Dataset Information

Progressive Support for Activities of Daily Living for Persons Living With Dementia.

ABSTRACT: Background and Objectives:Dementia is accompanied by increasing need for support in activities of daily living (ADLs). This brief report/literature review summarizes the practices to care for early stage, middle stage, and late stage ADL needs (dressing, toileting, and eating/nutrition), and examines commonalities across ADL needs and the extent to which practices are reflected in guidelines and/or evidence. Research Design and Methods:A review of the grey and peer-reviewed literature, using some but not all procedures of a systematic review. Key terms were identified for ADLs overall and for each of the 3 ADLs, and a search was conducted using these words in combination with (a) dementia, Alzheimer's disease, and similar terms, and (b) practices, interventions, guidelines, recommendations, and similar terms. Searches were conducted using databases of peer-reviewed literature as well as the Grey Literature Reports and Google search engine. Sources were included if they provided evidence or recommendations on interventions to address ADL functioning for dressing, toileting, and feeding for persons living with dementia. Results:As cognitive and functional impairment increases, the number of care practices and themes that embody care practices increases. The majority of practices are evidence-based, and most evidence is incorporated into guidelines. Discussion and Implications:Virtually all practices reflect person-centered care principles. Five recommendations summarize the evidence and recommendations related to providing support to persons living with dementia in relation to dressing, toileting, and eating/nutrition.

SUBMITTER: Prizer LP

PROVIDER: S-EPMC5881654 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Progressive Support for Activities of Daily Living for Persons Living With Dementia.

Prizer Lindsay P LP Zimmerman Sheryl S

The Gerontologist 20180101 suppl_1

<h4>Background and objectives</h4>Dementia is accompanied by increasing need for support in activities of daily living (ADLs). This brief report/literature review summarizes the practices to care for early stage, middle stage, and late stage ADL needs (dressing, toileting, and eating/nutrition), and examines commonalities across ADL needs and the extent to which practices are reflected in guidelines and/or evidence.<h4>Research design and methods</h4>A review of the grey and peer-reviewed litera ...[more]

PMID: 29361063

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Project description:Objectives:To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis. Design:A multi-country cross-sectional study. Setting and Participants:Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included. Methods:Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated. Results:Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples. Conclusions and Implications:The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.

Project description:BackgroundThe everyday practical capabilities of dementia patients have a direct influence on a patient's independence and thus on the person's quality of life and on the amount of care needed. These capabilities are therefore important as therapeutic goals and are also important from a health-economic point of view. To date, no economical and valid performance test is available. The E-ADL-Test developed by Grä?el et al. in 2009 is a short performance test that has, however, only been validated on a small sample thus far. The objective of the present study is to re-validate the E-ADL-Test and explore possibilities for further development.MethodsThe data were obtained from an RCT with a sample of 139 dementia patients in 5 nursing homes in Bavaria (Germany). The internal consistency was calculated as a measure of reliability. An item analysis was performed for the sample and subgroups with various degrees of dementia. Criterion and construct validity were tested based on five hypotheses. For validation, the residents' capabilities were examined using the Barthel-Index (BI), the Nurses' Observation Scale for Geriatric Patients (NOSGER), the Alzheimer's Disease Assessment Scale (ADAS), and the Mini-Mental Status Examination (MMSE).ResultsThe internal consistency was .68 for the sample and .73 for the subgroup with severe dementia. The item analysis yielded good difficulty indices and discrimination power for moderate and severe dementia. The tasks were found to be too easy for mild dementia. The predictive criterion-related validity was confirmed by a correlation of r = .54 with the care level after 22 months and significant mean differences in the E-ADL-Test between persons with and without an increase in the care level. A differentiated correlation profile supported the three hypotheses on construct validity.ConclusionsThe E-ADL-Test in its current form is a valid and reliable instrument for assessing the ADL capabilities of patients with moderate and severe dementia. More difficult items should be developed for use with mild dementia.Trial registrationhttp://www.isrctn.com Identifier: ISRCTN87391496.

Project description:Background and purposeScreening tests for dementia such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment are widely used, but there are drawbacks to their efficient use. There remains a need for a brief and easy method of assessing the activities of daily living (ADL) that can be administered to elderly individuals by healthcare workers. We have therefore developed a new scale named the Simple Observation Checklist for Activities of Daily Living (SOC-ADL).MethodsWe developed the SOC-ADL scale as a team of experts engaged in caring for individuals with dementia. This scale comprises eight items and was designed based on the Korean instrumental activities of daily living (K-IADL) scale and the Barthel activities of daily living scale (Barthel Index). The new scale was validated by enrolling 176 patients with cognitive dysfunction across 6 centers. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed. We assessed its concurrent validity by performing comparisons with the Korean-MMSE, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, K-IADL, and Barthel Index, and its criterion validity by performing comparisons between mild cognitive impairment (MCI) and dementia. We also used Cronbach's alpha to assess the interitem reliability. The appropriate cutoff values were determined by analyzing receiver operating characteristic curves, including the areas underneath them.ResultsEFA extracted one factor and CFA revealed that all of the model fits exceeded the minimum acceptable criteria. The SOC-ADL scores were strongly correlated with those of the other tools for dementia and could be used to differentiate MCI from dementia. Cronbach's alpha values indicated that the results were reliable. The optimal cutoff value of the SOC-ADL for discriminating dementia from MCI was 3 points, which provided a sensitivity and specificity of 74.5% and 75.7%, respectively.ConclusionsOur results demonstrate that the SOC-ADL is a valid and reliable tool for differentiating dementia from MCI based on an assessment of ADL. This new tool can be used for screening ADL in elderly subjects who have difficulty communicating, and to increase the efficiency of dementia screening at the population level.

Dataset Information

Progressive Support for Activities of Daily Living for Persons Living With Dementia.

Publications

Progressive Support for Activities of Daily Living for Persons Living With Dementia.

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