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Environ Health Prev Med (2013) 18:1623 DOI 10.1007/s12199-012-0283-9
REGULAR ARTICLE
Decreased activity of daily living produced by the combination of Alzheimers disease and lower limb fracture in elderly requiring nursing care
Toshimitsu Inagawa Toshio Hamagishi Yuji Takaso Yoshiaki Hitomi Yasuhiro Kambayashi
Yuri Hibino Aki Shibata Nguyen T. M. Ngoc Jiro Okochi Kotaro Hatta
Kiyoshi Takamuku Tadashi Konoshita Hiroyuki Nakamura
Received: 11 March 2012 / Accepted: 18 April 2012 / Published online: 11 May 2012 The Japanese Society for Hygiene 2012
AbstractObjectives Alzheimers disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture.
Methods We examined present illness and ADL in 4340 elderly aged 82.8 9.36 years [average standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants. Results We recognized that activities of cognitive function (p \ 0.001), eating (dysphagia) (p \ 0.001), eating (feeding) (p \ 0.001), and toilet use (p \ 0.001) in the elderly with AD were signicantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p \ 0.05), transfer and locomotion (p \ 0.001), and bathing (p \ 0.05) in the elderly with a fracture treated with surgery were signicantly lower, which differed from the results of AD. Signicant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p \ 0.001), dysphagia (p \ 0.01), feeding (p \ 0.001), and
toilet use (p \ 0.05) show that the combination had a much more profound inuence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery.
Conclusions These results demonstrated that the combined effects of AD and lower limb fracture were signicantly greater than expected additive effects...