Background: While older adults with dementia nowadays stay at home as long as possible, they need to have access to places outside home. Accessing (getting to, using) places outside home where activities are performed is a key prerequisite for participation. Yet access provides both benefits, such as participation in daily activities, and challenges, such as finding one's way. A significant gap exists in our knowledge about patterns of access in urban as well as rural contexts for people with dementia-primarily because we have not measured access adequately. This presentation covers the development of a questionnaire (ACT-OUT) to address this gap. Methods: First, theoretical constructs were identified and elaborated on to build the questionnaire. Second, experts in various fields -geography, medicine, occupational therapy, sociology -and members of the Swiss Alzheimer's association reviewed the questionnaire for content validity. Third, three rounds of nine cognitive interviews (n¼27) were conducted with older adults without dementia, and the questionnaire was revised in each step. Fourth, the questionnaire was tested with older adults with dementia and their significant other. A qualitative content analysis of debriefing questions combined to a double panel review method was used to revise the questionnaire in English, French and Swedish over 3 years (April 2013-March 2016. Results: The current version of the ACT-OUT covers 26 types of places older adults may access organized in 4 clusters (commercial and administrative; health-care; social, spiritual and cultural; and recreation and physical places) combined with questions concerning transportation, familiarity and perceived risks. ACT-OUT provides an understanding of outside world that older adults interact with and how they access those places; it also identifies changes. Conclusions: Understanding how people with dementia engage in activities or experience restrictions in participation in outside home activities and places needs way of measuring this phenomenon. A joint project will use ACT-OUT to map, better understand and compare the accessibility of places in Sweden, Switzerland and USA. It will also help to better apprehend how ACT-OUT works and refine the tool itself.Background: Evaluation of dependence has been suggested as a potential method for translating the effect of changes in cognition, function, and behavior into a more holistic description of AD progression. This review evaluates the existing literature regarding the overall concept of dependence, its measurement, and its relationship with longitudinal outcomes. Methods: A systematic review of peer-reviewed articles published between January 1995 and October 2015 was performed using MEDLINE, EMBASE, and the Cochrane Central Library of Controlled Trials. Randomized clinical trials and observational studies evaluating 50 patients were included. Outcomes of interest included changes in dependence over time, the impact of dependence on changes in cognition, function, behavior, and quality of life...
