DOI QR코드

DOI QR Code

Comparison of Activities of Daily Living Differences with Dementia Stage

치매 단계별 일상생활수행능력의 차이 비교

  • 장종식 (극동대학교 작업치료학과)
  • Received : 2017.11.02
  • Accepted : 2017.12.08
  • Published : 2017.12.31

Abstract

This study aims to obtain information about the ADL and I-ADL functions of people with dementia living in the community and nursing care facilities regarding their dementia stages for the purpose of supporting occupational therapists working in dementia care centers. The information was collected from 100 people with dementia living in the community and 100 people with dementia staying in care facilities from October 1 to November 20, 2015. 15 facilities participated in this study, including nursing homes, day care centers, health centers, geriatric hospitals and metropolitan dementia centers. All of the assessors were trained in the use of the instruments, ADCS-ADL, S-IADL, S-ADL and MMSE-K, by the researcher before conducting any evaluations or interviews. In order to compare the differences in the levels of ADL according to the dementia stage, an analysis was made via the post-hoc test after conducting a one-way ANOVA. An analysis of the residence type and dementia stage was made through the independent t-test. The comparison of the level of ADL between the people with dementia living in the community and those living in nursing homes showed differences in the moderate level of dementia for all items of the I-ADL and ADL (p<.01). The post-hoc test showed that there is a difference among the minimum, mild, and moderate levels. When the differences in ADL according to the residence type were examined, there were no significant differences in any of the stages (p>.05). Considering these results, it may be critical to identify the changes in the I-ADL rather than those in the ADL for the outcome index when conducting future intervention studies on dementia.

본 연구는 지역사회와 시설에 거주중인 치매환자들의 단계에 따라 기본적 일상생활수행, 수단적 일상생활수행을 파악하여 임상현장에 근거를 제시하고 치매환자 관리를 위한 기초자료를 제공하고자 하였다. 자료 수집은 전국에 소재한 요양원, 주간보호센터, 지역사회, 보건소, 요양병원, 요양원, 광역치매지원센터 등 15개의 기관에서 실시하였으며, 2015년 10월 1일 ~ 2015년 11월 20일까지 지역사회거주 치매환자 100명, 시설거주 치매환자 100명을 평가하였다. 모든 자료는 연구자와 평가방법에 대해 충분한 교육을 받은 평가자들이 ADCS-ADL, S-IADL, S-ADL, MMSE-K를 직접 평가하였다. 치매환자의 단계별 일상생활수행수준의 차이를 비교하기 위해 일원배치 분산분석 후 사후검정과 시각적 그래프를 통해 분석하였으며 거주형태와 치매단계에 따른 분석은 독립표본 t 검정을 실시하였다. 지역사회거주 치매환자와 시설거주 치매환자의 일상생활수행수준의 차이를 비교한 결과 수단적 일상생활수행과 기본적 일상생활수행의 모든 항목이 중등도 치매단계에서 차이를 보였으며(p<.01), 사후검정결과 최경도, 경도와 중등도 간에 차이가 있는 것으로 보였다. 치매거주 형태별로 일상생활수행의 차이를 확인한 결과 모든 단계에서 유의한 차이를 보이지 않았다(p>.05). 본 연구의 결과로 미루어 볼 때 향후 진행되는 치매연구에서는 효과의 지표로써 일상생활수행평가의 적용 시 기본적 일상생활수행보다는 수단적 일상생활의 변화를 확인하는 것이 매우 중요할 것으로 사료된다.

Keywords

References

  1. Statistics Korea. Present condition with view of the world and korea. Seoul, South of Korea: Statistics Korea, 2015.
  2. Seoul National University Bundang Hospital. 2012 dementia prevalence rate Survey. Seoul, South of Korea: Seoul national university Bundang hospital, 2012.
  3. Ministry of Health and Welfare. Comprehensive plan of nation dementia management. Seoul, Korea: Ministry of health and welfare, 2012.
  4. S. G. Min, Phychiatry. Seoul, South of Korea: ilchokak, 2015.
  5. R. A. Hansen, G. Gartlehner, K. N. Lohr, D. Kaufer, "Functional outcomes of drug treatment in alzheimer's disease: A systematic review and meta-analysis", Drugs & Aging, vol. 24, no. 2, pp. 155-67, 2007. DOI: https://doi.org/10.2165/00002512-200724020-00007
  6. F. I. Mahoney, D. W. Barthel, "Functional evaluation: The barthel index", Maryland State Medical Journal, vol. 14, pp. 61-65, 1965. DOI: https://doi.org/10.1037/t02366-000
  7. A. K. Desai, G. T. Grossberg, D. N. Sheth, "Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment", CNS Drugs, vol. 18, no. 13, pp. 853-875, 2004. DOI: https://doi.org/10.2165/00023210-200418130-00003
  8. D. A. Gold, "Anexamination of instrumental activities of daily living assessment in older adults and mild cognitive impairment", Journal of Clinical and Experimental Neuropsychology, vol. 34, no. 1, pp. 11-34, 2012. DOI: https://doi.org/10.1080/13803395.2011.614598
  9. H. H. Dodge, T. Kadowaki, T. Hayakawa, M. Yamakawa, A. Sekikawa, H. Ueshima, "Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: The azuchi study", The Gerontologist, vol. 45, no. 2, pp. 222-230, 2005. DOI: https://doi.org/10.1093/geront/45.2.222
  10. J. D. Lepeleirea, B. Aertgeertsa, I. Umbacha, P. Pattyna, F. Tamsina, L. Nestora, F. Krekelbergha, "The diagnostic value of IADL evaluation in the detection of dementia in general practice", Aging & Mental Health, vol. 8, no. 1, pp. 52-57, 2004. DOI: https://doi.org/10.1080/13607860310001613338
  11. E. H. Rubin, J. C. Morris, E. A. Grant, T. Vendegna, "Very mild senile dementia of the Alzheimer type I", Clinical assessment. Archives of Neurology, vol. 46, no. 4, pp. 379-382, 1989. DOI: https://doi.org/10.1001/archneur.1989.00520400033016
  12. P. Barberger-Gateau, C. Fabrigoule, I. Rouch, L. Letenneur, J. F, Dartigues, "Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction of dementia", Journal of Gerontology Psychological Sciences & Social Sciences, vol. 54, no. 5, pp. 293-303, 1999. DOI: https://doi.org/10.1093/geronb/54B.5.P293
  13. M. Schmitter-Edgecombe, E. Woo, D. R. Greeley, "Characterizing multiple memory deficits and their relation to everyday functioning in individuals with mild cognitive impairment", Neuropsychology, vol. 23, no. 2, pp. 168-177. 2009. DOI: https://doi.org/10.1037/a0014186
  14. S. H. Kim, H. R. Yang, Y. J. Choi, H. J. Kang, K. G. Choi, J. H. Jeong, "Predictive factors for decline in activities of daily living in Alzheimer's disease dementia with more than 2 follow-up", Dementia and Neurocognitive Disordoers, vol. 12, no. 4, pp. 100-106, 2013. DOI: https://doi.org/10.12779/dnd.2013.12.4.100
  15. K. B. Kim, H. K. Lee, S. R. Sok, "Activities of daily living and nursing needs of the elderly in nursing home", Journal of Korean Academy of Community Health Nursing, vol. 20, no. 1, pp. 1-11, 2009. DOI: https://doi.org/10.4040/jkan.2009.39.1.1
  16. D. Galasko, D. Bennet, M. Sano, C. Ernesto, R. Thomas, M. Grundman, S. Ferris, "An inventory to assess activities of daily living for clinical trials in alzheimer's disease", Alzheimer Disease and Associated Disorder, vol. 11, no. 2, pp. 33-39, 1997. DOI: https://doi.org/10.1097/00002093-199700112-00005
  17. H. H. Hong, M. O. Gu, "Feeding difficulty and its influencing factors of elders with dementia in long-term care facilities", Journal of academia-industrial technology, vol. 16, no. 2, pp. 1240-1252, 2015.
  18. H. M. Ku, J. H. Kim, H. S. Lee, H. J. Ko, E. J. Kwon, S. Jo, D. Y. Kim, "A study on the reliability and validity of Seoul-Activities of Daily living(S-ADL)", Journal of Korean Geriatrics Society, vol. 8, no. 4, pp. 206-214, 2004.
  19. T. H. Kim, J. H. Jhoo, J. H. Park, J. L. Kim, S. W. Moon, I. H. Choo, D. W. Lee, J. C. Yoon, Y. J. Do, S. B. Lee, M. D. Kim, K. W. Kim, "Korean version of mini mental status examination for dementia screening and it's short form", Journal of Phychiatry investigation, vol. 7, no. 2, pp. 102-108, 2010. https://doi.org/10.4306/pi.2010.7.2.102
  20. U. J. Park, "Trends analysis of characteristics in patient with dementia", Journal of academia-industrial technology, vol. 18, no. 1, pp. 202-209, 2017. DOI: https://doi.org/10.5762/KAIS.2017.18.1.202