The Relation of Patient Dependence to Home Health Aide Use in Alzheimer's Disease

Abstract

Background Although there has been much research devoted to understanding the predictors of nursing home placement (NHP) in Alzheimer’s disease (AD) patients, there is currently a lack of research concerning the predictors of home health care. The objective of this study was to examine whether the Dependence Scale can predict home health aide (HHA) use. Methods The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers in the United States. Markov analyses (n = 75) were used to calculate annual transition probabilities for the “new onset” of HHA use (instances where an HHA was absent at the previous visit, but present at the next visit) as a function of HHA presence at the preceding year’s visit and dependence level at that preceding year’s visit. Results The dependence level at the previous year’s visit was a significant predictor of HHA use at the next year’s visit. Three specific items of the Dependence Scale (needing household chores done for oneself, needing to be watched or kept company when awake, and needing to be escorted when outside) were significant predictors of the presence of an HHA. Conclusion The Dependence Scale is a valuable tool for predicting HHA use in AD patients. Obtaining a better understanding of home health care in AD patients may help delay NHP and have a positive impact on the health and well-being of both the caregiver and the patient.

Longitudinal Relationships Between Alzheimer Disease Progression and Psychosis, Depressed Mood, and Agitation/Aggression

“…Nursing home placement may not fully capture a patient’s needs or the impact of these needs on the family. Dependence level correlates with dementia severity (13), level of disability (14), home health aide use (15), longitudinal increases in medical and non-medical costs (16), overall resource utilization (14), increases in caregiving time (17), and caregiver burden (14). Thus, identifying and treating specific contributors to dependence has the potential for wide-ranging impacts not only on patient quality of life, but also on care costs and family burden.…”

The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the Dependence in AD in England 2 longitudinal study

“…Although cognition, function and behaviour are commonly the focus for clinicians, it has been noted that each of these single indicators provides somewhat limited and conflicting information on typical AD progression pathways (Loveman et al, 2006). Dependence is a broader construct that reflects the level of assistance required by the person with AD, and preliminary research supports associations with clinical endpoints and resource use (Brickman et al, 2002;Scherer et al, 2008;Zhu et al, 2008). It is possible that the use of a broader measure, such as dependence, may allow further evidence to emerge with regard to the association between AD progression and QoL outcomes.…”

Community‐based serious illness care for patients with dementia

“…Our results agree with what is known about dementia in the larger population. It is a disease of aging [7] , impairs activities of daily living [8] , requires aides for assistance [9] , and is more prevalent among African-Americans than white Americans [10] . Importantly, in the REACH sample, having a diagnosis of dementia did not appear to affect mortality, nor did it augment or decrease the effect of REACH on hospitalizations or ED visits.…”