Risk factors for community-based home help services among patients with Alzheimer’s disease.

• 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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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

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