Association between detailed performance of ADL and level of needed long-term care among community-dwelling older adults with dementia: a cross-sectional exploratory study using PADA-D

Abstract

Aim: This study aims to explore the association between the long-term care insurance (LTCI) level and detailed implementation of activities of daily living (ADL) among community-dwelling older adults with dementia. Methods: The participants for this exploratory study were 105 community-dwelling older adults with dementia (80.36 ± 8.41 years old, female 73%) and utilizing outpatient and day-care facilities in Japan. The assessment of ADL abilities utilized the Process Analysis of Daily Activity for Dementia (PADA-D). Participants were divided into two groups according to the severity of their LTCI level. Multivariate analysis was employed to explore the relationship between ADL and the LTCI level. The process of ADL items that showed significant association with LTCI discrimination were compared between the two groups. Results: Certain instrumental ADLs, including cooking, housework, shopping, laundry, medication management, and money management, were significantly associated with the severity of LTCI level (p < .05). In addition, specific ADL processes, such as “management of bedding,” “garbage dumping,” “enter the store,” “find a product,” “put the laundry in the washing machine,” “start the washing machine,” and “handle cash,” showed significant impairments in older adults with dementia who had more severe LTCI level (p < .05). Conclusion: Impairments in processes related to checking, manipulating, and managing instrumental ADLs may be indicative of worsening care needs among community-dwelling older adults with dementia. Caregivers are encouraged to conduct comprehensive ADL assessments, such as the PADA-D, to provide tailored support that promotes independence from both environmental and human perspectives.