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The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment

Published online by Cambridge University Press:  03 February 2012

Patricia De Vriendt ,
Ellen Gorus ,
Elise Cornelis ,
Anja Velghe ,
Mirko Petrovic  and
Tony Mets
Patricia De Vriendt*
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Ellen Gorus
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Elise Cornelis
Affiliation:
Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
Anja Velghe
Affiliation:
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Mirko Petrovic
Affiliation:
Department of Geriatrics, Ghent University Hospital, Ghent, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
Tony Mets
Affiliation:
Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium Research in Gerontology and Geriatrics (REGG), Research Association between Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
*
Correspondence should be addressed to: Patricia De Vriendt, MrSc, Department of Frailty in Ageing (FRIA) Research Group and Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan, 103, B-1090 Brussels, Belgium. Phone: +32 479 654110; Fax: +02 477 63 64. Email: patricia.devriendt@uzbrussel.be.
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Abstract

Background: The notion of “minimal impairment in instrumental activities of daily living (i-ADL)” is important in the diagnosis of mild cognitive impairment (MCI), but is presently not adequately operationalized. ADL is stratified according to difficulty, complexity, and also to vulnerability to early cognitive changes in a threefold hierarchy: basic activities of daily living (b-ADL), i-ADL, and advanced activities of daily living (a-ADL). This study aims to gain a deeper understanding of the functional decline in the process of MCI.

Methods: In a qualitative design, 37 consecutive patients diagnosed with amnestic (a)-MCI and their proxies were interviewed at two geriatric day hospitals. Constant comparative analysis was used for the analysis.

Results: The a-ADL-concept emerged as important in the diagnosis of MCI. All participants were engaged in a wide range of activities, which could be clustered according to the International Classification of Functioning, Disability and Health (ICF). Participants reported subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to an activity disruption and an insufficiency in functioning.

Conclusion: This study asserts the inclusion of an evaluation of a-ADL in the assessment of older persons. When evaluating ADL at three levels (b-ADL, i-ADL, and a-ADL), all the activities one can perform in daily living are covered.

Keywords

functional impairmentearly cognitive disordersAlzheimer's diseaseactivities of daily living evaluationInternational Classification of FunctioningDisability and Health (ICF)
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 6 , June 2012 , pp. 974 - 986
Copyright
Copyright © International Psychogeriatric Association 2012

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