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Daily activities and suspected dementia among community-dwelling older adults: a cross-sectional study

BMC Geriatrics volume 24, Article number: 1046 (2024) Cite this article

Abstract

Background

Dementia is undiagnosed among many older adults, and more than half the people in local communities live with symptoms of dementia are not properly treated.

Objective

The study aims to explore the relationship between decline of daily activities and the incidence of suspected dementia.

Methods

A two-stage sampling method was used to conduct a multicenter cross-sectional survey. Older adults who have not been diagnosed as dementia were recruited from the local community. The Revised Hasegawa Dementia Scale (HDS-R) was used to evaluate the cognitive function. We evaluated daily activities from several aspects (bathing, dressing, toileting, grooming, feeding, transportation, walking, telephone, housekeeping, and taking medications). Logistic regression was adopted to assess the influence of daily activities on the risk of suspected dementia after controlling for the covariates.

Results

The analysis included 2458 individuals. Daily activities included toileting (OR = 1.830, 95%CI 1.581 ~ 2.119), grooming (OR = 1.938, 95%CI 1.659 ~ 2.265), dressing (OR = 1.771, 95%CI 1.542 ~ 2.033), bathing (OR = 1.793, 95%CI 1.591 ~ 2.022), feeding (OR = 1.821, 95%CI 1.565 ~ 2.118), transportation (OR = 1.996, 95%CI 1.743 ~ 2.285), walking (OR = 2.069, 95%CI 1.685 ~ 2.542), telephone (OR = 3.640, 95%CI 2.738 ~ 4.838), housekeeping (OR = 1.415, 95%CI 1.213 ~ 1.649), and taking medications (OR = 1.633, 95%CI 1.451 ~ 1.839) were still related to the incidence of suspected dementia after controlling for age, education, post-retirement work, social activity, drinking, smoking, living with spouses, and diabetes.

Conclusions

Daily activities were related to the incidence of suspected dementia. Daily activities were affected even if the older adults were not diagnosed as dementia. Timely and accurate diagnosis of dementia should be encouraged among community-dwelling older adults.

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Introduction

Dementia is a complex syndrome resulting from different neurodegenerative processes that lead to cognitive decline, affecting memory, language, perception, and executive functions [1]. However, many people with dementia never receive a diagnosis, and most cases in lower income countries are likely to be undiagnosed [2]. Dementia is undiagnosed among many Chinese older adults, and more than half the people in local communities live with symptoms of dementia are not properly treated [3]. As dementia is an irreversible disease [4], early diagnosis and detection of dementia are critical for its prevention and treatment.

Dementia often, but not invariably, begins with memory impairment and eventually progresses to a stage where the individual is unable to independently manage daily activities [5]. Daily activities include instrumental activities of daily living (IADLs), such as transportation or taking medications, and basic activities of daily living (BADLs), such as feeding or grooming [6]. The BADLs and IADLs are two different categories used to assess an older adults’ functional ability, when evaluating their capacity to live independently. The severity of dementia interfered with the older adult’s performance in daily activities [7]. Cognitive decline, motor impairments, behavioral and psychological symptoms of dementia influence daily activities performance in individuals with dementia. Previous studies have highlighted the complex interplay between these factors and their impact on daily activities [8].

Diagnosis of dementia in older adults with cognitive impairment was quite tricky, which made it impossible to identify underlying dementia and to perform therapy at the early stage [9]. Identification of the characteristics of people who have undiagnosed dementia is challenging [10] and this is our study to explore whether daily activities of undiagnosed dementia is normal [11]. Comparable to complex diagnosis methods, the Hasegawa Dementia Scale-Revised (HDS-R) is a valuable initial screening tool for identifying individuals who may need further evaluation of possible dementia [12]. Previous research suggested that daily activities may be an essential variable, when determining the severity of dementia [13, 14]. Moreover, the fundamental tasks of BADLs are essential for personal survival and independent living, and difficulty with BADLs often signifies the need for direct care assistance. In patients with dementia, impairment in IADLs occur soon after onset [15]. Therefore, it is particularly important to explore the relationships between of daily activities impairment and incidence of suspected dementia among community-dwelling older adults.

Methods

Study design

The present study employed a multi-center, cross-sectional design utilizing a two-stage sampling methodology. In the first stage, a random selection process was employed to choose 21 communities located in Nantong, an eastern city situated in China. According to the data from Nantong Civil Affairs Bureau in 2018, Nantong city is divided into Chongchuan District, Gangzha District, and Kaifa district. In 2018, each community had a total population of 1,219,700, with individuals over the 60 comprising 19.73% (240,600) of the population. Secondly, we numbered the selected communities and selected 1000 people randomly. They were then assessed according to inclusion criteria and home visit permits by telephone appointment.

The research was performed in accordance with the Declaration of Helsinki protocol obtained ethical approval from the Ethics Committee of the Affiliated Hospital of Nantong University (2018-K042) and was duly registered on the Clinical Trial Registry (ChiCTR1900020923) on 2019/01/22. Oral and written information on objectives, procedures, potential risks, and benefits was presented to all participants. They were told that they could withdraw from our study unconditionally. Before the protocol, each participant received written informed consent.

Participants

Participants included in this study were individuals aged 60 and above using auditory-verbal communication. In cases where multiple older adults were present within a family unit, only one participant was selected for investigation. Exclusion criteria encompassed the following conditions: 1) previously diagnosed dementia based on the DSM-IV criteria; 2) blindness; 3) aphasia; or 4) deafness. Data collection starts in January and continues until June 2019. Five full-time investigators surveyed from February to June 2019 (Fig. 1).

Fig. 1
figure 1

Flowchart of participants from eligibility to data analysis

Full size image

Data collection

Demographic data and clinical information

The demographic information was initially obtained through the Community Health Service Center’s registration data. A face-to-face evaluation obtains the HDS-R score to the older adults by our professional investigators. The older adults’ self-reports obtained the older adults’ personal history, as medical history and family history. The data on basic activities of daily living were collected from older individuals and their family members, typically their children or partners, which may lead to potential recall bias. To review the information of older individuals living alone, telephone interviews with their children or relatives should be conducted.

Social activities refer to any event, action, or gathering where individuals come together to interact, communicate, and engage with people besides family members.

Dementia

The Revised Hasegawa Dementia Scale is designed to assess cognitive functions [16], with a sensitivity of 0.90 and a specificity of 0.82. It helps in the early detection of dementia by identifying cognitive impairment that may indicate the onset of the condition. The HDS-R is composed of questions and tasks that assess multiple cognitive functions, such as orientation, attention, memory, language, and visuospatial abilities. The test usually has a total score of 30 points. A lower score indicates greater cognitive impairment. The HDS-R score is 20 / 21, which is used to distinguish normal cognition from dementia. Therefore, people who scored less than 21 are defined as suspected dementia, referring to an early stage when signs and symptoms suggest a person may have dementia, but not yet definitively diagnosed [17].

Daily activities

We selected seven questions to examine the degree of limitation of people’s daily activities. Basic activities of daily living included 5 items, such as bathing, dressing, toileting, grooming, and feeding. The 5 items had four answer options: cares for self, with minor assistance, needs moderate assistance, completely unable [18]. Instrumental activities of daily living included 5 items, such as transportation, walking, telephone, housekeeping, and taking medications [19]. We assessed older adult’s ability of walking using three options (walk freely, use of assistive devices, barely walk) and transportation using four options (using transportation for a long distance, for a short distance, unable to get outside of the house, barely move or move in the chamber). We assessed the ability of telephone using three options (operates telephone on own initiative, with minor assistance, does not use telephone all), housekeeping using four questions (cares for self, with minor assistance, needs moderate assistance, completely unable), and taking medications using four questions (cares for self, with minor assistance, needs moderate assistance, completely unable).

Statistical analysis

Statistical analysis was achieved with the SPSS 25.0. Two persons were engaged in data entry separately. Epidata 3.1 checked the input errors. In the case of a low proportion of missing data (0 ~ 5.28%), the case-wise deletion method was used to deal with missing data. Minimum sample size calculation was performed according to Lee et al. [20]. A single population proportion formula was used to estimate the sample size. The sample proportion was assumed to be 0.405. To produce a confidence interval with a width of no more than 0.05, 837 subjects were needed. Anticipating a 20% dropout rate, 1047 older adults were enrolled. In the bivariate logistics regression analysis, age, education, post-retirement work, social activity, drinking, smoking, living with spouses, and diabetes were taken as controlled variables.

Results

A subset of 2964 elderly individuals met the eligibility criteria out of the evaluated sample size of 3913. A total of 369 (12.45%) individuals declined participation in the present study. Out of the sample size of 2595 participants, 137 (5.28%) had missing data, leaving 2458 participants’ data for the analysis. 559 (22.7%) older individuals were evaluated using the HDS-R to assess suspected dementia. (Fig. 1)

Age (OR = 2.000, 95%CI 1.780 ~ 2.248), education (OR = 0.782, 95%CI 0.682 ~ 0.896), post-retirement work (OR = 0.531, 95%CI 0.397 ~ 0.709), housework allocation (OR = 0.458, 95%CI 0.375 ~ 0.558), types of housework (OR = 0.530, 95%CI 0.452 ~ 0.622), social activity (OR = 0.595, 95%CI 0.461 ~ 0.767), drinking (OR = 0.716, 95%CI 0.559 ~ 0.917), smoking (OR = 0.726, 95%CI 0.541 ~ 0.976), living with spouses (OR = 0.599, 95%CI 0.487 ~ 0.738), and diabetes (OR = 1.419, 95%CI 1.126 ~ 1.787) were related to the incidence of suspected dementia (Table 1).

Table 1 Demographic data and clinical information for the older people (n = 2458)
Full size table

Similarly, daily activities included toileting (OR = 1.830, 95%CI 1.581 ~ 2.119), grooming (OR = 1.938, 95%CI 1.659 ~ 2.265), dressing (OR = 1.771, 95%CI 1.542 ~ 2.033), bathing (OR = 1.793, 95%CI 1.591 ~ 2.022), feeding (OR = 1.821, 95%CI 1.565 ~ 2.118), transportation (OR = 1.996, 95%CI 1.743 ~ 2.285), walking (OR = 2.069, 95%CI 1.685 ~ 2.542), telephone (OR = 3.640, 95%CI 2.738 ~ 4.838), housekeeping (OR = 1.415, 95%CI 1.213 ~ 1.649), and taking medications (OR = 1.633, 95%CI 1.451 ~ 1.839) were still related to the incidence of suspected dementia after controlling for age, education, post-retirement work, social activity, drinking, smoking, living with spouses, and diabetes (Table 2).

Table 2 Binary logistics regression analysis of daily activities and suspected dementia
Full size table

Discussion

A significant finding for this research was that daily activities were related to the incidence of suspected dementia. 22.7% older adults in communities were considered suspected dementia using the HDS-R.

Older adults exhibiting preclinical symptoms such as toileting disability, grooming disability, bathing disability, dressing disability, bathing disability, and feeding disability were related to incidence of dementia. Among community-dwelling older adults, the decline of BADLs was usually the more noticeable symptom compared to IADLs, and to which early medical attention should be attached [21]. The most easily accomplished behavioral independence was eating, and the hardest was transfer to grooming and bathing [22]. Muscle weakness of the lower extremities [23], blurring of vision, and insensitivity to temperature [24] in the older adults have been implicated with difficulties in bathing. Among the older adults, the prevalence of toileting disability is relatively high and requires prevention and management [25]. The loss of the inhibitory influence on micturition reflex and involuntary bladder contraction can cause toileting disability because they failed to realize that they need to empty the bladder. Previous studies have proved that feeding was associated with significant differences in the measure of dementia [26]. Some articles [27, 28] found that nutritional status measured by the Mini Nutritional Assessment was associated with dementia, and the nutritional status of dementia residents was low. Swallowing dysfunction or dysphagia emerges in 13-57% of people with dementia [29]. Moreover, periodontitis is common in older people, associated with an elevated serum pro-inflammatory status and neuro inflammation [30]. Mounting evidence suggests that neuro inflammation is involved in the progression of dementia [31, 32]. Besides, the study found that dressing is an important activity of daily living, but many older adults have difficulty due to physical injury [33]. Common dressing problems include difficulties in sequencing, forgetting to change clothes and fastenings [34].

Although function of IADLs declines over time [35], there were significant differences between older adults with suspected dementia and normal older adults. Unusual behavior and mobility patterns [36], such as the absence of ability of transportation, housekeeping, telephone, walking and taking medications may be early symptoms of dementia. Clinic staff can differentiate older adults’ performance of those abilities, as the basis for measuring competence. It has been previously demonstrated that evaluating IADLs is a crucial part of dementia diagnostic procedure [15]. Dementia stigma is a key concern of dementia advocacy.

Timely and accurate diagnosis of dementia is the key to the prevention and treatment of dementia. Numerous studies identify dementia stigma as a major concern in dementia advocacy [37, 38]. Stigma has been viewed as a key barrier to community engagement, thereby leading to social isolation, reduced quality of life among people with dementia [39]. Many young couples in China have to deal with dual pressures from their careers and from their responsibilities as caregivers for older relatives. Early intervention is a major goal of dementia prevention. Both family caregivers and community nurses play an important role in the care of the disabled elderly at home. Our goal is to prevent dementia as soon as possible by early detection of the decline of daily living function. To help people with dementia and their caregivers individually, research exploring which individual activities affect dementia is needed. We expected to provide useful information for determining patients with dementia as early as possible and contributing to social, health, and economic policies for people with dementia and their caregivers. Findings are beneficial to effective care management and the design of non-pharmaceutical interventions. The physical activity program improves cognitive function and BADLs in individuals with mild dementia [40]. Engaging in daily activity potentially exerts protective effects on cognitive function, including continuous cerebral blood flow, enhanced aerobic capacity, brain nutrient supply, and growth factors. Notably, one such growth factor is the brain-based neurotrophic factor, which facilitates neuronal survival, improves learning abilities, and mitigates cognitive decline [41]. Nursing strategies, such as verbal clues, gesticulates, or physical exercise guidance, can effectively maintain the functional ability of older adults with cognitive impairment if these strategies are used continuously in activities of daily living.

One of the strengths of this study was the large sample size of participants. At the same time, conducting surveys in the community is also our advantage. The data was based on community records and the older adults’ self-report, which may cause recall bias.

Limitation

Our study has some limitations. We used a scale to screen suspected dementia. Diagnosing suspected dementia involves a comprehensive assessment to distinguish it from other conditions that can cause similar symptoms. We selected ten questions to examine the degree of limitation of people’s daily activities. Further follow-up studies could use a standardized and validated scale. Finally, cross-sectional studies cannot identify the causal relationship between dementia and these variables, such as daily activities, age, education level, social activities and housework types. Further clinical randomized controlled studies are needed to clarify the causal relationship.

Conclusion

The data in this study suggest that through daily activities maintenance or promotion, it is possible to prevent or improve dementia with a highly structured behavioral nursing intervention and systematic approaches. Nursing research regarding behavioral gerontology in China has recently been carried out to describe and identify these concepts relevant to nursing practice. Thus, the need for further study is critical. Monitoring changes in daily activities over time can help healthcare professionals assess disease progression, tailor interventions, and provide appropriate support to enhance the individual’s quality of life.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

ADLs:

activities of daily living

BADLs:

Basic Activities of Daily Living

HDS-R:

The Revised Hasegawa Dementia Scale

IADLs:

Instrumental Activities of Daily Living

OR:

Odds Ratio

References

  1. Farfel JM, Capuano AW, Buchman AS, Schneider JA, Bennett DA. Association of Alzheimer’s Disease and Other Neuropathologies with Functional Disability in Persons With and Without Dementia. J Gerontol Biol Sci Med Sci. 2024.

  2. Ranson JM, Kuzma E, Hamilton W, Lang I, Llewellyn DJ. Case-finding in clinical practice: an appropriate strategy for dementia identification? Alzheimers Dement (N Y). 2018;4:288–96.

    Article  PubMed  Google Scholar 

  3. Gong N, Yang D, Zou J, He Q, Hu L, Chen W, Liao J. Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model. Bmc Geriatr. 2023;23(1):55.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jack CR. Advances in Alzheimer’s disease research over the past two decades. Lancet Neurol. 2022;21(10):866–9.

    Article  PubMed  Google Scholar 

  5. Kanapathy A, Nik Jaafar NR, Shaharir SS, Chan LF, Rozita M, Ch’ng SS. Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia. Lupus. 2019;28(7):854–61.

    Article  CAS  PubMed  Google Scholar 

  6. Vetrano DL, Roso-Llorach A, Fernandez S, Guisado-Clavero M, Violan C, Onder G, Fratiglioni L, Calderon-Larranaga A, Marengoni A. Twelve-year clinical trajectories of multimorbidity in a population of older adults. Nat Commun. 2020;11(1):3223.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. McDougall GJ, Han A, Staggs VS, Johnson DK, McDowd JM. Predictors of instrumental activities of daily living in community-dwelling older adults. Arch Psychiat Nurs. 2019;33(5):43–50.

    Article  Google Scholar 

  8. Becker S, Bode M, Brockmann K, Gasser T, Michaelis K, Solbrig S, Nuerk HC, Schulte C, Maetzler W, Zimmermann M, et al. Cognitive-driven activities of Daily Living Impairment as a predictor for Dementia in Parkinson Disease. Neurology. 2022;99(23):E2548–60.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gong Q, Ishii M, Numata O, Xie W, Hirata T. Utility of a shortened Hasegawa Dementia Scale revised questionnaire to rapidly screen and diagnose Alzheimer’s disease. Aging Med (Milton). 2021;4(2):109–14.

    Article  PubMed  Google Scholar 

  10. Cohen RA, Marsiske MM, Smith GE. Neuropsychology of aging. Handb Clin Neurol. 2019;167:149–80.

    Article  PubMed  Google Scholar 

  11. Holmes SD, Resnick B, Galik E, Levy S, Scherr S, O’Brien E. Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living. Aging Ment Health. 2024:1–7.

  12. Fujita K, Katsuki M, Takasu A, Kitajima A, Shimazu T, Maruki Y. Development of an artificial intelligence-based diagnostic model for Alzheimer’s disease. Aging Med (Milton). 2022;5(3):167–73.

    Article  PubMed  Google Scholar 

  13. Burridge G, Amato C, Bye R, Basic D, Ni Chroinin D, Hill S, Howe K, Liu KPY. Strategies adopted by informal carers to enhance participation in daily activities for persons with dementia. Australas J Ageing. 2024.

  14. Alfeo F, Lanciano T, Abbatantuono C, Gintili G, De Caro MF, Curci A, Taurisano P. Cognitive, emotional, and Daily Functioning domains involved in decision-making among patients with mild cognitive impairment: a systematic review. Brain Sci. 2024; 14(3).

  15. Suzuki Y, Sudo T, Mochizuki H. Awareness of Instrumental activities of Daily Living disability: pilot study for Elderly Requiring Care and caregivers. Dement Geriatr Cogn Dis Extra. 2022;12(2):94–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nonaka Y, Fujii R, Tanaka S, Tabira K. Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure. Jpn J Compr Rehabil Sci. 2023;14:78–83.

    Article  PubMed  Google Scholar 

  17. Ng CKM, Leung DKY, Cai X, Wong GHY. Perceived help-seeking difficulty, barriers, Delay, and Burden in Carers of people with suspected dementia. Int J Environ Res Public Health. 2021; 18(6).

  18. Liu M, Hou T, Li Y, Sun X, Szanton SL, Clemson L, Davidson PM. Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study. Bmc Geriatr. 2021;21(1):350.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jung YS, Park T, Kim EK, Jeong SH, Lee YE, Cho MJ, Song KB, Choi YH. Influence of Chewing Ability on Elderly Adults’ Cognitive Functioning: The Mediating Effects of the Ability to Perform Daily Life Activities and Nutritional Status. Int J Environ Res Public Health 2022, 19(3).

  20. Lee ATC, Richards M, Chan WC, Chiu HFK, Lee RSY, Lam LCW. Association of Daily Intellectual activities with Lower Risk of Incident Dementia among older Chinese adults. JAMA Psychiatry. 2018;75(7):697–703.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Liu C, Fong JH, Hoh JWT, Wu H, Dong Y, Gu D, Feng Q. Bathing and toileting difficulties of older adults in rural China: the role of environment. Bmc Geriatr. 2020;20(1):533.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nakayama N, Suzuki M, Endo A, Nitanda Y, Tanabe N, Watanabe A, Fukuda M, Endo T. Impact of dementia on behavioral independence and disturbance. Geriatr Gerontol Int. 2017;17(4):605–13.

    Article  PubMed  Google Scholar 

  23. Zou C, Amos-Richards D, Jagannathan R, Kulshreshtha A. Effect of home-based lifestyle interventions on cognition in older adults with mild cognitive impairment: a systematic review. Bmc Geriatr. 2024;24(1):200.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brown RT, Diaz-Ramirez LG, Boscardin WJ, Cappola AR, Lee SJ, Steinman MA. Changes in the Hierarchy of Functional Impairment from Middle Age to Older Age. J Gerontol Biol Sci Med Sci. 2022;77(8):1577–84.

    Article  Google Scholar 

  25. Fong JH, Feng Q. Toileting Disability among older adults in China and Role of Environmental factors. J Aging Health. 2021;33(10):852–64.

    Article  PubMed  Google Scholar 

  26. Kim MS, Han DH. Does reduced chewing ability efficiency influence cognitive function? Results of a 10-year national cohort study. Medicine. 2022; 101(25).

  27. Zhang XY, Li YQ, Yin ZH, Bao QN, Xia MZ, Chen ZH, Zhong WQ, Wu KX, Yao J, Liang FR. Supplements for cognitive ability in patients with mild cognitive impairment or Alzheimer’s disease: a protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ Open. 2024;14(4):e077623.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wang ZL, McHale JR, Belza B, Sonney J. Eating experiences in people living with dementia: A concept analysis using Rodgers’s methodology. J Adv Nurs. 2024.

  29. Chen JT, Tsai S, Chen MH, Pitiphat W, Matangkasombut O, Chiou JM, Han ML, Chen JH, Chen YC. Association between Oral Health and cognitive impairment in older adults: insights from a six-year prospective cohort study. J Dent. 2024:105088.

  30. Zekeridou A, Mombelli A, Cancela J, Courvoisier D, Giannopoulou C. Systemic inflammatory burden and local inflammation in periodontitis: what is the link between inflammatory biomarkers in serum and gingival crevicular fluid? Clin Exp Dent Res. 2019;5(2):128–35.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thakur S, Dhapola R, Sarma P, Medhi B, Reddy DH. Neuroinflammation in Alzheimer’s Disease: current progress in Molecular Signaling and therapeutics. Inflammation. 2023;46(1):1–17.

    Article  CAS  PubMed  Google Scholar 

  32. Leng F, Edison P. Neuroinflammation and microglial activation in Alzheimer disease: where do we go from here? Nat Rev Neurol. 2021;17(3):157–72.

    Article  PubMed  Google Scholar 

  33. Delwel S, Maier AB, Parvaneh D, Meijers J, Scherder EJA, Lobbezoo F. Chewing efficiency, global cognitive functioning, and dentition: a cross-sectional observational study in older people with mild cognitive impairment or mild to moderate dementia. Front Aging Neurosci. 2020;12:225.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Buse C, Twigg J. Dressing disrupted: negotiating care through the materiality of dress in the context of dementia. Sociol Health Illn. 2018;40(2):340–52.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Yang J, Zhang Y, Shen S, Yu H, Yang L, Zhao Y, Xiong Y, Su J, Wang L, Lei X. Instrumental activities of daily living trajectories and risk of mild cognitive impairment among Chinese older adults: results of the Chinese longitudinal healthy longevity survey, 2002–2018. Front Public Health. 2023;11:1165753.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Anton MA, Ordieres-Mere J, Saralegui U, Sun S. Non-invasive Ambient Intelligence in Real Life: dealing with noisy patterns to help older people. Sens (Basel). 2019; 19(14).

  37. Farina N, Hughes LJ, Jones E, Parveen S, Griffiths AW, Galvin K, Banerjee S. The effect of a dementia awareness class on changing dementia attitudes in adolescents. Bmc Geriatr. 2020;20(1):188.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Low LF, Purwaningrum F. Negative stereotypes, fear and social distance: a systematic review of depictions of dementia in popular culture in the context of stigma. Bmc Geriatr. 2020;20(1):477.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hung L, Leitch S, Hung R, Phinney A. Creating dementia-friendly and inclusive communities for social inclusion: a scoping review protocol. BMJ Open. 2020;10(6):e035028.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Satoh M, Ogawa JI, Tokita T, Nakaguchi N, Nakao K, Kida H, Tomimoto H. Physical Exercise with Music maintains activities of Daily living in patients with dementia: Mihama-Kiho Project Part 21. J Alzheimers Dis. 2017;57(1):85–96.

    Article  PubMed  Google Scholar 

  41. Miranda M, Morici JF, Zanoni MB, Bekinschtein P. Brain-derived neurotrophic factor: a key molecule for memory in the healthy and the pathological brain. Front Cell Neurosci. 2019;13:363.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank the staff of all communities for their kindness and collaboration. We gratitude to all the study participants, data collectors and supervisors.

Funding

This work was supported by the Project of Philosophy and Social Science Research in Colleges and Universities of Jiangsu Province under Grant number 2021SJZDA055.

Author information

Author notes

  1. Shuhan Yan and Zihan Geng contributed equally to this work and should be considered co-first author.

Authors and Affiliations

  1. School of Nursing and Rehabilitation, Nantong University, No.19 Qixiu Road, Nantong City, Jiangsu Province, China

    Shuhan Yan, Yaqin Shi & Feng Zhang

  2. Health School attached to Shanghai University of Medicine & Health Sciences, Shanghai, China

    Shuhan Yan

  3. Medical College, Nantong University, Nantong City, Jiangsu Province, China

    Zihan Geng & Jie Zhang

  4. Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong City, Jiangsu Province, China

    Huahua Liu & Zhifang Chen

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Contributions

FZ and YQS conceptualized the research questions, conducted data collection and statistical analyses, coordinated and supervised data collection, critically revised manuscript and approved the final manuscript as submitted.SHY and ZHG helped conceptualize the research questions, helped design the data collection methods, drafted the initial and revised manuscripts, and approved the final manuscript as submitted. JZ, HHL, and ZFC helped the research design, collected and inputted the data, conducted statistical analyses, helped draft the initial manuscript, and approved the final manuscript as submitted.

Corresponding authors

Correspondence to Yaqin Shi or Feng Zhang.

Ethics declarations

Ethics approval and consent to participate

The research was performed in accordance with the Declaration of Helsinki and the protocol obtained ethical approval from the Ethics Committee of the Affiliated Hospital of Nantong University (2018-K042) and was duly registered on the Clinical Trial Registry (ChiCTR1900020923). Oral and written information on objectives, procedures, potential risks, and benefits was presented to all participants. They were told that they could withdraw from our study unconditionally. Before the protocol, each participant received written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Yan, S., Geng, Z., Zhang, J. et al. Daily activities and suspected dementia among community-dwelling older adults: a cross-sectional study. BMC Geriatr 24, 1046 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05648-0

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05648-0

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BMC Geriatrics

ISSN: 1471-2318

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