Nationwide Database Analysis of Risk Factors Associated with Decreased Activities of Daily Living in Patients with Alzheimer’s Disease

Abstract

Background: Preserving activities of daily living (ADL) is the key issue for Alzheimer’s disease (AD) patients and their caregivers. Objective: To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years). Methods: Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL. Results: A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain. Conclusion: AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.

Sleep Duration and Functional Disability Among Chinese Older Adults: Cross-Sectional Study

“…One study involving nightshift workers in the United States found that individuals with a shorter sleep duration (<7 hours/day) had the highest prevalence of sleep problems (61.8%) and the highest prevalence of an impaired ADL score (24.8%) [ 48 ], revealing a correlation between shorter sleep duration and higher risk of ADL disability. Another study focusing on patients with dementia discovered that a longer sleep duration was associated with ADL disability [ 49 ]. Similarly, a cross-sectional study that recruited 1798 participants older than 90 years found that a long sleep duration (≥12 hours) may be associated with an increased risk of ADL disability for this population [ 19 ].…”

“…A study involved night shift workers in the United States found that the prevalence of shorter sleep duration (< 7 hours/day) was the highest sleep problems among night shift workers (61.8%) with the highest prevalence of impaired ADL score (24.8%) 47 , which revealed a correlation between shoter sleep duration and higher risk of ADL disability. Another study focused on dementia patients discovered that longer sleep duration was associated with ADL disability 48 .…”