title: Identifying factors of activities of daily living important for cost and caregiver outcomes in Alzheimer's disease.
abstract: BACKGROUND
  We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD).
  
  
  METHODS
  Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden.
  
  
  RESULTS
  Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD.
  
  
  CONCLUSIONS
  Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.
authors: Global Health Outcomes,Lilly Research Centre,Eli Lilly and Company Limited,Windlesham,Surrey,UK.
authors: Catherine
authors: C
authors: Reed
authors: Global Health Outcomes,Lilly Research Centre,Eli Lilly and Company Limited,Windlesham,Surrey,UK.
authors: Mark
authors: M
authors: Belger
authors: Gerontopole,Alzheimer's Disease Research and Clinical Center,INSERM 1027,Toulouse University Hospital,Toulouse,France.
authors: Bruno
authors: B
authors: Vellas
authors: Health Outcomes Research,Eli Lilly and Company Limited,Indianapolis,IN,USA.
authors: Jeffrey Scott
authors: JS
authors: Andrews
authors: Divisió d'avaluació,Servei Català de la Salut,Barcelona,Spain.
authors: Josep M
authors: JM
authors: Argimon
authors: Clinica della Memoria,Department of Neurological Sciences,University of Rome "Sapienza",Rome,Italy.
authors: Giuseppe
authors: G
authors: Bruno
authors: Department of Neurology,Philipps-University,Marburg,Germany.
authors: Richard
authors: R
authors: Dodel
authors: The Research Institute for the Care of Older People (RICE),The RICE Centre,Royal United Hospital,Bath,UK.
authors: Roy W
authors: RW
authors: Jones
authors: Division of Neurogeriatrics,Department of Neurobiology,Care Sciences and Society,Karolinska Institute,Stockholm,Sweden.
authors: Anders
authors: A
authors: Wimo
authors: Parc Santari Sant Joan de Déu,CIBERSAM,Universitat de Barcelona,Sant Boi de Llobregat,Barcelona,Spain.
authors: Josep Maria
authors: JM
authors: Haro
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000544:Alzheimer Disease / Q000191:economics* / Q000523:psychology / Q000628:therapy; D017028:Caregivers / Q000191:economics* / Q000523:psychology; D017281:Cost of Illness; D005163:Factor Analysis, Statistical; D005260:Female; D005602:France; D005858:Germany; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D011446:Prospective Studies; D012111:Residence Characteristics; D006113:United Kingdom
keywords: ADCS-ADL; Alzheimer’s disease; activities of daily living (ADL); caregiver burden; costs; function; supervision time