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KEY WORDS OBJECTIVE. To determine whether changes in hearing, cognition, depression, and vision affect daily life
cognition disorders participation and whether screening tests that identify problems could be used in the home.
depression METHOD. Interviewers assessed presence of medical conditions, social class, distance acuity, cognition,
hearing, depression, and participation using valid screening tools. Participation scores were subgrouped
hearing disorders
according to negative or positive results. Multiple regression analysis determined association of screening
home care services
tests with participation.
human activities
RESULTS. Eighty-eight older adults, ages 62–90, participated. Positive screening tests were found in
mass screening 43% of participants for distance acuity, 9% for cognitive problems, 8% for depression, and 15% for
vision disorders hearing loss. Relationships were found among age, cognition, depression, and vision and participation.
CONCLUSION. Mild levels of decreased vision, depression, and decreased cognition are associated with
lower participation. These conditions can be screened by occupational therapists and managed to help older
adults remain active and maintain their health.
Perlmutter, M. S., Bhorade, A., Gordon, M., Hollingsworth, H. H., & Baum, M. C. (2010). Cognitive, visual, auditory, and
emotional factors that affect participation in older adults. American Journal of Occupational Therapy, 64, 570–579.
doi: 10.5014/ajot.2010.09089
evaluator. Demographic information was collected, and participation, we also computed an effect size for vision,
the assessments were administered. Trained occupational cognition, depression, hearing, and age differences. A
therapy graduate students collected data for this pilot multiple regression analysis was performed to assess the
study over a period of 3 years as part of their master’s contribution of vision, cognition, depression, hearing,
degree projects. To understand the impact of these mild gender, and age to the variability of participation.
impairments, 8 study participants of the original 96 were
excluded from the analysis dataset because they had sig-
Results
nificant vision loss; more than two positive screening
values on cognitive, depressive, or auditory tests; or both. The participants ranged in age from 62 to 90 yr; the mean
age was 74.3 (Table 2). The participants were primarily
female (64%); self-identified White (96%); and married
Data Analysis (58%) and represented a uniform distribution of social
We calculated descriptive statistics including means, status.
standard deviations, and range of scores for each de- Table 3 reports the means, standard deviations, and
mographic and outcome variable. Correlation coefficients ranges for the ETDRS distance acuity chart, Short
were used to calculate relationships between variables. Blessed Test, Geriatric Depression Scale, Hearing Screen-
Student’s paired t tests were conducted to compare ac- ing Test, and age. In addition, mean activity participation
tivity participation for negative and positive findings for scores, as measured by the ACS, are stratified by classifi-
vision, cognition, depression, hearing, and age. To mea- cation on the screening tests as negative or positive. A
sure the magnitude of the standardized differences of participant could screen positive on more than one test, so
Table 3. Comparison of Mean Activity Participation Scores Stratified by Screening Status and Age
Activity Card Sort
Measure n (%) M (SD) Range
Early Treatment of Diabetic Retinopathy Study (binocular distance acuity) 52.0 (8.4) 28–66
Negative (better than 20/40) 53 (60) 48.8 (10.7)
Positive (220/40 or worse) 35 (40) 38.4 (10.8)
t(86) 5 24.44, p < .0001, r 5 .43
Short Blessed Test 2.7 (7.2) 0–16
Negative (<8) 80 (91) 45.3 (11.6)
Positive (³8) 8 (9) 38.7 (13.4)
t(86) 5 1.49, p 5 .14, r 5 .16
Geriatric Depression Scale 1.5 (0.6) 0–12
Negative (<5) 81 (92) 45.3 (11.9)
Positive (>5) 7 (8) 37.4 (9.1)
t(86) 5 1.70, p 5 .09, r 5 .18
Hearing Screening Test 4.8 (3.3) 0–5
Negative (5) 75 (85) 44.5 (12.5)
Positive (£4) 13 (15) 44.5 (7.5)
t(86) 5 2.26, p 5 .80, r 5 .03
Age 74.3 (7.2) 62–90
Younger (<75 years) 48 (55) 48.8 (11.4)
Older (³75 years) 40 (45) 39.7 (10.6)
t(86) 5 3.33, p 5 .001, r 5 .34
Note. N 5 88. M 5 mean; SD 5 standard deviation; r 5 effect size correlation.
Of the participants, 8% (n 5 7) had a positive The measures used in the data analysis were selected
screening value of ³5 on the Geriatric Depression Scale, from a much larger 2.5-hr battery of assessments used in
and 5% (n 5 4) reported mental health problems. a research project. The measures reported in this article
Among the 7 participants with a positive screening value required approximately 25 min to complete. Participants
for depression, the mean ACS score was 37.4 (SD 5 9.1) were receptive to the entire assessment process. All measures
compared with 45.3 (SD 5 11.9) for those with a nega- are available free of cost in the public domain and can easily
tive screening value (p 5 .09). The small effect size be used in the home setting or included in a routine initial
correlation was computed as .18. Older participants en- assessment to determine factors that influence design of
gaged in fewer activities (mean 5 39.7, SD 5 10.6) than rehabilitation programs.
younger participants (mean 5 48.8, SD 5 11.4, p <
.001). The moderate effect size correlation for this dif-
ference was .34 (Table 3). Discussion
Table 4 reports Pearson correlation coefficients be-
The PEOP Measurement Model (Baum & Christiansen,
tween gender, age, Hearing Screening Test, Short Blessed
2005) proved to be a valuable structure for guiding the
Test scores, Geriatric Depression Scale–Short Form rat-
assessment of sensory, affective, and cognitive problems
ing, ETDRS binocular distance visual acuity scores ob-
older adults face in their everyday lives and guided us to
tained under ambient light, and ACS participation scores.
address the physical and social environments as well.
The highest intercorrelations with the ACS were found
Pearson (2000) supported this notion, stating that a con-
for binocular distance visual acuity (r 5 .51), age (r 5
ceptual framework “provides the frame of reference for
2.45), Short Blessed Test scores (r 5 2.31), and Geriatric
understanding the variables studied, for selecting the in-
Depression Scale scores (r 5 2.39).
struments used to collect information and for interpreting
Table 5 reports a multiple regression analysis of the
results” (p. 22). By using the PEOP model, we were able
relationship of screening assessment scores (vision, de-
to create an approach to assessment that allowed us to
pression, hearing, and cognition) and demographic fac-
detect changes in daily activities in a community-residing
tors (age, gender) to activity participation. Factors that
sample of older adults and determined that vision, cognition,
significantly contributed to participation included age,
and depression had a significant impact on participation.
depression, cognition, and vision. Hearing and gender
The findings of this pilot study suggest that partici-
were not associated with ACS participation scores.
pation changes as people age. As would be expected,
younger participants were more active (engaging in 48.8 of
Table 5. Summary of Multiple Regression Analysis for Variables 80 activities) than older participants (engaging in 39.7 of
Predicting Active Participation (N 5 88) 80 activities). However, the problems of decreased vision,
Step and Variable B Standard Error b decreased cognition, and depression are limiting factors
1. Gender 23.76 1.20 2.15 beyond age and must be considered to foster health and
2. Age 20.35 0.15 2.21* participation in older adults. The importance of a com-
3. Hearing 20.55 1.52 2.03 prehensive screening procedure to identify factors that
4. Cognition 20.89 0.30 2.25* may limit participation is supported by the results. People
5. Depression 21.87 0.47 2.32*
at risk for restricted participation need to be identified
6. Distant vision 0.47 0.13 .34*
because many of these age-related conditions may be
Note. R 5 .48, F(6, 81) 5 12.54, p < .0001. B 5 unstandardized coefficients;
2