title: The newly revised interview for deteriorations in daily living activities in dementia (R-IDDD2): distinguishing initiative from performance at assessment.
abstract: Minimal evidence exists on the detailed deficits in complex instrumental activities of daily living (IADLs) in mild dementia. The aim of this study was twofold, to validate a revised questionnaire focusing measuring the initiative and performance of IADLs in mild dementia and to explore the relationship between individual IADLs and patient and carer well-being.
  
  
  
  A total of 183 carers of people with mild dementia completed a further modified Revised Interview for Deterioration in Daily Living Activities 2 (R-IDDD2), which comprised new activities such as computer use, as well as sub-activities on the performance scale. Carers also completed questionnaires assessing patient quality of life (QoL-AD), carer quality of life (AC-QoL), and burden (GHQ-12).
  
  
  
  Persons with dementia were significantly poorer initiating than performing cleaning, doing repair work, and preparing a hot or cold meal, whereas being poorer at performing dressing and following current affairs. Using the computer, preparing a hot meal, finance, and medication management were most impaired, whereas more basic activities of dressing, washing oneself, brushing hair or teeth, and preparing a hot drink were most preserved. Poor initiative and performance on nearly all activities were significantly related to reduced carer and patient well-being.
  
  
  
  The R-IDDD2 offers a platform to comprehensively assess everyday functioning. Deteriorations in initiative and performance need to be targeted separately in interventions, as the former requires effective triggering and the latter structured training and support. Most activities were significantly associated with well-being, particularly patient quality of life so that improving any activity should improve well-being.
authors.affiliation: School of Health Sciences,University of East Anglia,Norwich,UK.
authors.forename: Clarissa M
authors.initials: CM
authors.lastname: Giebel
authors.affiliation: Personal Social Services Research Unit,The University of Manchester,Manchester,UK.
authors.forename: David
authors.initials: D
authors.lastname: Challis
authors.affiliation: Division of Neuroscience and Experimental Psychology,University of Manchester,Manchester,UK.
authors.forename: Daniela
authors.initials: D
authors.lastname: Montaldi
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D003704:Dementia / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*; D006113:United Kingdom
keywords: carer burden; dementia; initiative; instrumental activities of daily living; performance; quality of life