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- Wattmo, Carina, et al.
(författare)
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A longitudinal study of risk factors for community-based home help services in Alzheimer's disease: the influence of cholinesterase inhibitor therapy
- 2013
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Ingår i: Clinical Interventions in Aging. - 1178-1998. ; 8, s. 329-339
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Tidskriftsartikel (refereegranskat)abstract
- Background: To investigate the long-term effects of cholinesterase inhibitor (ChEI) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS) by patients with Alzheimer's disease (AD). Methods: This 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used. Results: During the study, 332 patients (38%) used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS. Conclusions: Higher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The "silent group" of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization.
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- Wattmo, Carina, et al.
(författare)
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Risk factors for community-based home help services among patients with Alzheimer’s disease.
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To identify factors that predict the use of community-based home help services in long-term cholinesterase inhibitor (ChEI)-treated patients with Alzheimer’s disease (AD). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, prospective, non-randomized, multicentre study in a routine clinical setting. Patients with AD living at home at the time of inclusion received treatment with donepezil, rivastigmine or galantamine. They were assessed with MMSE, IADL and PSMS scales at baseline and every 6 months over 3 years. The first 880 patients who had the opportunity to complete the full study were assessed regarding the use of home help services and adult day care. The following factors were investigated: gender, APOE e4 carrier status, living alone or with spouse, education level, age, illness duration and cognitive and functional level at baseline. Results: One hundred and thirty-nine patients (16%) received home help services at the start of ChEI treatment (average, 5.7 hours/week). After 3 years, 31% of the remaining 286 patients living at home used a mean of 8.7 h of home help/week. Among the patients with an MMSE score of 10–14, 8% of those living with a spouse used home help services compared with 62% of those living alone. Use of adult day care increased (from 3% to 19%) during the 3-year study among the patients without home help services; 89% of those using day care were not living alone. Solitary living (p<0.001), older age (p=0.004) and lower ADL abilities at baseline (p<0.001) were risk factors for use of home help services. These 4 variables correctly classified 90% of the patients regarding whether they used these services. Conclusions: Functional, but not cognitive, ability influenced the need for home help in AD patients. Solitary living, age and functional status predicted the use of community-based home help services with high accuracy. Patients not living alone seemed to use adult day care as a substitute for home help services.
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