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The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment

Published online by Cambridge University Press:  03 February 2012

Patricia De Vriendt ,
Ellen Gorus ,
Elise Cornelis ,
Anja Velghe ,
Mirko Petrovic  and
Tony Mets
Patricia De Vriendt*
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Ellen Gorus
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Elise Cornelis
Affiliation:
Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
Anja Velghe
Affiliation:
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Mirko Petrovic
Affiliation:
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Tony Mets
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
*
Correspondence should be addressed to: Patricia De Vriendt, MrSc, Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan, 103, B-1090 Brussels, Belgium. Phone: +32 479 654110; Fax: +02 477 63 64. Email: [email protected].
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Abstract

Background: The notion of “minimal impairment in instrumental activities of daily living (i-ADL)” is important in the diagnosis of mild cognitive impairment (MCI), but is presently not adequately operationalized. ADL is stratified according to difficulty, complexity, and also to vulnerability to early cognitive changes in a threefold hierarchy: basic activities of daily living (b-ADL), i-ADL, and advanced activities of daily living (a-ADL). This study aims to gain a deeper understanding of the functional decline in the process of MCI.

Methods: In a qualitative design, 37 consecutive patients diagnosed with amnestic (a)-MCI and their proxies were interviewed at two geriatric day hospitals. Constant comparative analysis was used for the analysis.

Results: The a-ADL-concept emerged as important in the diagnosis of MCI. All participants were engaged in a wide range of activities, which could be clustered according to the International Classification of Functioning, Disability and Health (ICF). Participants reported subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to an activity disruption and an insufficiency in functioning.

Conclusion: This study asserts the inclusion of an evaluation of a-ADL in the assessment of older persons. When evaluating ADL at three levels (b-ADL, i-ADL, and a-ADL), all the activities one can perform in daily living are covered.

Keywords

functional impairmentearly cognitive disordersAlzheimer's diseaseactivities of daily living evaluationInternational Classification of FunctioningDisability and Health (ICF)
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 6 , June 2012 , pp. 974 - 986
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Baltes, P. B. and Baltes, M. M. (1990). Succesful Aging: Perspectives from the Behavioral Sciences. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Bogdan, R. and Biklen, S. (2003). Qualitative Research for Education: An Introduction to Theories and Methods. Boston, MA: Rearson.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Ustun, B. and Stucki, G. (2005). ICF linking rules: an update based on lessons learned. Journal of Rehabilitation Medicine, 37, 212–218.CrossRefGoogle ScholarPubMed
Dubois, B. et al. (2010). Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurology, 9, 1118–1127. doi:10.1016/S1474-4422(10)70223-4.CrossRefGoogle ScholarPubMed
Farias, S. T., Mungas, D., Reed, B. R., Harvey, D., Cahn-Weiner, D. and Decarli, C. (2006). MCI is associated with deficits in everyday functioning. Alzheimer Disease and Associated Disorders, 20, 217–223. doi:10.1097/01.wad.0000213849.51495.d9.CrossRefGoogle ScholarPubMed
Farias, S. T. et al. (2008). The measurement of everyday cognition (ECog): scale development and psychometric properties. Neuropsychology, 22, 531–544. doi:10.1037/0894-4105.22.4.531.CrossRefGoogle ScholarPubMed
Ferguson, E. and Cox, T. (1997). The functional dimensions of coping scale: theory, reliability and validity. British Journal of Health Psychology, 2, 109–129.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Freedman, V. A. (2009). Adopting the ICF language for studying late-life disability: a field of dreams? Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 64, 1172–1174; discussion 1175–1176.Google ScholarPubMed
Geda, Y. E. et al. (2011). Engaging in cognitive activities, aging, and mild cognitive impairment: a population-based study. Journal of Neuropsychiatry and Clinical Neurosciences, 23, 149–154. doi:10.1176/appi.neuropsych.23.2.149CrossRefGoogle ScholarPubMed
Giovannetti, T. et al. (2008). Characterization of everyday functioning in mild cognitive impairment: a direct assessment approach. Dementia and Geriatric Cognitive Disorders, 25, 359–365. doi:10.1159/000121005CrossRefGoogle ScholarPubMed
James, B. D., Boyle, P. A., Buchman, A. S. and Bennett, D. A. (2011). Relation of late-life social activity with incident disability among community-dwelling older adults. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 66, 467–473. doi:10.1093/gerona/glq231.Google ScholarPubMed
Jefferson, A. L. et al. (2008). Characterization of activities of daily living in individuals with mild cognitive impairment. American Journal of Geriatric Psychiatry, 16, 375–383. doi:10.1097/JGP.0b013e318162f197.CrossRefGoogle ScholarPubMed
Jette, A. M. (2009). Toward a common language of disablement. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 64, 1165–1168.Google Scholar
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185, 914–919.CrossRefGoogle Scholar
Kitwood, T. (1993). Towards a theory of dementia care: the interpersonal process. Ageing and Society, 13, 51–67.CrossRefGoogle Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lazarus, R. S. and Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer.Google Scholar
Lindseth, A. and Norberg, A. (2004). A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 18, 145–153. doi:10.1111/j.1471-6712.2004.00258.x.CrossRefGoogle ScholarPubMed
Mariani, E., Monastero, R. and Mecocci, P. (2007). Mild cognitive impairment: a systematic review. Journal of Alzheimer's Disease, 12, 23–35.CrossRefGoogle ScholarPubMed
Njegovan, V., Hing, M. M., Mitchell, S. L. and Molnar, F. J. (2001). The hierarchy of functional loss associated with cognitive decline in older persons. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 56, M638–643.Google ScholarPubMed
Nygard, L. (2003). Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment? Acta Neurologica Scandinavica (Suppl.), 179, 42–46.CrossRefGoogle ScholarPubMed
Nygard, L. and Ohman, A. (2002). Managing changes in everyday occupations: the experience of persons with Alzheimer's disease. Occupation Participation and Health, 22, 70–81.CrossRefGoogle Scholar
Pedrosa, H. et al. (2010). Functional evaluation distinguishes MCI patients from healthy elderly people – the ADCS/MCI/ADL scale. Journal of Nutrition, Health and Aging, 14, 703–709.CrossRefGoogle ScholarPubMed
Peres, K., Chrysostome, V., Fabrigoule, C., Orgogozo, J. M., Dartigues, J. F. and Barberger-Gateau, P. (2006). Restriction in complex activities of daily living in MCI: impact on outcome. Neurology, 67, 461–466. doi:10.1212/01.wnl.0000228228.70065.f1.CrossRefGoogle ScholarPubMed
Perneczky, R. et al. (2006). Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing, 35, 240–245. doi:10.1093/ageing/afj054.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194. doi:10.1111/j.1365-2796.2004.01388.x.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2011). Clinical practice. Mild cognitive impairment. New England Journal of Medicine, 364, 2227–2234. doi:10.1056/NEJMcp0910237.CrossRefGoogle ScholarPubMed
Preston, L., Marshall, A. and Bucks, R. S. (2007). Investigating the ways that older people cope with dementia: a qualitative study. Aging and Mental Health, 11, 131–143. doi:10.1080/13607860600844572.CrossRefGoogle ScholarPubMed
Reuben, D. B., Laliberte, L., Hiris, J. and Mor, V. (1990). A hierarchical exercise scale to measure function at the Advanced Activities of Daily Living (AADL) level. Journal of the American Geriatrics Society, 38, 855–861.CrossRefGoogle ScholarPubMed
Robinson, L., Clare, L. and Evans, K. (2005). Making sense of dementia and adjusting to loss: psychological reactions to a diagnosis of dementia in couples. Aging and Mental Health, 9, 337–347. doi:10.1080/13607860500114555.CrossRefGoogle ScholarPubMed
Roth, M. et al. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle Scholar
Sanchez-Benavides, G., Manero, R. M., Quinones-Ubeda, S., de Sola, S., Quintana, M. and Pena-Casanova, J. (2009). Spanish version of the Bayer Activities of Daily Living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity. Dementia and Geriatric Cognitive Disorders, 27, 572–578. doi:10.1159/000228259.CrossRefGoogle ScholarPubMed
Tuokko, H., Morris, C. and Ebert, P. (2005). Mild cognitive impairment and everyday functioning in older adults. Neurocase, 11, 40–47. doi:10.1080/13554790490896802.CrossRefGoogle ScholarPubMed
WHO (2001). International Classification of Functioning, Disability and Health. Geneva: World Health Organisation.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246. doi:10.1111/j.1365-2796.2004.01380.x.CrossRefGoogle Scholar
Yeh, Y. C., Lin, K. N., Chen, W. T., Lin, C. Y., Chen, T. B. and Wang, P. N. (2011). Functional disability profiles in amnestic mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 31, 225–232. doi:10.1159/000326910.CrossRefGoogle ScholarPubMed
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle Scholar