EVALUATING THE RISK OF DEPENDENCE IN ACTIVITIES OF DAILY LIVING AMONGCOMMUNITY-LIVING OLDER ADULTS WITH MILD-TO-MODERATE COGNITIVE IMPAIRMENT

Background. Although cognitive impairment has been implicated as a ris k factor for dependence in activities of daily living (ADLs), little i s known about the risk of ADL dependence among older adults with cogni tive impairment. Methods. Among a representative cohort of 1,103 commu nity-living adults aged 72 years and older, we evaluated the 237 subje cts with mild to moderate cognitive impairment who were independent in their basic ADLs. All cohort members had undergone a comprehensive as sessment, including a battery of qualitative and timed performance tes ts. Results. ADL dependence developed in 31 (16%) of the 197 subjects who had complete data at the 1-year follow-up. Of the self-reported ch aracteristics, only three - living alone, not being currently married, and having an impairment in IADL function - were significantly associ ated (p <.05) with the onset of ADL dependence. Several simple tests o f physical performance, on the other hand, were strongly associated wi th the development of ADL dependence. Both timed and qualitative perfo rmance tests successfully identified subjects at risk for ADL dependen ce. A combination of two performance tests - rapid gait and qualitativ e chair stands - was particularly effective at distinguishing subjects at low (4.7%) and high (34%-39%) risk for ADL dependence. Conclusions . Among community-living older adults with mild to moderate cognitive impairment, the risk of ADL dependence is high but varies considerably depending on how well and how quickly one can perform simple tasks of everyday function. An assessment strategy based on tests of physical performance may allow clinicians to identify subgroups of cognitively impaired elders at low and high risk for ADL dependence.