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Disability in Older Women with Heart Failure

Raina, Ketki Dhruv (2005) Disability in Older Women with Heart Failure. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Heart failure is a major cause of disability among older adults in the United States, costing approximately $28.8 billion in 2004. The majority of these costs can be attributed to HF-related activity limitations. This dissertation explored limitations in activities of daily living in community dwelling older women with HF in three studies. The first study explored the concordance of four activity assessment methods (self-report, proxy-report, clinical judgment, and performance observation in the clinic) with a criterion method (performance observation in the home) in a single sample (n = 55). Multitrait-multimethod matrix analyses revealed that the best concordance with the criterion was achieved with in-clinic performance observation, however, the concordance was marginal at best - fair for 3 activity domains (functional mobility, personal care, and cognitive instrumental activities) and poor for 1 (physical instrumental activities) domain. With the same sample, the second study examined the influence of the environment on activity performance, by performance testing the same activities in an occupational therapy clinic and in participants' homes. The environment influenced the performance of daily living activities in neutral, enabling, and disabling ways, depending on whether activity independence, safety, or adequacy was being measured and whether measurement accounted for functioning at the global, domain, or individual activity level. The third study examined the trajectory of activity limitations and impairments in the same heart failure sample compared to a group of older women without disabling diseases (n = 57) over 6 months. At baseline and follow-up, the non-disabled group performed more independently and adequately than the heart failure group but equally safely. Both groups experienced a loss of independence and adequacy over time but not of safety. Physical impairment and depression emerged as the most likely candidates responsible for the group differences and changes in functioning. Findings from these studies suggest that performance observation in the home may be the most valid method of assessing disability, the influence of the environment on performance is variable, and older women with heart failure sustain greater activity limitations than those without disabling diseases but the rate of change over time is similar.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Raina, Ketki Dhruvkbd5@pitt.eduKBD5
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairRogers, Joan Cjcr@pitt.eduJCR
Committee MemberTowers, Adele LTowersAL@upmc.eduTOWERS
Committee MemberChandler,
Committee MemberHolm, Margo Bmbholm@pitt.eduMBHOLM
Committee MemberStudenski, Stephanie Astudenskis@msx.dept-med.pitt.eduSAS33
Date: 13 October 2005
Date Type: Completion
Defense Date: 29 September 2005
Approval Date: 13 October 2005
Submission Date: 5 October 2005
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Data-gathering methods; Disability; Elderly; Heart Failure; Trajectory; Women
Other ID:, etd-10052005-112917
Date Deposited: 10 Nov 2011 20:02
Last Modified: 19 Dec 2016 14:37


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