Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia

OBJECTIVES: To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults.

DESIGN: Observational cohort study.

SETTING: Community.

PARTICIPANTS: Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study (N = 7,609).

MEASUREMENTS: Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n = 457), probable dementia without reported dementia diagnosis (n = 581), possible dementia (n = 996), or no dementia (n = 5,575). Potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) were examined according to dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity.

RESULTS: Fifty-nine participants (17.4%) had, at least, one report of medication nonadherence. Logistic regression analyses indicated for every point increase on the DRS Conceptualization subscale (OR = 1.14; 95% CI = 1.02–1.27), there was a 14% increase in the odds of nonadherence. For every point increase on the DRS Memory subscale (OR = 0.89; 95% CI = 0.81–0.97) and DRS Initiation/Perseveration subscale (OR = 0.93; 95% CI = 0.87–1.00), there was an 11% decrease and 7% decrease in the odds, respectively. Having at least one previous occurrence of medication nonadherence (OR = 2.61; 95% CI = 1.18–5.62) and taking at least four medications (OR = 2.58; 95% CI = 1.31–5.29), both increased the odds by over 2.5-fold.

CONCLUSION: Our unique finding that better conceptualization predicted nonadherence has important implications for healthcare providers' approaches to improve adherence in older adults with cognitive impairment. Replication in future studies is warranted. Copyright © 2012 John Wiley & Sons, Ltd.