| BackgroundActivities of daily living(ADL)are important indicators to assess the care needs of people with senile dementia.Impairment in ADL of people with senile dementia exists in the whole process of the disease.And ADL impairment of people with senile dementia aggravates with cognitive impairment and behavioral and psychological symptoms of dementia(BPSD),increasing the number and complexity of care needs.It is helpful to improve the quality of life of patients and their caregivers through understanding the damage characteristics and difficulty of care support of ADL of people with senile dementia.Objectives(1)Understand the impairment characteristics and the characteristics of dependence of ADL of people with senile dementia,and the difficulty of ADL care faced by caregivers.(2)Explore the correlation between ADL and cognitive function and BPSD,to further understand the ADL impairment characteristics of people with senile dementia.MethodsThis study adopted mixed-methods design.The first part was a qualitative study.Face-to-face semi-structured in-depth interviews were conducted with 12 family caregivers of people with senile dementia to understand the impairment characteristics and the difficulty of ADL care faced by caregivers.The second part was a quantitative study.Based on the research hypotheses proposed by the qualitative study,retrospectively analyze the correlation between specific ADL impairment(assessed by Barthel Index)and specific cognitive domain impairment(assessed by Mini-Mental State Examination)and specific BPSD(assessed by Neuropsychiatric Inventory).Results(1)Four themes were identified from the qualitative research:Impairment characteristics and characteristics of dependence of ADL of people with senile dementia,the difficulty of ADL care perceived by caregivers,the burden of ADL care perceived by caregivers,the demand and utilization of external resources of caregivers.Due to cognitive impairment,people could not initiate an activity at the appropriate time and frequency,and needed to be reminded by others;or they could not complete an activity step by step or focus on an activity,and needed to be supervised by others;or because of their partially limited physical function,they could not complete an activity by themselves and needed some help from others.(2)Quantitative research results:Spearman correlation analysis showed that most of basic activities of daily living of home-cared and institutionalized senile dementia patients were positively correlated with temporal orientation(r=0.13～0.31 vs.0.25～0.41,P<0.05),memory(r=0.15～0.35 vs.0.27～0.52,P<0.01)and attention(r=0.14～0.24 vs.0.32～0.53,P<0.01);toilet use was positively correlated with spatial orientation(r=0.27 vs.0.44,P<0.01);dressing was positively correlated with visuospatial function(r=0.13 vs.0.59,P<0.01).Bladder(r=-0.36,P<0.01),bathing(r=-0.41,P<0.01),mobility(r=-0.44,P<0.01)was negatively correlated with sleep disorders in home-cared patients.Conclusion(1)The damage characteristics of ADL of people with senile dementia are unique.Cognitive impairment,BPSD and comorbidity are the important associated factors for ADL of people with senile dementia.Dementia-specific ADL damage leads to different levels of dependence.Some BPSD do not directly damage the ADL of people with senile dementia,but increase difficulty of caregivers’ ADL support,especially resistiveness to care.The need for a large amount of supervision time increases the caregiver’s care load,and the demand for the replacement of supervision time is reported by most of the family caregivers.The patient’s will,threshold of the treatment,wrong concept,and other factors hinder the caregivers to use the services.(2)Different cognitive functions may have different effects on specific ADL.The correlation between specific BPSD and ADL are different between home-cared and institutional patients,which may be related to the higher accuracy of BPSD reported by family caregivers than institutional caregivers or the underestimation of ADL performance of patients. |
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