Causes of decreased activity of daily life in elderly patients who need daily living care

How patients with dementia influence caregiver burden using the Dementia Assessment Sheet for Community-based Integrated Care System-21 items (DASC-21) and Zarit Caregiver Burden Interview (ZBI)

BACKGROUND

Dementia is a disease that is frequently associated with significant caregiving burden. The present study was conducted on patients with dementia in order to investigate the causes of caregiver burden using the Dementia Assessment Sheet for Community-based Integrated Care System-21 items (DASC-21) and Zarit Caregiver Burden Interview (ZBI).

METHODS

The study subjects consisted of 206 elderly patients (mean age: 80.9 ± 5.9 years) with dementia in an outpatient clinic. Current age, gender, type of dementia, Mini-Mental State Examination, Hasegawa Dementia Scale-Revised, Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS) and the DASC-21 were investigated. Caregiver burden was assessed by using the ZBI. Behavioural and Psychological Symptom of Dementia (BPSD) were evaluated by using the Neuropsychiatric Inventory (NPI). Simple regression analysis for the ZBI was performed with respective risk factors as independent variables. Thereafter, multiple regression analysis was performed.

RESULTS

The mean ZBI score was 28.0 ± 18.1, whereas mean DASC-21 score was 44.4 ± 13.2. Simple regression analysis for the ZBI was performed with respective risk factors as independent variables. The DASC-21 (P < 0.001), CDR (P < 0.001), NPI (P < 0.001), and GDS (P = 0.034) were significantly associated with the ZBI. For each item of the DASC-21, Memory (P < 0.001), Orientation (P < 0.001), Solving issues/Common sense (P < 0.001), Instrumental activities of daily living (IADL) outside the home (P < 0.001), IADL inside the home (P < 0.001), Physical ADL① (P < 0.001) and Physical ADL② (P = 0.014) were also significantly associated with the ZBI. To find the independent association of the ZBI, multiple regression analysis was performed. The results showed that DASC-21 (P < 0.001) and NPI (P < 0.001) had significant correlation. For each item of the DASC-21, Memory (P = 0.014) and Solving issues/Common sense (P < 0.001) were also shown to have significant correlation.

CONCLUSIONS

Both BPSD, cognition and IADL have affected caregiver burden. The DASC-21 is useful for determining the causes of caregiver burden of dementia patients.

Effect of Diabetes Mellitus on Daily Functioning and Cognition of Alzheimer’s Disease Patients Evaluated by DASC-21

<b><i>Introduction:</i></b> Diabetes mellitus (DM) is a risk factor for Alzheimer’s disease (AD). It has also been pointed out that AD associated with DM may have unique characteristics. However, the characteristics of impairment in daily functioning when associated with DM have not been sufficiently investigated. <b><i>Methods:</i></b> In the present study, we compared the characteristics of 261 patients with AD diagnosed in the outpatient memory clinic of a university hospital, divided into diabetic and nondiabetic groups. The MMSE was used to assess cognitive function, and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) was used as an observational method to assess cognitive function and activities of daily livings. The two groups were compared. Furthermore, simple and multiple regression analysis was carried out in order to find the independent association of age, sex, education, DM, and HbA1c with the DASC-21 and each individual item of the DASC-21. <b><i>Results:</i></b> Diabetic subjects were as follows: MMSE 18.8 ± 4.0, DASC-21 46.0 ± 13.2, and HbA1c 7.07 ± 1.24%, respectively. On the other hand, nondiabetic subjects were as follows: MMSE 19.0 ± 4.5 and DASC-21 42.1 ± 12.2, respectively. In the diabetic group, total score of DASC-21 was higher (DM vs. nondiabetes mellitus [NDM]: 46.0 ± 13.2 vs. 42.1 ± 12.2; <i>p</i> &#x3c; 0.05) and solving issues and common sense on the DASC-21 were higher than in the nondiabetic group (NDM) (DM vs. NDM: 8.58 ± 2.71 vs. 7.76 ± 2.66; <i>p</i> &#x3c; 0.05). Multiple regression analysis showed that the presence of DM was the significant determinant of solving issues and common sense on the DASC-21 (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> In AD patients, DM may be associated with impairment of solving issues and common sense.

Gut microbiota in common elderly diseases affecting activities of daily living

Gut microbiota are involved in the development or prevention of various diseases such as type 2 diabetes, fatty liver, and malignancy such as colorectal cancer, breast cancer and hepatocellular carcinoma. Alzheimer’s disease, osteoporosis, sarcopenia, atherosclerotic stroke and cardiovascular disease are major diseases associated with decreased activities of daily living (ADL), especially in elderly people. Recent analyses have revealed the importance of gut microbiota in the control of these diseases. The composition or diversity of these microbiota is different between patients with these conditions and healthy controls, and administration of probiotics or prebiotics has been shown effective in the treatment of these diseases. Gut microbiota may affect distant organs through mechanisms that include regulating the absorption of nutrients and/or the production of microbial metabolites, regulating and interacting with the systemic immune system, and translocating bacteria/bacterial products through disrupted mucosal barriers. Thus, the gut microbiota may be important regulators in the development of diseases that affect ADL. Although adequate exercise and proper diet are important for preventing these diseases, their combination with interventions that manipulate the composition and/or diversity of gut microbiota could be a promising strategy for maintaining health condition and preserving ADL. This review thus summarizes current understanding of the role of gut microbiota in the development or prevention of diseases closely associated with the maintenance of ADL.

The association among knowledge of and confidence in home health care services, acculturation, and family caregivers' relationships to older adults of Mexican descent

The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.

[Risks for impaired daily life function in the elderly with type 2 diabetes in Japan]

AIM

The purpose of the present investigation was to explore the process towards functional disability and predicting factors in Japanese diabetic elderly.

METHODS

We recruited 317 older patients aged 65 or over among participants in the large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial (J-EDIT). We analyzed the changes of daily life function prospectively for 6 years. Information about diabetes, blood examinations and complications was obtained, and basic activity of daily living (ADL) and instrumental ADL (IADL) were assessed by total Barthel index score and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index), respectively.

RESULTS

During 6 years of follow-up, 13.6% of subjects had developed a new ADL disability (bADL) and 38.3% had developed a new functional impairment assessed by TMIG index. In the 65-74 years age group, basic ADL decreased only in males, while females became functionally impaired. In 75-84 years age group, basic and IADL decreased in both men and women. Older age and metabolic syndrome negatively affected ADL, while baseline IADL impairment, cognitive dysfunction, physical inactivity, and insulin therapy were significant predictors of a future decline in the IADL.

CONCLUSION

This study identified the disability process and prognostic factors, including the future decline of basic ADL and IADL in diabetic elderly patients. There are modifiable factors for ADL impairment, comprehensive treatment and care are required to keep Japanese diabetic elderly patients healthy in daily life functioning.

Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese Elderly Diabetes Intervention Trial

AIM

Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly.

METHODS

The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively.

RESULTS

After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL.

CONCLUSION

This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each functional problem are modifiable, comprehensive treatment and care are needed to allow Japanese diabetic elderly patients to have more favorable living conditions.

Radio electric asymmetric brain stimulation in the treatment of behavioral and psychiatric symptoms in Alzheimer disease

PURPOSE

Behavioral and psychiatric symptoms of dementia (BPSD) are common in Alzheimer's disease (AD) and disrupt the effective management of AD patients. The present study explores the use of radio electric asymmetric brain stimulation (REAC) in patients who have had a poor response to pharmacological treatment.

PATIENTS AND METHODS

Eight patients (five females and three males; mean [±standard deviation] age at study baseline: 69.9 ± 3.0 years) diagnosed with AD according to the DSM-IV-TR criteria (mean onset age of AD: 65.4 ± 3.5 years) were cognitively and psychometrically assessed with the Mini-Mental State Examination (MMSE), the Activity of Daily Living (ADL), the Instrumental Activity of Daily Living (IADL), and the Neuropsychiatric Inventory (NPI), prior to and after each of 2 REAC treatment cycles.

RESULTS

Scores on the MMSE and all subscales of the NPI (frequency, severity, and distress), the ADL, and the IADL were significantly improved following the initial REAC treatment. There was further significant improvement in all measurements (with a tendency for improvement in the IADL) after the second REAC treatment cycle.

CONCLUSION

The improvement of cognitive and behavioral/psychiatric functioning following REAC treatment suggests that this innovative approach may be an effective, safe, and tolerable alternative to pharmacological treatment of AD patients, especially in the area of BPSD. Elderly patients suffering from other types of dementia may also benefit from REAC treatment.