Aging Begins at 30

Study Sheds Light On Aging, Dementia, and Dependency

My dancing partner last week told me that her mother had been diagnosed with dementia. Her mother was able to live alone but had visible deterioration in her ability to cope. How common is this?

For research purposes, functional dependence is measured by ability in six activities of daily living (ADLs) namely bathing, dressing, going to the toilet, transferring from bed to chair, continence, and self feeding. Dependence leads to a poor quality of life, increased health costs, and increased deaths. Most studies have been cross sectional sampling of people at age 75, 80, 85, and 90. The results are melded together as if these people had all been followed for 15 years or more. Dependence measured this way has varied widely and has been unreliable. Longitudinal study involves following the same people for 15 years. It is tedious, difficult, and expensive but more reliable.

We now have the first follow up of a longitudinal study of a Stockholm elderly general population. This sample of 1,745 people aged 75 or older (76% women, 13% in institutions, average age 82 to 85 years old). There were 1,182 functionally independent people and 563 disabled (32%). The disabled had dementia (12%), heart disease (17%) stroke (9%) cancer (12%) and hip fracture (11%). One disease was present in 28% and 14% had more than one disease.

After 40 months the functional status of the whole population was followed by measuring the six ADL activities. Information was obtained from the subjects or from their guardians when mental ability was low. Functional dependence was defined as the need for assistance in one or more of the six ADLs.

Among chronic diseases only the interaction of dementia and heart disease added to functional dependency over that caused by dementia alone.

Functional dependency was present in one or more ADLs in 32% when the study began. So far another 14% have developed dependence within the 40 months of follow up. Age and dementia were associated with functional dependence throughout. Poor mental performance was also associated with dependence in the non-demented population. Half of the disability increase at follow up was caused by dementia. Thus age and poor scores in a brief mental status exam (a test based on the answers to 20 questions on orientation learning, attention and calculation, recall, language, and design) are good predictors of independent living. An easier test for the general physician or public is clock-dial drawing and inserting the hands at four thirty. It can be made more sophisticated with an objective scoring system.

Although heart, brain disease (largely stroke), and hip fracture were identified as causes of dependency at the start they had not added new cases of dependency during the follow up, death was the more likely consequence of these conditions. Cancer seems to have killed its victims before the baseline measurements were made.

My dance partner, elderly like me, was looking after an even more elderly parent. I have not yet found an elderly grandchild looking after an elderly grandparent but it could happen!

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See related Patient Topics Brain and Nervous System, Dementia, Mental Health and Behavior, Seniors' Health or Seniors' Health--General.

See related Provider Topics Brain and Nervous System, Dementia, Mental Health and Behavior, Seniors' Health or Seniors' Health--General.

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http://www.vh.org/adult/patient/internalmedicine/aba30/1998/dependency.html