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Solitary living in Alzheimer's disease over 3 years: association between cognitive and functional impairment and community-based services.

Wattmo, Carina LU ; Londos, Elisabet LU and Minthon, Lennart LU (2014) In Clinical Interventions in Aging 9. p.1951-1962
Abstract
Introduction: Many individuals with Alzheimer’s disease (AD) live alone, and this figure is expected to increase. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, and the potential predictors of their usage of community-based services.

Methods: This 3-year, prospective, multicenter study included 1,021 participants with mild-to-moderate AD (Mini-Mental State Examination score, 10–26) treated with cholinesterase inhibitors (ChEI) in a routine clinical setting. At the baseline and every 6 months, patients were assessed using cognitive, instrumental and basic activities of daily living (ADL) scales, and service utilization was recorded. Logistic regression models were used to predict... (More)
Introduction: Many individuals with Alzheimer’s disease (AD) live alone, and this figure is expected to increase. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, and the potential predictors of their usage of community-based services.

Methods: This 3-year, prospective, multicenter study included 1,021 participants with mild-to-moderate AD (Mini-Mental State Examination score, 10–26) treated with cholinesterase inhibitors (ChEI) in a routine clinical setting. At the baseline and every 6 months, patients were assessed using cognitive, instrumental and basic activities of daily living (ADL) scales, and service utilization was recorded. Logistic regression models were used to predict the usage of community-based services.

Results: At the start of ChEI therapy (time of AD diagnosis), 355 individuals (35%) were living alone. They were mainly female, older, had more impaired basic ADL capacity, and a larger number of concomitant medications compared with those living with family. Regarding the solitary-living patients, lower instrumental ADL (IADL) ability and more medications were independent predictors of usage of home-help services, whereas more impaired IADL at baseline and faster IADL deterioration were predictors of nursing-home admission. For those living with family, older age, lower basic ADL, and a greater number of medications predicted home-help services, whereas a larger amount of home help predicted nursing-home placement. In addition, female sex was a risk factor for both the utilization of home-help services and nursing-home placement. Cognitive ability was not significantly associated with usage of community-based services.

Conclusions: A large number of AD patients, predominantly females, live alone with severe cognitive and functional impairment. The amount of home-help services used did not reflect cognitive severity, suggesting that home help did not meet the needs related to cognitive deterioration. Increased knowledge of how community-based services can better accommodate the care needs of solitary-living individuals with AD is essential. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Home-help services, Living status, Activities of daily living, Cognition, Nursing-home placement, Longitudinal study
in
Clinical Interventions in Aging
volume
9
pages
1951 - 1962
publisher
Dove Medical Press Ltd.
external identifiers
  • wos:000344921600001
  • pmid:25484578
  • scopus:84924793682
ISSN
1178-1998
DOI
10.2147/CIA.S71709
language
English
LU publication?
yes
id
626e38a7-72ef-45e2-a8bd-f99475d58ea9 (old id 4908791)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25484578?dopt=Abstract
date added to LUP
2015-01-07 10:38:11
date last changed
2017-07-09 03:21:13
@article{626e38a7-72ef-45e2-a8bd-f99475d58ea9,
  abstract     = {Introduction: Many individuals with Alzheimer’s disease (AD) live alone, and this figure is expected to increase. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, and the potential predictors of their usage of community-based services.<br/><br>
Methods: This 3-year, prospective, multicenter study included 1,021 participants with mild-to-moderate AD (Mini-Mental State Examination score, 10–26) treated with cholinesterase inhibitors (ChEI) in a routine clinical setting. At the baseline and every 6 months, patients were assessed using cognitive, instrumental and basic activities of daily living (ADL) scales, and service utilization was recorded. Logistic regression models were used to predict the usage of community-based services.<br/><br>
Results: At the start of ChEI therapy (time of AD diagnosis), 355 individuals (35%) were living alone. They were mainly female, older, had more impaired basic ADL capacity, and a larger number of concomitant medications compared with those living with family. Regarding the solitary-living patients, lower instrumental ADL (IADL) ability and more medications were independent predictors of usage of home-help services, whereas more impaired IADL at baseline and faster IADL deterioration were predictors of nursing-home admission. For those living with family, older age, lower basic ADL, and a greater number of medications predicted home-help services, whereas a larger amount of home help predicted nursing-home placement. In addition, female sex was a risk factor for both the utilization of home-help services and nursing-home placement. Cognitive ability was not significantly associated with usage of community-based services.<br/><br>
Conclusions: A large number of AD patients, predominantly females, live alone with severe cognitive and functional impairment. The amount of home-help services used did not reflect cognitive severity, suggesting that home help did not meet the needs related to cognitive deterioration. Increased knowledge of how community-based services can better accommodate the care needs of solitary-living individuals with AD is essential.},
  author       = {Wattmo, Carina and Londos, Elisabet and Minthon, Lennart},
  issn         = {1178-1998},
  keyword      = {Home-help services,Living status,Activities of daily living,Cognition,Nursing-home placement,Longitudinal study},
  language     = {eng},
  pages        = {1951--1962},
  publisher    = {Dove Medical Press Ltd.},
  series       = {Clinical Interventions in Aging},
  title        = {Solitary living in Alzheimer's disease over 3 years: association between cognitive and functional impairment and community-based services.},
  url          = {http://dx.doi.org/10.2147/CIA.S71709},
  volume       = {9},
  year         = {2014},
}