Impact of loss of independence in basic activities of daily living on caregiver burden in patients with Alzheimer's disease: A retrospective cohort study

Abstract

Aim: To investigate the association between decline of basic activities of daily living (ADL) in each dimension and change in caregiver burden in patients with mild-to-moderate Alzheimer's disease.Methods: This retrospective study included 117 outpatients with Alzheimer's disease who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology in Japan between September 2010 and April 2014 (mean age 77.3 AE 6.4 years; 68.6% women). Patients and their caregivers completed comprehensive geriatric assessment at baseline and at the 3-year follow up. Caregiver burden was assessed using the Japanese version of the Zarit Burden Interview. ADL were assessed by the Barthel Index. Among patients with full points on each subitem of the Barthel Index at baseline, incident ADL decline was defined as a loss of at least 5 points at the 3-year follow up. Other confounding factors including demographic data, cognitive function, vitality, and behavioral and psychiatric symptoms of dementia were also assessed. The longitudinal relationship between incident ADL decline and changes in caregiver burden was evaluated by multivariate linear regression, adjusted for confounding variables.Results: In descending order, declines in ADL at 3 years were noted in bathing (25.4%), bowel control (25.4%), grooming (22.9%) and bladder control (22.9%). On multivariate analyses, ADL declines in feeding (b = 17.2, P < 0.01) and bathing (b = 11.0, P = 0.02) were significantly associated with increased caregiver burden.Conclusion: Incident ADL declines in feeding and bathing are significant risk factors for increased caregiver burden in patients with Alzheimer's disease.

The Trajectory of Caregiver Burden and Risk Factors in Dementia Progression: A Systematic Review

“…Among these eleven, the number of participants at baseline ranged from n = 41 to n = 2014. One study included 41 participants [15], three included between 100 and 200 participants [16][17][18], two studies included between 200 and 300 participants [19,20], and five included more than 300 participants [21][22][23][24][25]. The follow-up ranged from 3 to 36 months.…”

“…The follow-up ranged from 3 to 36 months. One study [25] had a follow up of 3 months, one study [18] had a follow up of 6 months, five studies [15,16,[22][23][24] had a follow up between 12 and 24 months, and four studies [17,[19][20][21] had a follow up of more than 24 months. Of the included studies, eight studies [15,17,18,[21][22][23][24][25] defined the negative impact of caregiving as caregiver burden.…”

“…One study [25] had a follow up of 3 months, one study [18] had a follow up of 6 months, five studies [15,16,[22][23][24] had a follow up between 12 and 24 months, and four studies [17,[19][20][21] had a follow up of more than 24 months. Of the included studies, eight studies [15,17,18,[21][22][23][24][25] defined the negative impact of caregiving as caregiver burden. Of these eights studies with burden as outcome, seven studies [15,17,[21][22][23][24][25] used the Zarit Burden Interview (ZBI), while Raccichini et al [18] used the Caregiver Burden Inventory (CBI).…”

Caregiver burden and caregiving time among caregivers of patients with Alzheimer's disease

“…We read with interest the results presented by Kawaharada et al showing that a decline in basic activities of daily living (ADL) among patients with mild-to-moderate Alzheimer's disease increases caregiver burden, after adjusting for behavioral and psychiatric symptoms of dementia and other factors contributing to confusion in patients. 1 We would like to present some discussion points regarding their conclusions.…”

“…It is noteworthy that Kawaharada et al reported that an ADL decline in feeding (taking a long time to eat or requiring qualified food and feeding assistance) was significantly related to an increased caregiver burden score. 1 Furthermore, the authors showed that in the mild-to-moderate stages, appetite changes and resistive behaviors were oftentimes observed, and considerably increased caregiving time. We agree with this point.…”