t he berg balance scale (BBS) and t imed up and go t est (TUG).
Execut ive funct ion performance t est included four t asks t o be performed by t he subject . It included cooking, t elephoning, medicat ion and billing t asks. For each of t hese t asks, t he EF (executive function) component s of the task were m easu r ed . Th e EF co m p on en t s i ncl u ded init iat ion, organizat ion, sequencing, judgment & safet y, com plet ion. SF36 includes 36 it em s assessing 8 healt h concept s by using mult i-it em scales (35 it em s): physical f unct ioning (10 items), role limit ations caused by physical healt h problems (4 it ems), w ell-being (5 items), energy and fat igue (4 it ems), pain (2 it ems), and general healt h percept ions (5 it ems). Funct ional balance of t he su bj ect s w as m easu r ed u si ng Ber g Balance Scale and Timed Up and Go Test (TUG). Ber g bal ance scale is a 14 it em scal e f o r m easuring f unct ional balance. It uses a five point ordinal scale for scoring, ranging from 0-4. The educat ional st at us of t he subject s w as considered as the t otal number of years of formal educat ion.
The result s of t he present st udy show ed t hat EFPT and BBS are negat ively correlat ed t o each ot her w it h r-value -0.271. This means t hat low er t he score of EFPT, bet t er w ill be t he score of BBS. The qualit y life domains 4 and 8 show ed a posit ive correlat ion w it h t he funct ional balance score (BBS score). While t he ot her qualit y of life dom ains nam ely 1, 2, 3, 5, 6 and 7 show ed negative correlat ions w ith t he functional balance score. M oreover, t he educat ional stat us score showed a low posit ive correlation wit h functional balance w it h r-value 0.358. This m eans t hat higher t he educat ional st at us of t he individual, higher w ill be t he funct ional balance.
and t o det erm ine w het her it independent ly det ermines balance or not . They concluded t hat t he low er scores of execut ive funct ion indicat e higher risks of falls among t he st udy populat ion. This show s t hat t he execut ive funct ion and funct ional balance of t he individuals are relat ed t o each ot her. Higher t he level of execut ive funct ion, bet t er t he funct ional balance of t he individual. Thus, execut ive f unct ion can be consider ed as a predict or of t he funct ional balance performance of t he individual. [14] The result s of t his st udy w ere consist ent w it h t he st udy of Jennifer Davis et al. (2010). They conducted a st udy to determine the cont ribution of execut ive funct ion t o t he healt h r elat ed qualit y of life. From t his st udy t hey concluded t hat t he execut ive funct ion has an independent co nt r i bu t i on t o t h e q u al i t y o f l i f e o f t h e individual. Execut ive funct ion of t he individual affect s t he qualit y of life of t he individual. Bet t er t he execut ive funct ion, bet t er t he qualit y of life and physical performance of t he individual. [15] M oreover, t he result s of our st udy show ed t hat educat ional st at us of t he individual is direct ly r el at ed t o t h e f u nct i on al b al an ce o f t h e individual. These result s are consist ent w it h t he st udy of Amer C. et al. (2009). They conduct ed a st udy w it h an aim t o det ermine t he influence of educat ional level and age on TM T performance (a t est to measure execut ive funct ion) in healthy elderly Portuguese speakers. They concluded t hat t he educat ional level and age significant ly affect t he TM T performance. The result s of t his st udy w ere also consist ent w it h t he previous st udies done on t he Brazilian populat ion [16].
Similar result s w ere found out in t he st udy of Cahn-Weiner DA et al. (2000). They conducted a st udy t o predict t he funct ional st at us from t he n eur o p sy ch ol o gical t est s p er f o r m an ce i n communit y elderly individuals. They concluded that the executive dysfunct ion can be considered as t he best predict or of funct ional decline in elderly individuals. Also memory, language and spat ial skills did not cont ribut e significant ly t o t he predict ion of funct ional st at us [17]
The pract ical implicat ion of t his st udy is t he early ident ificat ion of t he individuals w ho are at risk o f co gn i t iv e decl in e so t hat ap p r op r i at e interventions can be given to retard the cognitive decline and improve t he quality of life. Execut ive
funct ion screening should be implement ed for t he early det ect ion of execut ive funct ion st at us of t he geriat ric populat ion. So t hat necessary int ervent ions can be provided t o t hem.
Limitations: The limit at ions of t he st udy are low sam p l e si ze and t he st u d y d esign . Th e prospect ive st udy design w ould have yielded bet t er clinical findings.
CONCLUSION
Execut ive funct ion is correlat ed to the functional balance. This implies t hat higher t he execut ive funct ion bet t er w ill be t he funct ional balance of t he individual. M oreover, Educat ional stat us is also m oderat ely correlat ed t o t he funct ional balance. Qual it y of li f e h as n o signi f i cant correlat ion w it h t he funct ional balance of t he individual.
Conflicts of interest: None
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