Top

Environmental Health and Preventive Medicine

Published in:

01-01-2013 | Regular Article

Decreased activity of daily living produced by the combination of Alzheimer’s disease and lower limb fracture in elderly requiring nursing care

Authors: Toshimitsu Inagawa, Toshio Hamagishi, Yuji Takaso, Yoshiaki Hitomi, Yasuhiro Kambayashi, Yuri Hibino, Aki Shibata, Nguyen T. M. Ngoc, Jiro Okochi, Kotaro Hatta, Kiyoshi Takamuku, Tadashi Konoshita, Hiroyuki Nakamura

Published in: Environmental Health and Preventive Medicine | Issue 1/2013

Abstract

Objectives

Alzheimer’s disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture.

Methods

We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants.

Results

We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery.

Conclusions

These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.

Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol. 2011;7(3):137–52.PubMedCrossRef

Riccio D, Solinas A, Astara G, Mantovani G. Comprehensive geriatric assessment in female elderly patients with Alzheimer disease and other types of dementia. Arch Gerontol Geriatr. 2007;44(Suppl 1):343–53.PubMedCrossRef

Malone DC, McLaughlin TP, Wahl PM, Leibman C, Arrighi HM, Cziraky MJ, et al. Burden of Alzheimer’s disease and association with negative health outcomes. Am J Manag Care. 2009;15(8):481–8.PubMed

Mazoteras Munoz V, Abellan van Kan G, Cantet C, Cortes F, Ousset PJ, Rolland Y, et al. Gait and balance impairments in Alzheimer disease patients. Alzheimer Dis Assoc Disord. 2010;24(1):79–84.PubMedCrossRef

Tysiewicz-Dudek M, Pietraszkiewicz F, Drozdzowska B. Alzheimer’s disease and osteoporosis: common risk factors or one condition predisposing to the other? Ortop Traumatol Rehabil. 2008;10(4):315–23.PubMed

Zhou R, Deng J, Zhang M, Zhou HD, Wang YJ. Association between bone mineral density and the risk of Alzheimer’s disease. J Alzheimers Dis. 2011;24(1):101–8.PubMed

Pretto M, Spirig R, Kaelin R, Muri-John V, Kressig RW, Suhm N. Outcomes of elderly hip fracture patients in the Swiss healthcare system: a survey prior to the implementation of DRGs and prior to the implementation of a geriatric fracture Centre. Swiss Med Wkly. 2010;140:w13086.PubMed

Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc. 2008;56(6):1075–9.PubMedCrossRef

Ekström W, Miedel R, Ponzer S, Hedström M, Samnegård E, Tidermark J. Quality of life after a stable trochanteric fracture—a prospective cohort study on 148 patients. J Orthop Trauma. 2009;23(1):39–44.PubMedCrossRef

10.

Nielsen KA, Jensen NC, Jensen CM, Thomsen M, Pedersen L, Johnsen SP, et al. Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study. BMC Health Serv Res. 2009;9:186.PubMedCrossRef

11.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRef

12.

American PA. Diagnostic and statistical manual of mental disorders. Revised 3rd ed. Washington; 1987.

13.

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939–44.PubMedCrossRef

14.

Hughes LF, Perkins K, Wright BD, Westrick H. Using a Rasch scale to characterize the clinical features of patients with a clinical diagnosis of uncertain, probable, or possible Alzheimer disease at intake. J Alzheimers Dis. 2003;5(5):367–73.PubMed

15.

Okochi J, Utsunomiya S, Takahashi T. Health measurement using the ICF: test–retest reliability study of ICF codes and qualifiers in geriatric care. Health Qual Life Outcomes. 2005;3:46.PubMedCrossRef

16.

Correia Sde M, Morillo LS, Jacob Filho W, Mansur LL. Swallowing in moderate and severe phases of Alzheimer’s disease. Arq Neuropsiquiatr. 2010;68(6):855–61.PubMedCrossRef

17.

Suh MK, Kim H, Na DL. Dysphagia in patients with dementia: Alzheimer versus vascular. Alzheimer Dis Assoc Disord. 2009;23(2):178–84.PubMedCrossRef

18.

Carpenter GI, Hastie CL, Morris JN, Fries BE, Ankri J. Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatr. 2006;6(7):1–8.

19.

Zanetti O, Frisoni GB, Rozzini L, Bianchetti A, Trabucchi M. Validity of direct assessment of functional status as a tool for measuring Alzheimer’s disease severity. Age Ageing. 1998;27(5):615–22.PubMedCrossRef

20.

Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007;55(3):407–13.PubMedCrossRef

21.

Alarcón T, González-Montalvo JI, Gotor P, Madero R, Otero A. Activities of daily living after hip fracture: profile and rate of recovery during 2 years of follow-up. Osteoporos Int. 2010;22(5):1609–13.PubMedCrossRef

22.

Mariani E, Monastero R, Mecocci P. Mild cognitive impairment: a systematic review. J Alzheimers Dis. 2007;12(1):23–35.PubMed

23.

Olofsson B, Lundström M, Borssén B, Nyberg L, Gustafson Y. Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand J Caring Sci. 2005;19(2):119–27.PubMedCrossRef

24.

Moncada LV, Andersen RE, Franckowiak SC, Christmas C. The impact of cognitive impairment on short-term outcomes of hip fracture patients. Arch Gerontol Geriatr. 2006;43(1):45–52.PubMedCrossRef

25.

Furlaneto ME, Garcez-Leme LE. Impact of delirium on mortality and cognitive and functional performance among elderly people with femoral fractures. Clinics. 2007;62(5):545–52.PubMedCrossRef

26.

Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119–22.PubMedCrossRef

27.

Samuelsson B, Hedström MI, Ponzer S, Söderqvist A, Samnegård E, Thorngren KG, et al. Gender differences and cognitive aspects on functional outcome after hip fracture—a 2 years’ follow-up of 2,134 patients. Age Ageing. 2009;38(6):686–92.PubMedCrossRef

Title: Decreased activity of daily living produced by the combination of Alzheimer’s disease and lower limb fracture in elderly requiring nursing care
Authors: Toshimitsu Inagawa
Toshio Hamagishi
Yuji Takaso
Yoshiaki Hitomi
Yasuhiro Kambayashi
Yuri Hibino
Aki Shibata
Nguyen T. M. Ngoc
Jiro Okochi
Kotaro Hatta
Kiyoshi Takamuku
Tadashi Konoshita
Hiroyuki Nakamura
Publication date: 01-01-2013
Publisher: Springer Japan
Published in: Environmental Health and Preventive Medicine / Issue 1/2013
Print ISSN: 1342-078X
Electronic ISSN: 1347-4715
DOI: https://doi.org/10.1007/s12199-012-0283-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Decreased activity of daily living produced by the combination of Alzheimer’s disease and lower limb fracture in elderly requiring nursing care

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Folate-deficiency induced cell-specific changes in the distribution of lymphocytes and granulocytes in rats

Association of urinary 8-OHdG with lifestyle and body composition in elderly natural disaster victims living in emergency temporary housing

Social development conditions and related factors for children in Japanese kindergarten in Shanghai, China

The effects of socio-economic status and physical health on the long-term care needs of Japanese urban elderly: a chronological study

An overview of the China National Tobacco Corporation and State Tobacco Monopoly Administration

An overview of health forecasting