Measurement of ability or inability to perform activities of daily living is important to in describing the functional status of a person and then implementing an intervention. Evaluations of ADLs are mainly used in nursing and in rehabilitation of people with disabilities and the elderly. Measuring ability to perform ADLs is crucial for the management of healthcare in aging societies. It is important to understand differences between categories of ADLs and challenges in their evaluation that are connected (...) to the roles of family members. (shrink)

Activities of daily living are usually defined as skills needed in typical daily self-care. Instrumental activities of daily living are more complex skills beyond basic self-care, and their measurement evaluates how individuals function in their homes, workplaces, and outdoor environments. The skills that pertain to IADLs are exposed to dysfunctions resulting from aging or illness. Reductions in those skills may begin to cause problems with independence but these problems can be solved with the (...) help of others - for example, family members, social workers, and nurses. (shrink)

Objectives: The present study aimed to systematically analyze the effects of physical activity on executive function, working memory, cognitive flexibility, and activities of daily living in Alzheimer's disease patients and to provide a scientific evidence-based exercise prescription.Methods: Both Chinese and English databases were used as sources of data to search for randomized controlled trials published between January 1980 and December 2019 relating to the effects of physical activity on executive function, working memory, cognitive flexibility, and ADL issues (...) in AD patients. Sixteen eligible RCTs were ultimately included in the meta-analysis.Results: Physical activity had significant benefits on executive function [standard mean difference = 0.42, 95% confidence interval 0.22–0.62, p < 0.05], working memory, cognitive flexibility, and ADLs among AD patients. Subgroup analysis indicated that, for executive function issues, more than 60 min per session for 16 weeks of moderate-to-high-intensity dual-task exercises or multimodal exercise had a greater effect on AD patients. For working memory and cognitive flexibility issues, 60–90 min of moderate-intensity dual-task exercises 1–4 times/week was more effective. For ADL issues, 30–90 min of multimodal exercise at 60–79% of maximal heart rate 3–4 times/week had a greater effect on AD patients.Conclusions: Physical activity was found to lead to significant improvements in executive function, working memory, cognitive flexibility, and ADLs in AD patients and can be used as an effective method for clinical exercise intervention in these patients. However, more objective, scientific, and effective RCTs are needed to confirm this conclusion. (shrink)

Feminist research on community care and ‘informal carers’ identified this as a women's issue but failed to address the interests and experiences of older and disabled women – those who received ‘care’ One consequence is that such feminist research has implicitly, and sometimes explicitly, undermined disabled women's rights to a home, children and personal relationships. Using qualitative research, the article highlights the actual experience of women whose physical impairment means that they need help with daily living activities, (...) looking at the different circumstances in which such help is received. The disability movement's concept of ‘independent living’ raises particular issues for disabled women. ‘Independent living’ is about having choice and control over the assistance needed, rather than necessarily doing everything for yourself. However, gender inequalities may also inhibit the choice and control that women have in their lives. Assistance can be given within a personal relationship as an expression of love, but disabled women may also experience abusive, restrictive or exploitative relationships. Public services do not generally provide assistance in a way which enables a woman to have choice and control in her life, or even to carry out child-caring or homemaking tasks. The research on the various ways of receiving personal assistance found that those women who were able to purchase their own help were most likely to be living independently, in the sense of exerting choice and control in their lives. Feminist research can help to create a space for disabled women's absent voices, and add to the pressure for change in the way that personal assistance needs are met. This is a human and civil rights issue which has a key impact on the control that disabled women have over their lives. (shrink)

Previous research on Physical Activity has been highly valuable in elucidating how PA affects the structure and function of the hippocampus in elderly populations that take part in structured interventions. However, how PA affects the hippocampus in younger populations that perform PA during daily-life activities remains poorly understood. In addition, this research has not examined the impact of PA on the internal structure of the hippocampus. Here, we performed a cross-sectional exploration of the way structural and functional aspects (...) of the hippocampus are associated with habitual PA performed during work, leisure time, and sports in the daily lives of healthy young adults. We assessed PA in these three different contexts through a validated questionnaire. The results show that PA performed during work time correlated with higher subicular volumes. In addition, we found that PA changed functional connectivity between a location in the middle/posterior hippocampus and regions of the default mode network, and between a location in the anterior hippocampus and regions of the somatomotor network. No statistical effects of PA performed during leisure time and sports were found. The results generalize the impact of PA on younger populations and show how PA performed in daily-life situations correlates with the precise internal structure and functional connectivity of the hippocampus. (shrink)

This article raises the question of ‘normality’ today and the fracturing of health ideals along new lines of enablement and function. In particular the study asks if ‘functional’ and ‘dysfunctional’ are displacing ‘normal’ and ‘pathological’ as master biopolitical binarisms, and if so, what distinctions can be drawn between them. The discourse of ‘function’ and ‘dysfunction’ is certainly ubiquitous in two areas of research and practice: gerontology and sexology. In the former case ‘functional health’ is linked to successful aging represented by (...) technical tests around activities of daily living (ADLs) and risk-assessment profiles. In the latter case, sexual function and dysfunction have become all-encompassing markers of heterosexual competence, now largely detached from reproductive imperatives, but refashioned as integral to responsible and successful self-management. Presenting examples from both cases, the article concludes that functionality, circulating under the signs of ‘normal’, ‘natural’ and ‘healthy’, furnishes economic, technological, educational, professional, pharmacological and policy fields with a rich intellectual, practical and regulatory resource. (shrink)

Background: Maintaining dignity is important for successful aging, but there is lack of validated research instruments in the nursing literature to investigate dignity as perceived by the old people. Objective: This is a methodological study aiming to investigate the psychometric properties of the Greek version of Jacelon Attributed Dignity Scale as translated in the Greek language. Research design: A methodological approach consisting of translation, adaptation, and cross-cultural validation. A sample of 188 Greek-speaking old Cypriot persons drawn from the Hospital outpatient (...) departments was asked to complete the Greek versions of Jacelon Attributed Dignity Scale and the Instrumental Activities of Daily Living. Data analyses included internal consistency reliability (Cronbach’s alpha coefficient), item analysis, and exploratory factor analysis using principal component method with orthogonal varimax rotation. Ethical considerations: The study protocol was approved by the National Bioethics committee according to the national legislation. Permission to use the research instrument was granted from the author. Information about the aim and the benefits of the study was included in the information letter. Findings: Cronbach’s alpha for Greek version of Jacelon Attributed Dignity Scale was 0.90. Four factors emerged explaining 65.28% of the total variance, and item to total correlation values ranged from 0.25 to 0.74 indicating high internal consistency and homogeneity. Mean item score in Instrumental Activities of Daily Living was 5.6 (standard deviation = 1.7) for men and 6.7 (standard deviation = 1.7) for women, and the correlations between demographics, Instrumental Activities of Daily Living, and the four factors of the Greek version of Jacelon Attributed Dignity Scale were low; also in multiple linear regression, the values of R2 are presented low. Discussion: Demographic characteristics and degree of functionality seem to be associated with some of the dimensions of dignity but with low correlations; therefore, they cannot predict attributed dignity. Conclusion: The Greek version of Jacelon Attributed Dignity Scale is a valid and reliable tool to measure attributed dignity in Greek-speaking older adults, but further testing of the psychometric properties and other potential factors that may affect the attributed dignity is needed. (shrink)

Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense (...) of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children, and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good >0.79). Proprioceptive error was larger for children with uCP than TDC, indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies. (shrink)

Many activities of daily living require that we physically interact with one or more objects. Object manipulation provides an intriguing domain in which the presence and extent of manual asymmetries can be studied on a motor planning and a motor execution level. In this literature review we present a state of the art for manual asymmetries at the level of motor planning during object manipulation. First, we introduce pioneering work on grasp posture planning. We then sketch the (...) studies investigating the impact of future task demands during unimanual and bimanual object manipulation tasks in healthy adult populations. In sum, in contrast to motor execution, there is little evidence for hand-based performance differences in grasp posture planning. We discuss potential reasons for the lack of manual asymmetries in motor planning and outline potential avenues of future research. (shrink)

Spiritual Writer, theologian, and philosopher, Fr. Robert Spitzer S.J., tackles the topic of recognizing and overcoming spiritual evil. His focus is the human heart. His goal: our spiritual and moral transformation, which leads to true peace and genuine happiness. The book is divided into two main parts: (1) the realities of God's goodness and of spiritual evil, and (2) recognizing and overcoming the diabolical tactics of deception, temptation, and sin. The author synthesizes the best advice given by Catholic spiritual masters (...) throughout the ages and gives a practical guide to implementing it in our busy lives. Father Spitzer provides the biblical and theological background of Jesus' victory over evil. He also explores the reality of the devil, including extraordinary manifestations of diabolic activity such as possession. With insights from modern psychology, he shows how prayer can transform the subconscious psyche, making us better able to resist temptation, detach from the world, and grow in holiness. (shrink)

The coronavirus disease-2019 pandemic impacted the lives of children and adolescents, leading to many changes in their routines, especially in education. Face-to-face physical education classes during COVID-19 were affected in organization, possibly conditioning students' participation, motivation, and learning. In the extreme conditions of the coronavirus, it may be assumed that daily physical activity became much less than before, partly because students are learning outside the school environment and PE lessons taught using remote forms do not fulfill their purpose. The (...) aim of the study was to assess the pupil's perception of inclusion in school education during the remote learning caused by the COVID-19 pandemic and to compare the results with the control group. Moreover, the physical activity of respondents during social isolation due to the coronavirus was examined. The sample consisted of 111 pupils of both genders, aged 14–21 years. The Perceptions of Inclusion Questionnaire was used to measure the perception of inclusion in school education. The structure of the participants' physical activity was examined using the International Physical Activity Questionnaire-Long Form for adolescents. It was observed that the pupils' gender did not differentiate their perception of inclusion in school education. It was proved that respondents participating in research during the COVID-19 pandemic obtained statistically significantly lower results in the case of “emotional wellbeing in school” but a higher mean was observed in relation to “social relationships with other pupils” than the control group. Girls achieved a higher mean in the case of walk Metabolic Equivalent of Task than boys. In addition, it was observed that the recommendation of vigorous physical activities was achieved by 37.78% of boys and 34.85% of girls. In turn, 69.70% of female pupils and 77.78% of male respondents met the recommendations for medium physical activities. It was also noted that 87.88% of girls and 86.67% of boys participating in the research achieved the recommendation for total physical activities. The analysis showed negligible and low positive correlations between examined variables. (shrink)

A major concern of public health authorities is to also encourage adults to be exposed to enriched environments during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing the (...) game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases. The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility, through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies. (shrink)

Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and constraints. (...) The work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld. Examining lived experience of embodied intentionality, skilled bodily capacities as highlighted in Merleau-Ponty's non-mechanistic physiology opens new therapeutic, coping and caregiving possibilities. Matching temporal rhythms can decrease the stress of being assisted with activities of daily living. For example, caregivers and patients alike can be taught strategies for extending their lived bodily capacities by altering rhythms, by shifting hyperactivity to different parts of the body and other strategies that change the perceptual experience associated with walking in different environment. A medical account of the pathophysiology of PD is nessessary and useful, but not sufficient for designing caregiving in ways that enrich and extend the existential skills of dwelling of persons with PD. The dominance of mechanistic physiology makes caregivers assume that it is the 'real discourse' about the disease, causing researchers and caregivers alike to overlook the equally real lived experience of the patient which requires different descriptive discourses and different sources of understanding. Lack of dialogue between the two discourses is tragic for patients because caregivers need both in order to provide attuned, effective caregiving. (shrink)

Wearing a myoelectric prosthesis is a basic way for limb amputees to restore their lost limb functions in the activities of daily living. However, it is estimated that around 40% of amputees refuse the prosthesis. One of the primary reasons would be that the current prostheses lack appropriate sensory feedback. Currently, the amputees only depend on their visual feedback when using their arm prostheses. It would be difficult for them to accurately control the wrist position, which is (...) vital for flexible manipulation in ADLs. This manuscript designed a myoelectric arm prosthesis with wrist position feedback. To study the effect level of position feedback on prosthetic control, two tests were performed. The vibrotactile perception range test aims to analyze the perception sensitivity of the vibration in humans and obtain the optimal perception range utilized in the sensory feedback test. The sensory feedback test analyzes the effectiveness of the position feedback by comparing three feedback methods of Vis-FB, WP-FB, and a combination of Vis-FB and WP-FB. These tests were conducted by asking six able-bodied subjects to perform 20 movement combinations of five target positions. The WP-FB was transiently activated with five vibrating motors embedded in an armband to stimulate the arm stump when the prosthetic wrist rotates to the target positions. Our experimental results showed that when WP-FB was added to the prosthetic control, the absolute angular error of the prosthetic wrist declined from 4.50° to 1.08° while the success rate 3 increased from 0.34 to 0.84, respectively. This study demonstrates the importance of WP-FB to the effective control of the arm prosthesis. (shrink)

Topics in Cognitive Science, Volume 14, Issue 2, Page 295-310, April 2022.

The coronavirus disease 2019 pandemic is influencing our lives in an enormous and unprecedented way. Here, we explore COVID-19-lockdown's consequences for creative activity. To this end, we relied on two extensive diary studies. The first, held on March 2019, involved 78 students who reported their emotions and creativity over 2 weeks. The second, conducted on March 2020, involved 235 students who reported on their emotions, creativity, and the intensity of thinking and talking about COVID-19 over a month. We found that (...) compared with 2019, during the lockdown, students engaged slightly yet statistically significantly more in creative activities. An analysis of diaries collected during the pandemic also showed that the days when students spent more time discussing or searching for information about COVID-19 were characterized by a higher creative activity yet also mixed emotions. We discuss potential explanations of these unexpected results along with future study directions. (shrink)

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary (...) with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment. Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test, grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r = −0.73, p = 0.017]; grip strength: [r = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors. (shrink)

Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, (...) the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

In this paper we examine how the use of robots in caring for elders can impact the meaningfulness of elders’ lives. We present a framework for understanding ‘meaningfulness in life’, and then apply that framework in discussing ways in which the use of robots to assist in activities of daily living can preserve, enhance or undermine the meaningfulness of elders’ lives. We conclude with a discussion of if and how having false beliefs about companion robots can affect (...) meaningfulness in the life of the person having those false beliefs. (shrink)

Tailoring assistive systems for guiding and monitoring an individual in daily living activities is a complex task. This paper presents ALI, an assistive system combining a formal possibilistic argumentation system and an informal model of human activity: the Cultural-Historic Activity Theory, facilitating the delivery of tailored advices to a human actor. We follow an activity-centric approach, taking into consideration the human’s motives, goals and prioritized actions. ALI tracks a person in order to I) determine what activities (...) were performed over a period of time (activity recognition tracking), and II) send personalized notifications suggesting the most suitable activities to perform (decision-making monitoring). The ALI system was evaluated in a formative pilot study related to promote social activities and physical exercise. (shrink)

Revenge is common in our daily lives, and people feel good when engaging in revenge behavior. However, revenge behavior is a complex process and remains somewhat of a puzzle of human behavior. Neuroimaging studies have revealed that revenge behaviors are associated with activation of a neural network containing the anterior cingulate cortex, ventral striatum, inferior frontal gyrus, and dorsolateral prefrontal cortex. Recent brain stimulation research using transcranial direct current stimulation and transcranial magnetic stimulation has shown a causal relationship between (...) brain regions and revenge behaviors, but the findings have been mixed. In the present study, we aimed to study whether stimulation in the DLPFC can change participants’ revenge behavior in conditions where participants’ wealth was taken away in different ways. We adapted the moonlighting game and designed a new paradigm. Our study revealed that revenge behavior increased following activation in the right DLPFC, suggesting that the right DLPFC plays an important role in overriding self-interest and retaliation. In addition, our results revealed that the right DLPFC is crucial in revenge behavior related to the motivation of invasion. (shrink)

Amygdala is an intensively researched brain structure involved in social processing and multiple major clinical disorders, but its functions are not well understood. The functions of a brain structure are best hypothesized on the basis of neuroanatomical connectivity findings, and of behavioral, neuroimaging, neuropsychological and physiological findings. Among the heaviest neuroanatomical interconnections of amygdala are those with perirhinal cortex (PRC), but these are little considered in the theoretical literature. PRC integrates complex, multimodal, meaningful and fine-grained distributed representations of objects and (...) conspecifics. Consistent with this connectivity, amygdala is hypothesized to contribute meaningful and fine-grained representations of intangible knowledge for integration by PRC. Behavioral, neuroimaging, neuropsychological and physiological findings further support amygdala mediation of a diversity of such representations. These representations include subjective valence, impact, economic value, noxiousness, importance, ingroup membership, social status, popularity, trustworthiness and moral features. Further, the formation of amygdala representations is little understood, and is proposed to be often implemented through embodied cognition mechanisms. The hypothesis builds on earlier work, and makes multiple novel contributions to the literature. It highlights intangible knowledge, which is an influential but insufficiently researched factor in social and other behaviors. It contributes to understanding the heavy but neglected amygdala-PRC interconnections, and the diversity of amygdala-mediated intangible knowledge representations. Amygdala is a social brain region, but it does not represent species-typical social behaviors. A novel proposal to clarify its role is postulated. The hypothesis is also suggested to illuminate amygdala’s involvement in several core symptoms of autism spectrum disorder (ASD). Specifically, novel and testable explanations are proposed for the ASD symptoms of disorganized visual scanpaths, apparent social disinterest, preference for concrete cognition, aspects of the disorder’s heterogeneity, and impairment in some activities of daily living. Together, the presented hypothesis demonstrates substantial explanatory potential in the neuroscience, social and clinical domains. (shrink)

Home care is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good care involves attending (...) to the needs of another out of a concern for their well‐being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care.. (shrink)

Previous research has indicated older adults value listening to music as a leisure activity. Yet, recent research into listening practices broadly has often focused on younger adults and the use of newer, digital listening technologies. Nonetheless, the radio, which is familiar to older people who grew up with it at the forefront of family life, is important to consider with regard to listening practices and the potential associated well-being benefits. This research investigated older adults’ everyday radio listening practices, in order (...) to begin to understand how the radio fits into their daily lives and how it might influence their sense of well-being. Twenty-five Australian residents (aged 66–87; 56% female, 44% male) participated in semi-structured, one-to-one interviews. The results of a qualitative thematic analysis revealed themes concerning listening preferences, listening routines, access, and motivations/outcomes. While personal preferences (concerning content, stations, and presenters) were diverse, individuals clearly communicated these as well as their established listening routines and habits. Listener motivations varied: some people focused on the enjoyment that listening to the radio creates while some noted benefits to their well-being, such as relaxation, modifying their mood, and feelings of comfort and community. Radio listening practices can be defined in terms of differing engagement styles, as characterized using continua ranging from passive to active, or focused, listening as well as generalized or specific listening. Based on participants’ experiences, a proposed engagement space model links how people engage with the radio to the possible outcomes mentioned. Importantly, benefits to well-being can result from varied engagement styles. The findings presented provide an in-depth understanding of how the radio fits into older adults’ everyday life, with implications for considering how the radio might be used as a widely accessed, low-cost tool for maintaining and enhancing quality of later life. (shrink)

BackgroundThe BelRAI Screener is a short-form assessment consolidating internationally validated interRAI items focusing on physical and psychological aspects of functioning and problems with activities of daily living. It was fully implemented in the Flemish home care setting as of June 2021. In a biopsychosocial model for developing a personalized and effective care plan social and contextual aspects are considered equally important to biomedical ones. Thus, a social supplement to the BelRAI Screener was collaboratively developed with stakeholders and (...) tested to gather additional information on the social context of community-dwelling adults with care needs.Objective and methodsTo examine the interrater reliability of the BelRAI Social Supplement in Flanders, Belgium, an observational study was conducted using a convenience sample. The method of simultaneous rating was used due to strict COVID-19 guidelines at the time and to minimize assessment burden. Fifty two community-dwelling adults requesting home care support were simultaneously assessed by two independent assessors during home visits. Interrater reliability was tested on all 80 items of the BelRAI Social Supplement using observed agreement, kappa coefficients, and intraclass correlation coefficients.ResultsThe kappa mean and median values for nominal items, show substantial agreement, while the kappa mean and median values for ordinal items were 0.81 and 0.90, which correspond to almost perfect agreement. Following the traditional cut-off points for the interpretation of the kappa statistic, reliability was almost perfect for 49% of all items, substantial for 33%, moderate for 8%, and poor for 10%. The majority of items with poor kappa value, showed a high observed agreement, reflecting homogeneity of the sample rather than poor agreement.ConclusionThe strength of kappa agreement for the items in this version of the BelRAI Social Supplement is generally substantial to almost perfect, with high proportions of observed agreement. COVID-19 restrictions had a large impact on the planning and execution of the home visits. A final optimization of the instrument and accompanying manual according to the findings will result in an improved version ready for nation-wide implementation. (shrink)

In recent years, much attention has been paid to how older people living at home can remain independent and manage their illness themselves, while less attention has been given to those who have become frail and need assistance with challenges of everyday life. In this article, I drew on Latimer's formulation of care for frail older people as relational and world‐making and on Foucault's work related to the care of the self in developing an understanding of how frail older (...) persons manage to live well at home in the final years of their lives. I use data from an ethnographic study of home care nursing in the homes of 15 frail older people to develop an understanding of how their care at home can be developed. The participants were holding on to life, which reflected their vitality and vulnerability as well as agency in continuing to explore ways to preserve and build their world at home. With declining ability and stamina relations with material things, relatives and official care workers become of central importance in holding on to life. Home care services can be thought of as part of life, as world‐forming, where workers contribute to daily activities that support living well at home. (shrink)

Background:Smart Aging is a serious game (SG) platform that generates a 3D virtual reality environment in which users perform a set of screening tasks designed to allow evaluation of global cognition. Each task replicates activities of daily living performed in a familiar environment. The main goal of the present study was to ascertain whether Smart Aging could differentiate between different types and levels of cognitive impairment in patients with neurodegenerative disease.Methods:Ninety-one subjects (mean age = 70.29 ± 7.70 (...) years)—healthy older adults (HCs,n= 23), patients with single-domain amnesic mild cognitive impairment (aMCI,n= 23), patients with single-domain executive Parkinson's disease MCI (PD-MCI,n= 20), and patients with mild Alzheimer's disease (mild AD,n= 25)—were enrolled in the study. All participants underwent cognitive evaluations performed using both traditional neuropsychological assessment tools, including the Mini-Mental State Examination (MMSE), Montreal Overall Cognitive Assessment (MoCA), and the Smart Aging platform. We analyzed global scores on Smart Aging indices (i.e., accuracy, time, distance) as well as the Smart Aging total score, looking for differences between the four groups.Results:The findings revealed significant between-group differences in all the Smart Aging indices: accuracy (p< 0.001), time (p< 0.001), distance (p< 0.001), and total Smart Aging score (p< 0.001). The HCs outperformed the mild AD, aMCI, and PD-MCI patients in terms of accuracy, time, distance, and Smart Aging total score. In addition, the mild AD group was outperformed both by the HCs and by the aMCI and PD-MCI patients on accuracy and distance. No significant differences were found between aMCI and PD-MCI patients. Finally, the Smart Aging scores significantly correlated with the results of the neuropsychological assessments used.Conclusion:These findings, although preliminary due to the small sample size, suggest the validity of Smart Aging as a screening tool for the detection of cognitive impairment in patients with neurodegenerative diseases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Where Does It Go From Here?John Bond (bio) and Lynne Corner (bio)Keywordsbiomedicalization, dementia, mild cognitive impairment, subjectivityThe joy of formal interdisciplinary discussion of this kind is the way that ideas presented through the gaze of social scientists stimulate such exciting thoughts and responses from other disciplines such as philosophy and psychology. We would like to thank Sabat and Thornton for their supportive and provocative reactions to our (...) paper. In the spirit of their responses, it is not our intention to respond to their thoughts directly; rather, we take the opportunity to theorize sociologically about this new category of psychiatry that has come to be known simply as mild cognitive impairment (MCI). In reviewing the responses of Sabat and Thornton, three thoughts emerged. First, together we have covered ontologic, epistemologic, methodologic, and theoretical questions about MCI, but none of us has posed basic political questions, such as: Why has MCI emerged as a new psychiatric label at this particular time? Second, this discussion brings together social scientists with a psychologist and a philosopher, but important constituents are missing. Consequently we are missing "insider" views on the importance of MCI to clinical practice. Third, this discussion highlights for us even more acutely the central question: Is MCI a real entity? In the following, we reflect on the first of these because our response also addresses the third. We first revisit the "evidence" about the importance of MCI for clinical practice.The notion of MCI as the transitional state between normal aging and Alzheimer's disease and other dementias has existed in a number of guises for many years, with benign senescent forgetfulness (Kral 1962) being the forerunner of a number of other terms, including questionable dementia, incipient dementia, isolated memory impairment, mild neurocognitive decline, age-associated memory impairment, age-associated cognitive decline, and cognitive-impairment-not-demented (Geda et al. 2004). Given that psychiatric labels implying the existence of MCI have been part of the practice landscape for over forty years, it is perhaps not surprising that its reinvention in the form of MCI has not, it appears, raised much attention outside specialist centers in North America and Europe. The reaction from grassroots clinical practice has been similar in intensity to their subdued reaction to the antipsychiatry movement in the 1960s. But for specialist clinics like the Mayo Clinic in Rochester, Minnesota, it has been an expanding [End Page 29] industry with numerous published papers, international conference presentations, and research funding opportunities.MCI can be distinguished from similar diagnostic categories that preceded its appearance in 1991. A key diagnostic criteria is the requirement for a subjective memory complaint by the person subsequently diagnosed as having MCI. Other diagnostic criteria include normal general cognitive function, normal activities of daily living, and memory being impaired for age, but not being demented (Petersen et al. 1999; Petersen and Morris 2003). To our knowledge, the idea of subjectivity being an important diagnostic criterion, as opposed to a means of identifying signs and symptoms, is a first in medical science. We know of no other medical category or diagnosis where subjectivity plays such a significant role, other than perhaps severe health phobias. Broadly speaking, two kinds of clinical evidence for MCI exist: first, that originating from studies (some quite small) applying the diagnostic criteria in specialist clinic populations; and, second, that found in large population studies. The main distinction between these two sets of evidence is that one is based on selected clinic populations and the other on unselected community populations. Most studies conclude that people whose memory is impaired for their age, as measured by similar cognitive tests such as the Mini-Mental State Examination, show decline in cognition that often leads to Alzheimer's disease and other kinds of dementia in the future. This finding is not remarkable given that it has long been known that age is a predictor of cognitive impairment. However, the population studies suggest a lower conversion rate than those for specialist clinics (Ritchie, Artero, and Touchon 2001).Petersen (2005) provides a robust defense as to why MCI might be a useful category in research and also indicates the potential benefits of treating MCI... (shrink)

Moments of moral disquiet encounter clock time as well as lived time, and thus professional human practices are existential and take place in time and space. Professional practices as existential involve human bodies and relationships, and are based on trust, responsibility, and vulnerability. The paper explores the relation between lived time and moments of disquiet. We borrow lived experience descriptions from students in professional practices and analyse them phenomenologically. Our informants are students in profession studies of nursing, social work and (...) education interviewed individually in or after external institutional practice during their education. In the interviews they share their experiences of personal responsibility in situations orienting to others in professional practices. As a life existential, time shapes and organises our bodies and activities from birth to grave and is lived and experienced in a variety of ways in daily life and life as such. Time is thus a precondition of human life and life itself. Our interest in this paper is to show and argue phenomenological-pedagogically why and how it is of professional significance to teach students to take the required time to care, and to encourage them to be attentively present in situations when other persons’ lives take place. (shrink)

The chapter aims to introduce an integrated approach to concepts of smart cities and age-friendly cities and communities. Although these ideas are widely promoted by the European Union and the World Health Organisation, they are perceived as separate. Meanwhile, these concepts are closely intermingled in theory and practise concerning the promotion of healthy and active ageing, a universal design, usability and accessibility of age-friendly environments, reducing of the digital divide and robotic divide, and reducing of older adults’ social isolation. The (...) conclusion underlines the need for participatory creation of ambient assisted living technologies and applications with older adults and the need for advocacy to promote AAL in the context of the silver economy especially in the Central and Eastern Europe. (shrink)

This research study aimed to explore the relationship between language functioning, cognitive decline, and functional independence in elderly individuals with disabilities. A cross-sectional research design was employed, and data were collected from a sample of 120 elderly participants. Language functioning was assessed using the Boston Diagnostic Aphasia Examination (BDAE), cognitive decline was measured using the Mini-Mental State Examination (MMSE), and functional independence was evaluated using the Activities of Daily Living (ADL) scale. Correlation analyses were conducted to examine (...) the associations between these variables. The results revealed a significant negative correlation between language functioning and cognitive decline (r = -0.45**, p < 0.01), indicating that language impairments often co-occur with declines in other cognitive domains. A significant positive correlation was observed between language functioning and functional independence (r = 0.60**, p < 0.01), highlighting the importance of effective communication in maintaining autonomy in daily living activities. Additionally, a significant negative correlation between cognitive decline and functional independence (r = -0.55**, p < 0.01) indicated that individuals with greater cognitive decline may experience challenges in performing daily tasks independently. These findings emphasize the need for comprehensive assessments and targeted interventions to support language functioning, cognitive health, and functional independence in elderly individuals with disabilities. (shrink)

The net uptake and loss of any element by a living organism can be described as the quotient of the total amount of the element, present in the organism, and its residence time in the organism. Theoretically it can be derived that the residence time i , equals V i 1–b /k, in which b, the morphometric coefficient, is related to size and shape of the organism (volume V i ); k, the turnover coefficient, is related to its metabolic (...) activity. The net uptake or excretion, i , of an element then follows from = k C i V i b , C i being the (average, whole animal) concentration of the element.Residence times, derived from the quotient of body volume (weight) and daily food intake of various animal species of different sizes, show that, independent of animal or element species, the morphometric coefficient and turnover coefficient have values of b = 0.735 and k = 71.4 dm. year-1 respectively. The turnover coefficient may show some variation, related to the metabolic activity of the organism. The value of the morphometric coefficient implies that residence times may vary with body size: in small animals the residence times of the elements may be in the order of several hours, whereas in the largest organisms residence times may be as long as several years. (shrink)

Despite much research on the relationship between awareness and dementia little can be concluded concerning their relationship and the role of other factors. It is likely that studies capture different phenomena of awareness. This study aimed at identifying and delineating such variation by analysing data from three questionnaires obtained during the longitudinal study of awareness in 101 people with early-stage dementia. The data concerned awareness in relation to memory, activities of daily living and socio-emotional function. Significant differences (...) in patterns of discrepancies were obtained. This suggests that the awareness phenomena involved were structurally different; and that, in turn, this may reflect variation in the intrinsic linking between awareness and its ‘object’ . The identification of such differences is necessary so that appropriate methodologies can be applied to the study of awareness in different contexts. (shrink)

BackgroundPost-stroke depression is one of the most common neuropsychiatric diseases in patients with stroke, and it can increase the disability rate, mortality, and recurrence rate of stroke. Currently, many clinical studies have indicated that traditional Chinese medicine, such as acupuncture and herbs, Western medicine, rehabilitation, repeated transcranial magnetic stimulation, and other treatment methods, are effective in treating PSD. However, no study has formulated a comprehensive treatment plan that integrates TCM, Western medicine, and rehabilitation for PSD. Thus, this trial aims to (...) assess the efficacy and safety of integrative medicine for treating PSD.MethodsThis multicenter, prospective, randomized, controlled study aims to form a set of effective clinical treatment schemes that integrate TCM, Western medicine, and rehabilitation for PSD. A total of 202 participants recruited from four centers will be randomized into either the integrative medicine or standard care group. Standard care—basic treatment, general nursing care, and exercise therapy—will be provided to all participants. The integrative medicine group will also receive acupuncture, Chinese herbs, and repeated transcranial magnetic stimulation. Participants will receive acupuncture and rTMS treatments five times per week for 4 weeks and will be administered Chinese herbs, basic treatment, general nursing care, and exercise therapy for 4 weeks. The primary outcomes include the Hamilton Depression Scale, Self-Rating Depression Scale, and Activity of Daily Living Scale. And the secondary outcomes include the Montreal Cognitive Assessment Scale, the Fugl-Meyer Assessment Scale, and the Pittsburgh Sleep Quality Index. All outcome measures will be evaluated at baseline, week 4, and week 8. Safety assessments will be performed throughout the study.DiscussionThis study is expected to verify the efficacy and safety of integrative medicine for treating PSD, providing an evidence-based clinical reference for the future development of a standardized scheme.Clinical trial registrationClinicalTrials.gov, identifier: NCT05187975. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations (...) with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

A deep investigation of proprioceptive processes is necessary to understand the relationship between sensory afferent inputs and motor outcomes. In this work, we investigate whether and how perception of wrist position is influenced by the direction along which the movement occurs. Most previous studies have tested Joint Position Sense through 1 degree of freedom wrist movements, such as flexion/extension or radial/ulnar deviation. However, the wrist joint has 3-DoF and many activities of daily living produce combined movements, requiring (...) at least 2-DoF wrist coordination. For this reason, in this study, target positions involved movement directions that combined wrist flexion or extension with radial or ulnar deviation. The chosen task was a robot-aided Joint Position Matching, in which blindfolded participants actively reproduced a previously passively assumed target joint configuration. The JPM performance of 20 healthy participants was quantified through measures of accuracy and precision, in terms of both perceived target direction and distance along each direction of movement. Twelve different directions of movement were selected and both hands tested. The left and right hand led to comparable results, both target extents and directions were differently perceived according to the target direction on the FE/RUD space. Moreover, during 2-DoF combined movements, subjects’ perception of directions was impaired when compared to 1-DoF target movements. In summary, our results showed that human perception of wrist position on the FE/RUD space is symmetric between hands but not isotropic among movement directions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Techniques of the Self:Nourishing Life as Art of LivingLi Manhua (bio)Daoism and Environmental Philosophy: Nourishing Life. By Eric S. Nelson. London and New York: Routledge, 2021.This essay proposes an account of the techniques of the self in early Daoism in light of Eric S. Nelson's Daoism and Environmental Philosophy: Nourishing Life (Routledge, 2021). It argues that the techniques of the self involved in nourishing life (yangsheng 養生) are indispensable (...) to the creation of the interdependent human-nature rapport that Nelson considers. Such interdependence does not require a moralistic stance that negates the self or forsakes individual desires in the cause of the environment—as in some of the existing Western ecological discourse—but a new form of self-relation involving the practice of a set of techniques of the self that relates the human to the non-human. The present contribution begins by arguing that the practice of nourishing life entails a series of bodily and spiritual techniques (shu 術) of the self, with the example of Cook Ding. This is followed by my exposition of different categories of such techniques, and why the techniques of nourishing the spirit (shen 神) are prioritized over those of the preservation of the bodily form (xing 形). Finally, I extend my discussion on the specific techniques of nourishing the spirit with regard to his chapter "Emptying Ecology," where Nelson argues that undoing fixations of the self and being responsive (ying 應) to things are attainable through deconstructive, skeptical, and paradoxical communicative strategies (p. 80).To start with, Nelson regards nourishing life as a way of living and speaking that goes beyond the binary opposition or a hierarchical relation between the human and other forms of life in some Western ecological philosophies:In the current crisis conditions, it appears that humans need every motivating ecology available whether it be light or dark green, anthro- or bio-centric, shallow or deep. All of these contending discourses are equalized in a Daoist ecology of shifting perspectives and ways of speaking. A benefit of dao-centric models—that as inflections of the "way" encompass and extend beyond notions of "bios" (specific life) and "zōe" (life in general)—is that they contest the binary oppositions and stratified hierarchies that have dominated recent Western environmental discourses: anthropocentrism/biocentrism, and humanism/posthumanism [End Page 762] (although the latter finds biocentrism still too anthropocentric in positing the very distinction between them).(p. 31, my emphasis)In other words, a non-hierarchical and non-opposing rapport between the human and the non-human lies in a practice of changing perspectives and, more concretely and importantly, adjusting communicative ways. Such a way of perceiving and speaking beyond boundaries between the individual and the general forms of life (sheng 生) is epitomized by the practice of nourishing life of Cook Ding in the third chapter of the Zhuangzi 庄子, titled "The Master of Nourishing Life" (Yangsheng zhu 養生主). When Ding—Lord Wenhui's chef—cuts up an ox, he avoids violent and forced slaughter, slitting through the tender parts of the animal without touching any bone. As such, by concentrating only on the intestines of the ox, his movement is so agile that the knife produces a musical rhythm.More precisely, Nelson regards the example of Ding as "a cultivated and practiced process in which nature can come to be itself" (p. 36). In the context of the Zhuangzi, nature (tian 天) as an extension of the Dao goes beyond the "one-and-many" anthropocentric paradigm wherein humans have exclusive knowledge of the One, namely the unifying principle of reality (Chai 2018, p. 265). In this sense, specific life forms, bios, are undifferentiated from the wholeness of the One in the generic life, zōe. In other words, as the root of all life lies in Dao in terms of the onto-cosmological attunement of nothingness (wuwei 無為), our bodies (shen 身) mirror Heaven or Nature (tian 天) and the Earth (di 地) in the way they attune to the flow of vital energetic dynamics, responding to the myriad things and Heaven and Earth in an organic totality. This is manifest in Ding, as he nourishes life by turning his daily activity into a practice of encountering non-human life forms... (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a (...) “living ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Making Sense of the World: Living, Learning and Teaching with Radical Philosophy of Education proposes that human knowledge arises from an integrated physical and metaphysical experience involving the continuing social acts of personal and community cultures and languages. It seeks to provide a means of thinking about and acting with the philosophical nature of human existence, so that the daily activities and achievements of all are respected and taken into account. Given the dominance of neoliberal politics and (...) economics in many countries, it is unusual to find the work of educators and practitioners being framed generally by an explicit philosophy of knowledge. (shrink)

Dignity is one of the essential values and central concepts in nursing care. Dignity can be threatened due to radical life changes; therefore, this idiographic case study aimed to explore the sense of dignity experienced by a woman with multiple sclerosis. An interpretative phenomenological analysis was adopted, using data collected through a face‐to‐face semistructured interview with Emily, a 45‐year‐old woman. The study was approved by the local ethics committee. Six personal experiential themes were identified: To be ruled by a sick (...) body; Silent progression; Loss of independence as a burden for the family; Will to fight for the meaning of life; Maintaining dignity‐in‐relation; Dignified care in a period of greater vulnerability. Emily's dignity is based on the effort to fight for a meaningful life, utilization of her full potential, maintain independence in activities of daily living and support in relationships. Continuous changes in functional ability, loss of self‐control and an uncertain future have a negative impact on the experience of her dignity. In the context of dignified health care, she considers individual care and maintaining autonomy important. The idiographic case study can contribute to a better understanding of the experience of a woman suffering from multiple sclerosis. It is possible to carry out interventions that aim to support her dignity, improve her quality of life and contribute to individually oriented health care. (shrink)

With the world's population aging, hospitals are facing pressure to adequately meet the needs of a growing number of frail older patients. For this population, comorbidities combined with a limited ability to face stressful situations contribute to frailty whereby a small injury or illness can lead to significant loss of function. It is widely recognized that hospitalized older patients are more vulnerable to physical or cognitive functional decline and require increased assistance in activities of daily living (Creditor (...) 1993; Sager et al. 1996; Mahoney, Sager, and Jalaluddin 1998; Kortebein et al. 2008; English and PaddonJones 2010; Covinsky, Pierluissi, and Johnston 2011; Zisberg et al. 2011;... (shrink)

At the end of life, pain management is commonly a fundamental part of the treatment plan for patients where curative measures are no longer possible. However, the increased recognition of opioid diversion for secondary gain coupled with efforts to treat patients in the home environment towards the end of life creates the potential for ethical dilemmas in the palliative care management of terminal patients in need of continuous pain management. We present the case of an end-stage patient with rectal cancer (...) who required a continuous residential narcotic infusion of fentanyl for pain control due to metastatic disease. His functional status was such that he had poor oral intake and ability to perform other activities of daily living, but was able to live at home with health agency nursing care. The patient presented to this institution with a highly suspect history of having lost his fentanyl infusion in a residential accident and asking for a refill to continue home therapy. The treating physicians had concerns of diversion of the infusion medication by caregivers and were reluctant to continue the therapeutic relationship with the patient. This case exemplifies the tension that can exist between wanting to continue with palliative care management of an end-stage patient and the fear of providers when confronted by evidence of potential diversion of opioid analgesic medications. We elucidate how an ethical framework based on a combination of virtue and narrative/relationship theories with reference to proportionality can guide physicians to a pragmatic resolution of these difficult situations. (shrink)

Mental disorders have been suggested to differ from somatic diseases because they lack an organic correlate. We show that this argument is both empirically wrong and theoretically irrelevant, because diseases are defined by functional impairments and not biological variation. Due to human diversity, a multitude of functions can be defined, and any selection of medically relevant functional impairments is necessarily value-based. We suggest that such values include individual survival and living in a shared world with others, and that their (...) definition requires public debate and a critical reflection by Philosophical Anthropology. However, the presence of functional impairments that are generally relevant for human life and survival only fulfils the so-called disease criterion, which is necessary but not sufficient to diagnose a clinically relevant malady. This would only be justified if such functional impairments cause individual harm, either because they are accompanied by suffering (the illness criterion) or because they interfere with basic activities of daily living such as personal hygiene and food intake (the sickness criterion of a clinically relevant malady). We apply this theory to mental disorders, conclude that only a fraction of such “disorders” currently listed in international classifications of diseases are clinically relevant mental maladies, suggest focusing on the needs of persons with such maladies and recommend avoiding “pathologization” of human diversity. (shrink)

Interactive sonification of biomechanical quantities is gaining relevance as a motor learning aid in movement rehabilitation, as well as a monitoring tool. However, existing gaps in sonification research have prevented its widespread recognition and adoption in such applications. The incorporation of embodied principles and musical structures in sonification design has gradually become popular, particularly in applications related to human movement. In this study, we propose a general sonification model for the sit-to-stand transfer, an important activity of daily living. (...) The model contains a fixed component independent of the use-case, which represents the rising motion of the body as an ascending melody using the physical model of a flute. In addition, a flexible component concurrently sonifies STS features of clinical interest in a particular rehabilitative/monitoring situation. Here, we chose to represent shank angular jerk and movement stoppages, through perceptually salient pitch modulations and bell sounds. We outline the details of our technical implementation of the model. We evaluated the model by means of a listening test experiment with 25 healthy participants, who were asked to identify six normal and simulated impaired STS patterns from sonified versions containing various combinations of the constituent mappings of the model. Overall, we found that the participants were able to classify the patterns accurately, confidently, and in a timely manner. The amount of sonified kinematic information significantly impacted classification accuracy. The six STS patterns were also classified with significantly different accuracy depending on their kinematic characteristics. Learning effects were seen in the form of increased accuracy and confidence with repeated exposure to the sound sequences. We found no significant accuracy differences based on the participants' level of music training. Overall, we see our model as a concrete conceptual and technical starting point for STS sonification design catering to rehabilitative and clinical monitoring applications. (shrink)

This booklet on Active Assisted Living (AAL) technologies has been created as part of the GoodBrother COST Action, which has run from 2020 to 2024. COST Actions are European research programs that promote collaboration across borders, uniting researchers, professionals, and institutions to address key societal challenges. GoodBrother focused on ethical and privacy concerns surrounding video and audio monitoring in care settings. The aim was to ensure that while AAL technologies help older adults and vulnerable individuals, their privacy and data (...) protection rights remain a top priority. This booklet is designed to guide you through the role that AAL technologies play in improving the quality of life for older adults, caregivers, and people with disabilities. AAL technologies offer tools for those facing cognitive or physical challenges. They can enhance independence, assist with daily routines, and promote a safer living environment. However, the rise of these technologies also brings important questions about data protection and user autonomy. (shrink)

Research on dyscalculia in neurodegenerative diseases is still scarce, despite high impact on patients’ independence and activities of daily living function. Most studies address Alzheimer’s Disease; however, patients with Parkinson’s Disease also have a higher risk for cognitive impairment while the relation to arithmetic deficits in financial contexts has rarely been studied. Therefore, the current exploratory study investigates deficits in two simple arithmetic tasks in financial contexts administered within the Clinical Dementia Rating in a sample of 100 (...) PD patients. Patients were classified as cognitively normal or mildly impaired according to Level I consensus criteria, and assessed using a comprehensive neuropsychological test battery, neurological motor examination, and sociodemographic and clinical questionnaires. In total, 18% showed arithmetic deficits: they were predominately female, had longer disease duration, more impaired global cognition, but minor signs of depression compared to PD patients without arithmetic deficits. When correcting for clinical and sociodemographic confounders, greater impairments in attention and visuo-spatial/constructional domains predicted occurrence of arithmetic deficits. The type of deficit did not seem to be arbitrary but seemed to involve impaired place × value processing frequently. Our results argue for the importance of further systematic investigations of arithmetic deficits in PD with sensitive tests to confirm the results of our exploratory study that a specific subgroup of PD patients present themselves with dyscalculia. (shrink)