Catherine Reed1, Mark Belger1, Bruno Vellas2, Jeffrey Scott Andrews3, Josep M Argimon4, Giuseppe Bruno5, Richard Dodel6, Roy W Jones7, Anders Wimo8, Josep Maria Haro9. 1. Global Health Outcomes,Lilly Research Centre,Eli Lilly and Company Limited,Windlesham,Surrey,UK. 2. Gerontopole,Alzheimer's Disease Research and Clinical Center,INSERM 1027,Toulouse University Hospital,Toulouse,France. 3. Health Outcomes Research,Eli Lilly and Company Limited,Indianapolis,IN,USA. 4. Divisió d'avaluació,Servei Català de la Salut,Barcelona,Spain. 5. Clinica della Memoria,Department of Neurological Sciences,University of Rome "Sapienza",Rome,Italy. 6. Department of Neurology,Philipps-University,Marburg,Germany. 7. The Research Institute for the Care of Older People (RICE),The RICE Centre,Royal United Hospital,Bath,UK. 8. Division of Neurogeriatrics,Department of Neurobiology,Care Sciences and Society,Karolinska Institute,Stockholm,Sweden. 9. Parc Santari Sant Joan de Déu,CIBERSAM,Universitat de Barcelona,Sant Boi de Llobregat,Barcelona,Spain.
Abstract
BACKGROUND: We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD). METHODS: Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden. RESULTS: Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD. CONCLUSIONS: Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.
BACKGROUND: We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD). METHODS: Baseline data from a prospective observational study of community-living ADpatients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden. RESULTS: Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD. CONCLUSIONS: Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.
Entities:
Keywords:
ADCS-ADL; Alzheimer’s disease; activities of daily living (ADL); caregiver burden; costs; function; supervision time
Authors: Gad A Marshall; Sietske A M Sikkes; Rebecca E Amariglio; Jennifer R Gatchel; Dorene M Rentz; Keith A Johnson; Oliver Langford; Chung-Kai Sun; Michael C Donohue; Rema Raman; Paul S Aisen; Reisa A Sperling; Douglas R Galasko Journal: Alzheimers Dement (Amst) Date: 2020-10-30