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Abstract
Objective: To quantify the impact of activities of daily living (ADL) scores on the risk of nursing home placement (NHP) in Alzheimer's disease (AD) patients.
Setting: Models predicting NHP for AD patients have depended on cognitive deterioration as the primary measure. However, there is increased recognition that both patient functioning and cognition are predictive of disease progression.
Methods: Using the database from a prospective, randomised, double-blind trial of rivastigmine and donepezil, two treatments indicated for AD, Cox regression models were constructed to predict the risk of NHP using age, gender, ADL and MMSE (Mini-Mental State Examination) scores as independent variables.
Participants: Patients aged 50–85 years, with MMSE scores of 10–20, and a diagnosis of dementia of the Alzheimer type.
Results: Cox regression analyses indicated that being female, older age, lower ADL score at baseline, and deterioration in ADL all significantly increased the risk of NHP. Over 2 years, risk of NHP increased by 3% for each 1-point deterioration in ADL score independent of cognition.
Conclusion: Data analyses from this long-term clinical trial established that daily functioning is an important predictor of time to NHP. Further research may be required to confirm whether this finding translates to the real world.
Acknowledgements
Declaration of interest: This analysis was funded as contracted work between Novartis, the marketer of one of the drugs studied (rivastigmine), and Hind T. Hatoum & Company. S.-J.L. is a consultant to Hind T. Hatoum & Company. S.K.T. and R.L. are employees of Novartis and own stocks in the company. R.B. has sat on advisory boards, talked at various local, national and international meetings and performed commercial research for Novartis (as well as Pfizer, Eisai, J&J, Lundbeck, Sanofi, Lilly, Servier and other companies).
Novartis Pharmaceuticals Corporation provided funding for this study, and furnished the clinical trial database deployed in this analysis. However, authors maintained complete autonomy in all aspects of the study and interpretation of the findings. Authors take full responsibility for the integrity of the data and the accuracy of the data analysis. Editorial assistance with the production of the manuscript was provided by Alpha-Plus Medical Communications Ltd. (UK) and this assistance was funded by Novartis.
H.T.H. and S.K.T. were involved in the study concept. S.-J.L. and H.T.H. were involved in the study analysis. Interpretation of the study data was performed by all authors. All authors contributed to the preparation of the manuscript. Data used in the study were provided by Novartis and are part of a previously conducted clinical trial (the EXCEED study). R.B. and R.L. were involved in all aspects of EXCEED and subsequently published papers.
