School of Psychological Sciences, University of Manchester, Manchester, UK; Personal Social Services Research Unit, University of Manchester, Manchester, UK
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
Dementia (London). 2016 Sep;15(5):1068-81. doi: 10.1177/1471301214553614. Epub 2014 Oct 2.
The ability to perform instrumental activities of daily living deteriorates early in dementia and affects people with dementia and their carers. However, little is known about individual instrumental activities of daily living impairments. This study therefore investigated instrumental activities of daily living deficits in mild dementia by exploring the relationship between instrumental activities of daily living initiative and performance and general cognition, people with dementia quality of life and carer stress. Moreover, this study explored the contribution of social instrumental activities of daily livings, which to date have received little or no attention.
Twenty carers were administered a revised Interview for Deterioration for Daily Living Activities in Dementia and measures of carer stress (General Health Questionnaire-12) and quality of life in dementia (Quality of Life in Alzheimer's Disease). The people with dementia completed measures of general cognition (Mini-Mental State Examination and Montreal Cognitive Assessment). Data were analysed using frequency and bivariate correlation analyses and basic thematic analysis was employed to the qualitative data on carer stress.
Carer interviews showed that instrumental activities of daily living impairments were associated more with performance than with initiative deficits. Increased social isolation and reluctance to engage in hobbies were particularly stressful to carers and impacted negatively on the people with dementia quality of life, yet were not reported as critical in the qualitative assessment.
This study shows that people with mild dementia are impaired to different degrees on their initiative and performance of instrumental activities of daily livings and that impairments relating to social activities particularly relate to well-being. The revised Interview for Deterioration for Daily Living Activities in Dementia with its social instrumental activities of daily livings can help shift the focus of interventions to address those activities that are frequently impaired in mild dementia and relate to people with dementia and carer well-being.
在痴呆症早期，人们执行工具性日常生活活动的能力会恶化，这会影响到痴呆症患者及其照顾者。然而，对于个体工具性日常生活活动的损伤知之甚少。因此，本研究通过探讨工具性日常生活活动的主动性和表现与一般认知、痴呆症患者的生活质量和照顾者的压力之间的关系，来研究轻度痴呆症患者的工具性日常生活活动缺陷。此外，本研究还探讨了社会工具性日常生活活动的贡献，迄今为止，这些活动几乎没有或没有得到关注。
对 20 名照顾者进行了改良的痴呆日常生活活动恶化访谈，以及照顾者压力（一般健康问卷-12）和痴呆症患者生活质量（阿尔茨海默病生活质量）的测量。痴呆症患者完成了一般认知（简易精神状态检查和蒙特利尔认知评估）的测量。数据分析采用频率和双变量相关分析，对照顾者压力的定性数据采用基本主题分析。
照顾者访谈显示，工具性日常生活活动的损伤与表现相关，而与主动性缺陷相关。社会孤立的增加和不愿从事业余爱好对照顾者特别有压力，并对痴呆症患者的生活质量产生负面影响，但在定性评估中并未被视为关键因素。
本研究表明，轻度痴呆症患者在主动性和工具性日常生活活动的表现上存在不同程度的损伤，与社会活动相关的损伤尤其与幸福感有关。改良的痴呆日常生活活动恶化访谈及其社会工具性日常生活活动可以帮助将干预的重点转移到解决那些在轻度痴呆症中经常受损并与痴呆症患者和照顾者幸福感相关的活动上。
