Characteristics And Factors Related To Basic Activities Of Daily Living In Institutionalized People With Dementia

Background Basic activities of daily living is the most basic ability of normal elderly to live independently.Impaired activity in daily life is one of the concomitant manifestations of patients with dementia.It is of great significance to understand the characteristics of activities of daily living of patients with dementia for understanding the care needs of patients with dementia,adjusting nursing intervention programs,and allocating appropriate care resources.Methods This study is a multi-country cross-sectional study involving 644 patients with dementia from 19 long-term care institutions in China,Japan,South Korea,Taiwan,and Thailand.The Barthel index was used to evaluate the basic activities of daily living in patients with dementia;the Clinical Dementia Rating(CDR)was used to assess the severity of dementia;and the Mini-Mental State Examination(MMSE)was used to assess cognitive function;the Neuropsychiatric Inventory Nursing Home Version(NPI-NH)was used to assess the frequency and severity of BPSD.Using Rasch analysis to explore the patient's ability level and item difficulty hierarchy in different ADLs,and using Spearman correlation analysis to explore related factors of patients'daily life activities.Results1.A total 644 patients were included in this study,and the average age was 83.42±7.67.Rasch analysis of Barthel index evaluation data showed that item reliability(1.0)and person reliability(0.88)were acceptable.The Rasch dimension explained 72.9%of the variance(Eigenvalue=27)and the second largest dimension explained 6.6%of the variance(Eigenvalue=2.4).The "mobility" was found to misfit to the Rasch model(Infit mean square=1.86)with narrow threshold widths(<1.4 logits).Only three items("grooming","dressing",and "toilet use")were free from DIF across countries.2.Rasch analysis of Barthel index evaluation data showed that the overall difficulty of the BI exceeded patients' ability(location=-2.27,SD=2.71 logits).The item difficulty hierarchy is bathing>grooming>stair climbing>dressing>controlling one's bladder and toilet use>controlling one's bowel>feeding>mobility>transferring.The total score and item score of BI decreased with the aggravation of dementia severities.Except for the items of "Mobility".3.Spearman correlation analysis showed weak correlation between Barthel Index and score of NPI-NH scores(correlation coefficient were<|±0.3|),with dementia severity(r=-0.47,P<0.01),cognitive function(r=0.36,P<0.01),and age(r=-0.12,P<0.01).Multiple linear regression analysis showed that Barthel Index scores were associated with dementia severity,age,and cognitive function(standard ? coefficients were-0.31,-0.12,and 0.12,respectively).Conclusions1.The comparability of the assessment results of activities of daily living in different countries is doubtful,and the Barthel index has problems such as measuring blind area,redundant items and too many options when measuring patients with dementia,so it is recommended to apply the revised results in this population?2.The level of activity of daily life of patients with dementia in long-term care institutions is low,which is mismatched with the difficulty of items.However,the degree of ability damage in different activities of daily life is different.Nursing staff can make corresponding nursing strategies according to the patients' undamaged ability to improve the quality of life of patients.3.The age,severity and cognitive function of the patients with dementia are closely related to their daily life activities.The relationship between the BPSD and their daily life activities is highly variable,which may be affected by cultural factors.