Louise Nygård

Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment?

This paper challenges the requirements of normal activities of daily living/instrumental activities of daily living (ADL/IADL) functioning in mild cognitive impairment and stresses the need for further research and assessment refinement. Although people who develop dementia seem to experience subtle changes in complex IADLs long before the disease onset, studies that compare cognitively mildly impaired subjects with demented and nondemented subjects present no clear consensus regarding differentiation according to IADL ability. The traditional ADL/IADL assessment instruments and techniques seem to present a major problem when the purpose is to predict or differentiate between diagnoses. It is therefore argued that the diagnosis of MCI should include rather than exclude observed or experienced changes in complex everyday life activities.

The use of everyday technology by people with dementia living alone: Mapping out the difficulties

While the technological development available to society is taking quantum leaps, we have little knowledge of how people with mild dementia manage to cope with familiar technology at home, such as television and electronic household machines, or new technology, such as remote controls, cell phones and computers. As this technology represents a potential problem area, the aim of this qualitative, exploratory study was to identify and characterize difficulties with and hindrances to using everyday technology, as they appeared in data, for persons with early stage dementia. Eight participants with dementia were included in an extensive data collection consisting of repeated interviews and observations made in the home; the data were analyzed adopting a constant comparative approach. The results exhibit a taxonomy of difficulties in four domains, encompassing conditions that interfere with the use of the technology, deficiencies in knowledge and in the communication between users and their technology, and limitations in the use of instructions. Typically, difficulties appeared in complex combinations. They arose when familiar technology was being used, and not only when new technology was to be used. This raised concerns about the need these people have for support in home and in society. Further research is needed to validate the findings.

How can we get access to the experiences of people with dementia?: Suggestions and reflections

This paper suggests and discusses a methodological approach that aims to facilitate the inclusion of people with dementia in research where the ambition is to better understand their experiences. People with dementia have commonly not been included as informants in research as their cognitive deficits have been regarded as a hindrance. Moreover, in the qualitative research tradition, most inquiries rely on data obtained from interviews, thereby requiring communication and verbal skills, which are skills that are affected early in the cause of dementia. Consequently, the considerably under-researched area of how dementia is experienced and managed from the perspective of those afflicted has long been put aside. This paper suggests that a combination of qualitative observations and adapted interviews may make it possible for people with dementia to participate as research informants. Issues concerned with creating a relationship with informants with dementia and helping them to elicit their experiences are elaborated and discussed. Some suggestions are made concerning how the context can be used for this intent, and how the observations and interviews can be adapted to the informants with dementia.

Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review

IntroductionThere is a growing body of evidence that subtle deficits in instrumental activities of daily living (IADL) may be present in mild cognitive impairment (MCI). However, it is not clear if there are IADL domains that are consistently affected across patients with MCI. In this systematic review, therefore, we aimed to summarize research results regarding the performance of MCI patients in specific IADL (sub)domains compared with persons who are cognitively normal and/or patients with dementia.MethodsThe databases PsycINFO, PubMed and Web of Science were searched for relevant literature in December 2013. Publications from 1999 onward were considered for inclusion. Altogether, 497 articles were retrieved. Reference lists of selected articles were searched for potentially relevant articles. After screening the abstracts of these 497 articles, 37 articles were included in this review.ResultsIn 35 studies, IADL deficits (such as problems with medication intake, telephone use, keeping appointments, finding things at home and using everyday technology) were documented in patients with MCI. Financial capacity in patients with MCI was affected in the majority of studies. Effect sizes for group differences between patients with MCI and healthy controls were predominantly moderate to large. Performance-based instruments showed slight advantages (in terms of effect sizes) in detecting group differences in IADL functioning between patients with MCI, patients with Alzheimer’s disease and healthy controls.ConclusionIADL requiring higher neuropsychological functioning seem to be most severely affected in patients with MCI. A reliable identification of such deficits is necessary, as patients with MCI with IADL deficits seem to have a higher risk of converting to dementia than patients with MCI without IADL deficits. The use of assessment tools specifically designed and validated for patients with MCI is therefore strongly recommended. Furthermore, the development of performance-based assessment instruments should be intensified, as they allow a valid and reliable assessment of subtle IADL deficits in MCI, even if a proxy is not available. Another important point to consider when designing new scales is the inclusion of technology-associated IADL. Novel instruments for clinical practice should be time-efficient and easy to administer.

Perceived difficulty in everyday technology use among older adults with or without cognitive deficits

This studys purpose was comparing perceived relevance of and difficulty in use of everyday technology such as remote controls, cell phones, and microwave ovens, in older adults with/without cognitive deficits. Three groups included 157 participants; 34 had mild-stage dementia, 30 had mild cognitive impairment (MCI), and 93 lacked known cognitive impairments. Data were collected in structured interviews with the Everyday Technology Use Questionnaire (ETUQ). Analyses revealed that participants with no known cognitive deficits (Group 3) considered a higher proportion of technologies relevant to their life situation than participants with mild-stage dementia (Group 1) and those with MCI (Group 2). Furthermore, participants with no known cognitive deficits reported the lowest mean level of perceived difficulty in everyday technology use, followed by those with MCI and those with mild-stage dementia. All three groups differed significantly (p <0.01; p <0.001) in perceived difficulty using technology, indicating that measurement of perceived difficulty in everyday technology use may sensitively detect changes resulting from MCI/dementia. Findings indicate that perceived difficulty in using everyday technology increases in people with MCI and is accentuated in mild-stage dementia. This calls for increased attention to these issues when assessing functional ability in daily activities of older adults with possible MCI/dementia, and for further research.

Everyday Technology Use Questionnaire: Psychometric Evaluation of a New Assessment of Competence in Technology Use

People with mild cognitive impairment or dementia in a mild phase who live at home are expected to manage the everyday technology that is common in this context. However, the knowledge of how technology use may interfere with the performance of daily activities is sparse. The purpose of this study was to evaluate whether a new instrument measuring relevance and competence in everyday technology use, the Everyday Technology Use Questionnaire, could generate linear measures of competence in a valid manner when used in a population of 157 older adults with and without cognitive impairment or dementia. The results from this study indicate that the Everyday Technology Use Questionnaire demonstrates acceptable levels of scale validity and person response validity, supporting researchers and clinicians with a tool that generates a valid measure of competence in use of everyday technology for people with mild cognitive impairment or dementia in a mild phase who live at home.

Readiness for technology use with people with dementia: The perspectives of significant others

Technology is believed to have a potential for supporting significant others of people with dementia but little is known of their experiences and views of technology. The aim of this study is to explore how significant others relate to technology and to their relatives with dementia as technology users. The focus is on both their own use of technology as significant others and the use of technology by their relatives with dementia. Individual interviews and focus group discussions were undertaken and analyzed using a grounded theory approach. The significant others showed an overall readiness toward using technology in their present roles. Technology use in daily activities was perceived to be an important means to keeping retained abilities exercised but could also be perceived as a possible threat to health if activities were oversimplified. The significant others asked for flexible technology not perceived as stigmatizing, to be integrated into existing habits.

Detection of activity limitations in older adults with MCI or Alzheimer's disease through evaluation of perceived difficulty in use of everyday technology: a replication study.

Objectives and methods: Earlier research indicates that the ability to use everyday technology (ET) may be sensitive to subtle functional change. People with mild cognitive impairment (MCI) have been identified as significantly more disabled in ET use compared to controls, albeit less disabled than people with dementia. The aim of this study was to investigate the replicability of these findings using an improved version of the Everyday Technology Use Questionnaire (ETUQ) to compare perceptions of relevance and difficulty in ET use in participants with MCI or Alzheimers disease (AD) and controls. Additional aims were to explore the validity of ETUQ, and the relationships between perceived difficulty in ET use and cognitive status, mood state, and involvement in everyday life activities. In total, 118 participants were included, 37 with AD, 37 with MCI, and 44 controls. Results: Analyses confirmed that the rating scale of the ETUQ functioned well. The three groups overlapped but differed significantly in their perceptions of ETs relevance (p < 0.05) as well as of difficulties in ET use (p < 0.001). Moderate correlations were also found between ETUQ measures and cognitive status, mood, and involvement in activities, the strongest being that between ETUQ measures and involvement in activities (r = 0.563). Conclusion: Taken together, the findings underscore the plausibility of disability already in people with MCI, as the use of ET strongly correlates to involvement in activities. It is therefore important that professionals who meet older adults with cognitive impairment take this aspect of function into account in assessments and targeted interventions.

The influence of the environment on participation subsequent to rehabilitation as experienced by elderly people in Norway

The aim of this study was to illuminate how the environment may influence participation among elderly people who have undergone community-based rehabilitation in Norway, after an acute illness or accident. Fourteen persons over 65 years of age were selected with the specific intention of gaining a variety of ages, both genders, and people living in different kinds of housing. Three focus groups were established and repeated interviews were held with each group. A constant comparative analysis was used to analyse the data. The main finding was that the participants experienced pressure from their environment to concentrate on performing the most necessary daily activities rather than on participation. Three main encounters with environments seemed to be important for this: encountering people and society, encountering private and formal assistance, and encountering occupation. The support that the participants received from family and friends was more important for their participation than having accessible physical environments. The findings suggest that occupational therapists must consider themselves to be part of a societal environment that can hinder participation.

A Life-World of Altering Meaning: Expressions of the Illness Experience of Dementia in Everyday Life over 3 Years

The aim of this study was to describe the illness experiences of two participants with dementia, as expressed in their everyday lives during 3 years of disease progression. Data were collected at intervals by participant observations and conversational interviews and analyzed via a phenomenological and interpretive method. The findings describe an illness experience characterized by an altering meaning of the concretely present life-world for the participants. This was exhibited by an increasingly existential meaning of the objects and tasks of everyday life, while the perception of the life-world as taken for granted seemed to gradually decrease. Furthermore, participants experienced being threatened by a lack of order and control and uniquely responded to these experiences. Living with the changes and the threat seemed to imply insecurity and doubtful hope, diminishing social contacts, and increasing dependency, but the meaning of the consequences differed between participants. On the basis of the presented structure of the phenomena, a possible way of understanding the illness experience and its meaning in progressively dementing diseases in the occupations of everyday life was exemplified and suggested from a phenomenological point of view.