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


CONCLUSIONS
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.
Department of Frailty in Ageing, Vrije Universiteit Brussel, Brussels, Belgium. patricia.devriendt@uzbrussel.be
Patricia
P
De Vriendt
Ellen
E
Gorus
Elise
E
Cornelis
Anja
A
Velghe
Mirko
M
Petrovic
Tony
T
Mets
D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011597:Psychomotor Performance