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BMC Geriatrics
Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Care | Research article

Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up

Authors: Reidun Haarr Johansen, Karoline Olsen, Sverre Bergh, Jūratė Šaltytė Benth, Geir Selbæk, Anne-Sofie Helvik

Published in: BMC Geriatrics | Issue 1/2020

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Abstract

Background

Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function.

Methods

A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated.

Results

There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function.

Conclusion

The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.
Literature
1.
2.
Linnet K, Gudmundsson LS, Birgisdottir FG, Sigurdsson EL, Johannsson M, Tomasdottir MO, et al. Multimorbidity and use of hypnotic and anxiolytic drugs: cross-sectional and follow-up study in primary healthcare in Iceland. BMC Fam Pract. 2016;17(1):69.PubMedPubMedCentralCrossRef
3.
Tomasdottir MO, Getz L, Sigurdsson JA, Petursson H, Kirkengen AL, Krokstad S, et al. Co-and multimorbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT study and theoretical reflections concerning basic medical models. Eur J Pers Cent Healthc. 2014;2(3):335–45.
4.
Mossialos E, Wenzl M, Osborn R, Sarnak D. 2015 international profiles of health care systems: Canadian Agency for Drugs and Technologies in health; 2016.CrossRef
5.
Ågotnes G, McGregor MJ, Lexchin J, Doupe MB, Müller B, Harrington C. An international mapping of medical care in nursing homes. Health Services Insights. 2019;12:1178632918825083.PubMedPubMedCentralCrossRef
6.
7.
Wergeland JN, Selbæk G, Bergh S, Soederhamn U, Kirkevold ØJD. Predictors for nursing home admission and death among community-dwelling people 70 years and older who receive domiciliary care. Dement Geriatr Cogn Dis Extra. 2015;5(3):320–9.PubMedPubMedCentralCrossRef
8.
Gnjidic D, Stanaway FF, Cumming R, Waite L, Blyth F, Naganathan V, et al. Mild cognitive impairment predicts institutionalization among older men: a population-based cohort study (Mild Cognitive Impairment and Institutionalization). PLoS One. 2012;7(9):e46061.
9.
Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch Gerontol Geriatr. 2013;57(1):16–26.PubMedCrossRef
10.
Luppa M, Luck T, Weyerer S, König H-H, Brähler E, Riedel-Heller SG. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2009;39(1):31–8.PubMedCrossRef
11.
Bergh S, Holmen J, Saltvedt I, Tambs K, Selbæk G. Demens og nevropsykiatriske symptomer hos sykehjemspasienter i Nord- Trøndelag. Tidsskr Nor Laegeforen. 2012;132(17):1956–59.
12.
Helvik A-S, Engedal K, Benth JŠ, Selbæk G. Prevalence and severity of dementia in nursing home residents. Dement Geriatr Cogn Dis. 2015;40(3–4):166–77.CrossRef
13.
Selbaek G, Kirkevold O, Engedal K. The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007;22(9):843–9.PubMedCrossRef
14.
Swedish Council on Health Technology A. SBU Systematic Reviews. Dementia -- Caring, Ethics, Ethnical and Economical Aspects: A Systematic Review. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2008.
15.
Goodman RA, Lochner KA, Thambisetty M, Wingo TS, Posner SF, Ling SM. Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011-2013. Alzheimers Dement. 2017;13(1):28–37.PubMedCrossRef
16.
WHO. The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Genéve: World Health Organization; 1993.
17.
Skoldunger A, Wimo A, Sjogren K, Bjork S, Backman A, Sandman PO, et al. Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes: results from the U-age program (SWENIS study). Int J Geriatr Psychiatry. 2018;34(1):130–6.
18.
Sourial R, McCusker J, Cole M, Abrahamowicz M. Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. Int Psychogeriatr. 2001;13(2):183–97.PubMedCrossRef
19.
Broady TR, Saich F, Hinton T. Caring for a family member or friend with dementia at the end of life: a scoping review and implications for palliative care practice. Palliat Med. 2018;32(3):643–56.PubMedCrossRef
20.
Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240–9.PubMedCrossRef
21.
Bjork S, Juthberg C, Lindkvist M, Wimo A, Sandman PO, Winblad B, et al. Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study. BMC Geriatr. 2016;16:154.PubMedPubMedCentralCrossRef
22.
Selbaek G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc. 2013;14(3):161–9.PubMedCrossRef
23.
Zuidema SU, Derksen E, Verhey FR, Koopmans RT. Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry. 2007;22(7):632–8.PubMedCrossRef
24.
Selbaek G, Engedal K, Benth JŠ, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. 2014;26(1):81–91.PubMedCrossRef
25.
Helvik A-S, Selbæk G, Benth JŠ, Røen I, Bergh S. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS One. 2018;13(10):e0206147.PubMedPubMedCentralCrossRef
26.
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.PubMedPubMedCentralCrossRef
27.
Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H. Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi study. Gerontologist. 2005;45(2):222–30.PubMedCrossRef
28.
Helvik AS, Engedal K, Benth JS, Selbaek G. A 52 month follow-up of functional decline in nursing home residents - degree of dementia contributes. BMC Geriatr. 2014;14:45.PubMedPubMedCentralCrossRef
29.
Maki Y, Sakurai T, Okochi J, Yamaguchi H, Toba K. Rehabilitation to live better with dementia. Geriatr Gerontol Int. 2018;18(11):1529–36.
30.
Desai AK, Grossberg GT, Sheth DN. Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment. CNS Drugs. 2004;18(13):853–75.PubMedCrossRef
31.
Helvik A-S, Hagseth LD, Bergh S, Saltyte-Benth J, Kirkevold O, Selbaek G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. (Clinical report). BMC Geriatr. 2015;15(1):47.
32.
Slachevsky A, Forno G, Barraza P, Mioshi E, Delgado C, Lillo P, et al. Mapping the neuroanatomy of functional decline in Alzheimer’s disease from basic to advanced activities of daily living. J Neurol. 2019;266(6):1310–22.PubMedCrossRef
33.
Mioshi E, Hodges JR, Hornberger M. Neural correlates of activities of daily living in frontotemporal dementia. J Geriatr Psychiatry Neurol. 2013;26(1):51–7.PubMedCrossRef
34.
Potkin SG. The ABC of Alzheimer's disease: ADL and improving day-to-day functioning of patients. Int Psychogeriatr. 2002;14(Suppl 1):7–26.PubMedCrossRef
35.
Williams BC, Fries BE, Foley WJ, Schneider D, Gavazzi M. Activities of daily living and costs in nursing homes. Health Care Financ Rev. 1994;15(4):117–35.PubMedPubMedCentral
36.
McConnell ES, Branch LG, Sloane RJ, Pieper CF. Natural history of change in physical function among long-stay nursing home residents. Nurs Res. 2003;52(2):119–26.PubMedCrossRef
37.
McConnell ES, Pieper CF, Sloane RJ, Branch LG. Effects of cognitive performance on change in physical function in long-stay nursing home residents. J Gerontol A Biol Sci Med Sci. 2002;57(12):M778–84.PubMedCrossRef
38.
Banaszak-Holl J, Liang J, Quinones A, Cigolle C, Lee I-C, Verbrugge LM. Trajectories of functional change among long stayers in nursing homes: does baseline impairment matter? J Aging Health. 2011;23(5):862–82.PubMedPubMedCentralCrossRef
39.
Millán-Calenti JC, Tubío J, Pita-Fernández S, Rochette S, Lorenzo T, Maseda A. Cognitive impairment as predictor of functional dependence in an elderly sample. Arch Gerontol Geriatr. 2012;54(1):197–201.PubMedCrossRef
40.
Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48(4):445–69.PubMedCrossRef
41.
Mlinac ME, Feng MC. Assessment of activities of daily living, self-care, and Independence. Arch Clin Neuropsychol. 2016;31(6):506–16.PubMedCrossRef
42.
Ćwirlej-Sozańska AB, Sozański B, Wiśniowska-Szurlej A, Wilmowska-Pietruszyńska A. An assessment of factors related to disability in ADL and IADL in elderly inhabitants of rural areas of South-Eastern Poland. Ann Agric Environ Med. 2018;25(3):504–11.PubMedCrossRef
43.
Røen IM, Selbæk G, Kirkevold Ø, Engedal K, Testad I, Bergh S. Resource use and disease course in dementia-nursing home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes. BMC Health Serv Res. 2017;17(1):365.PubMedPubMedCentralCrossRef
44.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.PubMedCrossRef
45.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566–72.PubMedCrossRef
46.
Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–4.PubMedCrossRef
47.
O’Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, et al. Staging dementia using clinical dementia rating scale sum of boxes scores: a Texas Alzheimer's research consortium study. Arch Neurol. 2008;65(8):1091–5.PubMedPubMedCentralCrossRef
48.
Mjorud M, Kirkevold M, Rosvik J, Selbaek G, Engedal K. Variables associated to quality of life among nursing home patients with dementia. Aging Ment Health. 2014;18(8):1013–21.
49.
Cummings JL. The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology. 1997;48(5 Suppl 6):S10–6.PubMedCrossRef
50.
Selbaek G, Kirkevold O, Sommer OH, Engedal K. The reliability and validity of the Norwegian version of the neuropsychiatric inventory, nursing home version (NPI-NH). Int Psychogeriatr. 2008;20(2):375–82.PubMedCrossRef
51.
Selbæk G, Engedal K. Stability of the factor structure of the neuropsychiatric inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. Int Psychogeriatr. 2012;24(1):62–73.PubMedCrossRef
52.
Colombo M, Vitali S, Cairati M, Vaccaro R, Andreoni G, Guaita A. Behavioral and psychotic symptoms of dementia (BPSD) improvements in a special care unit: a factor analysis. Arch Gerontol Geriatr. 2007;44(1):113–20.PubMedCrossRef
53.
Lyketsos CG, Galik E, Steele C, Steinberg M, Rosenblatt A, Warren A, et al. The general medical health rating: a bedside global rating of medical comorbidity in patients with dementia. J Am Geriatr Soc. 1999;47(4):487–91.PubMedCrossRef
54.
Leoutsakos JM, Han D, Mielke MM, Forrester SN, Tschanz JT, Corcoran CD, et al. Effects of general medical health on Alzheimer's progression: the Cache County dementia progression study. Int Psychogeriatr. 2012;24(10):1561–70.PubMedPubMedCentralCrossRef
55.
Lyketsos CG, Toone L, Tschanz J, Rabins PV, Steinberg M, Onyike CU, et al. Population-based study of medical comorbidity in early dementia and "cognitive impairment, no dementia (CIND)": association with functional and cognitive impairment: the Cache County study. Am J Geriatr Psychiatry. 2005;13(8):656–64.PubMed
56.
Sylliaas H, Selbaek G, Bergland A. Do behavioral disturbances predict falls among nursing home residents? Aging Clin Exp Res. 2012;24(3):251–6.PubMedCrossRef
57.
58.
59.
Hishikawa N, Fukui Y, Sato K, Kono S, Yamashita T, Ohta Y, et al. Characteristic features of cognitive, affective and daily living functions of late-elderly dementia. Geriatr Gerontol Int. 2016;16(4):458–65.PubMedCrossRef
60.
Kaup BA, Loreck D, Gruber-Baldini AL, German P, Menon AS, Zimmerman S, et al. Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry. 2007;15(5):438–42.PubMedCrossRef
61.
Burge E, von Gunten A, Berchtold A. Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: a survival analysis. Arch Gerontol Geriatr. 2013;56(1):250–7.PubMedCrossRef
62.
Haibo X, Shifu X, Pin NT, Chao C, Guorong M, Xuejue L, et al. Prevalence and severity of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Chinese: findings from the Shanghai three districts study. Aging Ment Health. 2013;17(6):748–52.PubMedCrossRef
63.
Peng GP, Feng Z, He FP, Chen ZQ, Liu XY, Liu P, et al. Correlation of hippocampal volume and cognitive performances in patients with either mild cognitive impairment or Alzheimer's disease. CNS Neurosci Ther. 2015;21(1):15–22.PubMedCrossRef
64.
Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer's disease: What might be associated brain circuits? Mol Aspects Med. 2015;43–44:25–37.PubMedCrossRef
65.
Gauthier S, Lopez OL, Waldemar G, Jones RW, Cummings J, Zhang R, et al. Effects of donepezil on activities of daily living: integrated analysis of patient data from studies in mild, moderate and severe Alzheimer's disease. Int Psychogeriatr. 2010;22(6):973–83.PubMedCrossRef
66.
Kishi T, Matsunaga S, Oya K, Ikuta T, Iwata N. Protection against Brain Atrophy by Anti-dementia Medication in Mild Cognitive Impairment and Alzheimer's Disease: Meta-Analysis of Longitudinal Randomized Placebo-Controlled Trials. Int J Neuropsychopharmacol. 2015;18(12):1–7.
67.
Miller LS, Brown CL, Mitchell MB, Williamson GM. Activities of daily living are associated with older adult cognitive status: caregiver versus self-reports. J Appl Gerontol. 2013;32(1):3–30.PubMedCrossRef
68.
Snowdon DA, Ostwald SK, Kane RL. Education, survival, and independence in elderly Catholic sisters, 1936-1988. Am J Epidemiol. 1989;130(5):999–1012.PubMedCrossRef
69.
Burman J, Sembiah S, Dasgupta A, Paul B, Pawar N, Roy A. Assessment of poor functional status and its predictors among the elderly in a rural area of West Bengal. J Midlife Health. 2019;10(3):123–30.PubMedPubMedCentral
70.
Xu R, Zhou X, Cao S, Huang B, Wu C, Zhou X, et al. Health Status of the Elderly and Its Influence on Their Activities of Daily Living in Shangrao, Jiangxi Province. Int J Environ Res Public Health. 2019;16(10):1771.
Metadata
Title
Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up
Authors
Reidun Haarr Johansen
Karoline Olsen
Sverre Bergh
Jūratė Šaltytė Benth
Geir Selbæk
Anne-Sofie Helvik
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01877-1

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