The goals of this article are (a) to describe the daily life of the very old in terms of frequency, duration, variety, and social and physical contexts of activities, and (b) to examine the effects of background variables (e.g., age, sex, residential and marital status, income, and education) on late life activity engagement. A representative sample of 516 adults aged 70-105 was interviewed about their activities using the Yesterday Interview. In contrast to most research on activity engagement, this measurement approach allows for assessment of both the type and context of activities engaged in during the day preceding the interview. The results indicated high frequencies of obligatory activities but also showed substantial time spent in discretionary activities, with television viewing occupying most of the participants' leisure time. Most activities were done alone and at home. In bivariate and multiple regression analyses, age and residential status had the strongest association with activity frequency, duration, and variety; the oldest-old and those residing in long-term care facilities had lower levels of activity engagement. Results are discussed in terms of their relevance for successful aging.

The findings highlight the difficulties of assessing pain in cognitively impaired elders and the lack of knowledge among health care providers about effective pain management.

The Revised Observed Tasks of Daily Living (OTDL-R), a performance-based test of everyday problem solving, was administered to a sample of community-dwelling older adults. The OTDL-R included nine tasks, representing medication use, telephone use, and financial management. The OTDL-R had a desirable range of difficulty and satisfactory internal consistency and showed a relatively invariant pattern of relations between measured tasks and the underlying latent dimensions they represent across White and non-White subsamples. The OTDL-R also correlated significantly with age, education, self-rated health, a paper-and-pencil measure of everyday problem solving, and measures of basic cognitive functioning. Thus, the OTDL-R is a reliable and valid objective measure of everyday problem solving that has great practical utility for assessing performance in diverse populations.

BackgroundNursing home residents with dementia gradually lose the ability to process information so that they are less likely to express pain in typical ways. These residents may express pain through disruptive behaviors because they cannot appropriately verbalize their pain experience. The objective of this study was to investigate the effect of pain on disruptive behaviors in nursing home residents with dementia.MethodsThis is a secondary analysis of the Minimum Data Set (MDS 2.0) assessment data on long-term care from the state of Florida. The data used in this study were the first comprehensive assessment data from NH residents with dementia aged 65 and older (N = 56,577) in Medicare- or Medicaid-certified nursing homes between January 1, 2009 and December 31, 2009. Variables examined were pain, wandering, aggression, agitation, cognitive impairment, activities of daily living impairments, and demographic characteristics. Ordinal logistic regression was used to evaluate the effect of pain on disruptive behaviors.ResultsResidents with more severe pain are less likely to display wandering behaviors (OR = .77, 95% CI for OR = [0.73, 0.81]), but more likely to display aggressive and agitated behaviors (OR = 1.04, 95% CI for OR = [1.01, 1.08]; OR = 1.17, 95% CI for OR = [1.13, 1.20]).ConclusionsThe relationship between pain and disruptive behaviors depends on the type of behaviors. Pain is positively correlated with disruptive behaviors that do not involve locomotion (e.g., aggression and agitation), but negatively related to disruptive behaviors that are accompanied by locomotion (e.g., wandering). These findings indicate that effective pain management may help to reduce aggression and agitation, and to promote mobility in persons with dementia.

OBJECTIVES-To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN-Quasi-experimental, correlational study of older adults.SETTING-Data were collected from residents of nursing homes, assisted living, and retirement apartments in North/Central Florida. PARTICIPANTS-126 adults, mean age 83 years; 92 cognitively intact, 24 cognitively impaired.MEASUREMENTS-Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, MMSE, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to exacerbate pain. RESULTS-86%self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain after movement, but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired elders. Total number of pain behaviors was significantly related to self-reported pain intensity (Beta = .40, p = .000) in intact elders. CONCLUSION-Self-reported pain is diminished in cognitively impaired elders relative to intact elders, independent of analgesics, but only when assessed following movement. Behavioral pain indicators do not differ between groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. Findings support multidimensional pain assessment in persons with dementia.

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