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Am J Public Health. 1998 October; 88(10): 1452–1456.
PMCID: PMC1508485

Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study.


OBJECTIVES: The purpose of this investigation was to study the role of dementia and other common age-related diseases as determinants of dependence in activities of daily living (ADL) in the elderly. METHODS: The study population consisted of 1745 persons, aged 75 years and older, living in a district of Stockholm. They were examined at baseline and after a 3-year follow-up interval. Katz's index was used to measure functional status. Functional dependence at baseline, functional decline, and development of functional dependence at follow-up were examined in relation to sociodemographic characteristics and chronic conditions. RESULTS: At baseline, factors associated with functional dependence were age, dementia, cerebrovascular disease, heart disease, and hip fracture. However, only age and dementia were associated with the development of functional dependence and decline after 3 years. In a similar analysis, including only nondemented subjects. Mini-Mental State Examination scores emerged as one of the strongest determinants. The population attributable risk percentage of dementia in the development of functional dependence was 49%. CONCLUSIONS: In a very old population, dementia and cognitive impairment make the strongest contribution to both the development of long-term functional dependence and decline in function.

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  • Corti MC, Guralnik JM, Salive ME, Sorkin JD. Serum albumin level and physical disability as predictors of mortality in older persons. JAMA. 1994 Oct 5;272(13):1036–1042. [PubMed]
  • Guralnik JM. Understanding the relationship between disease and disability. J Am Geriatr Soc. 1994 Oct;42(10):1128–1129. [PubMed]
  • Wiener JM, Hanley RJ, Clark R, Van Nostrand JF. Measuring the activities of daily living: comparisons across national surveys. J Gerontol. 1990 Nov;45(6):S229–S237. [PubMed]
  • Winblad I. Comparison of the prevalence of disability in two birth cohorts at the age of 75 years and over. J Clin Epidemiol. 1993 Mar;46(3):303–308. [PubMed]
  • Guralnik JM, Simonsick EM. Physical disability in older Americans. J Gerontol. 1993 Sep;48(Spec No):3–10. [PubMed]
  • Fried LP, Ettinger WH, Lind B, Newman AB, Gardin J. Physical disability in older adults: a physiological approach. Cardiovascular Health Study Research Group. J Clin Epidemiol. 1994 Jul;47(7):747–760. [PubMed]
  • Boult C, Kane RL, Louis TA, Boult L, McCaffrey D. Chronic conditions that lead to functional limitation in the elderly. J Gerontol. 1994 Jan;49(1):M28–M36. [PubMed]
  • Campbell AJ, Busby WJ, Robertson MC, Lum CL, Langlois JA, Morgan FC. Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over. Disabil Rehabil. 1994 Apr-Jun;16(2):72–79. [PubMed]
  • Pinsky JL, Jette AM, Branch LG, Kannel WB, Feinleib M. The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community. Am J Public Health. 1990 Nov;80(11):1363–1367. [PMC free article] [PubMed]
  • Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, Kelly-Hayes M, Wolf PA, Kreger BE, Kannel WB. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994 Mar;84(3):351–358. [PMC free article] [PubMed]
  • Chen P, Yu ES, Zhang M, Liu WT, Hill R, Katzman R. ADL dependence and medical conditions in Chinese older persons: a population-based survey in Shanghai, China. J Am Geriatr Soc. 1995 Apr;43(4):378–383. [PubMed]
  • Mulrow CD, Gerety MB, Cornell JE, Lawrence VA, Kanten DN. The relationship between disease and function and perceived health in very frail elders. J Am Geriatr Soc. 1994 Apr;42(4):374–380. [PubMed]
  • Tuomilehto J, Nuottimäki T, Salmi K, Aho K, Kotila M, Sarti C, Rastenytè D. Psychosocial and health status in stroke survivors after 14 years. Stroke. 1995 Jun;26(6):971–975. [PubMed]
  • Bassett SS, Folstein MF. Cognitive impairment and functional disability in the absence of psychiatric diagnosis. Psychol Med. 1991 Feb;21(1):77–84. [PubMed]
  • Warren EJ, Grek A, Conn D, Herrmann N, Icyk E, Kohl J, Silberfeld M. A correlation between cognitive performance and daily functioning in elderly people. J Geriatr Psychiatry Neurol. 1989 Apr-Jun;2(2):96–100. [PubMed]
  • Kelly-Hayes M, Jette AM, Wolf PA, D'Agostino RB, Odell PM. Functional limitations and disability among elders in the Framingham Study. Am J Public Health. 1992 Jun;82(6):841–845. [PMC free article] [PubMed]
  • Palmore EB, Nowlin JB, Wang HS. Predictors of function among the old-old: a 10-year follow-up. J Gerontol. 1985 Mar;40(2):244–250. [PubMed]
  • Moritz DJ, Kasl SV, Berkman LF. Cognitive functioning and the incidence of limitations in activities of daily living in an elderly community sample. Am J Epidemiol. 1995 Jan 1;141(1):41–49. [PubMed]
  • Reed BR, Jagust WJ, Seab JP. Mental status as a predictor of daily function in progressive dementia. Gerontologist. 1989 Dec;29(6):804–807. [PubMed]
  • Freels S, Cohen D, Eisdorfer C, Paveza G, Gorelick P, Luchins DJ, Hirschman R, Ashford JW, Levy P, Semla T, et al. Functional status and clinical findings in patients with Alzheimer's disease. J Gerontol. 1992 Nov;47(6):M177–M182. [PubMed]
  • Mortimer JA, Ebbitt B, Jun SP, Finch MD. Predictors of cognitive and functional progression in patients with probable Alzheimer's disease. Neurology. 1992 Sep;42(9):1689–1696. [PubMed]
  • Fitz AG, Teri L. Depression, cognition, and functional ability in patients with Alzheimer's disease. J Am Geriatr Soc. 1994 Feb;42(2):186–191. [PubMed]
  • Fratiglioni L, Viitanen M, Bäckman L, Sandman PO, Winblad B. Occurrence of dementia in advanced age: the study design of the Kungsholmen Project. Neuroepidemiology. 1992;11 (Suppl 1):29–36. [PubMed]
  • Fratiglioni L, Grut M, Forsell Y, Viitanen M, Grafström M, Holmén K, Ericsson K, Bäckman L, Ahlbom A, Winblad B. Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991 Dec;41(12):1886–1892. [PubMed]
  • Fratiglioni L, Grut M, Forsell Y, Viitanen M, Winblad B. Clinical diagnosis of Alzheimer's disease and other dementias in a population survey. Agreement and causes of disagreement in applying Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Criteria. Arch Neurol. 1992 Sep;49(9):927–932. [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
  • Grut M, Fratiglioni L, Viitanen M, Winblad B. Accuracy of the Mini-Mental Status Examination as a screening test for dementia in a Swedish elderly population. Acta Neurol Scand. 1993 Apr;87(4):312–317. [PubMed]
  • Brorsson B, Asberg KH. Katz index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med. 1984;16(3):125–132. [PubMed]
  • Heitjan DF. Annotation: what can be done about missing data? Approaches to imputation. Am J Public Health. 1997 Apr;87(4):548–550. [PMC free article] [PubMed]
  • Birge SJ, Morrow-Howell N, Proctor EK. Hip fracture. Clin Geriatr Med. 1994 Nov;10(4):589–609. [PubMed]
  • Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc. 1994 Apr;42(4):368–373. [PubMed]

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