A Direct Performance Test for Assessing Activities of Daily Living in Patients with Mild Degenerative Dementia: The Development of the ETAM and Preliminary Results

Abstract

Background: There are currently only a few performance tests that assess the capacity to perform activities of daily living. These measures frequently require a long time to administer, are strongly cognition oriented, or have not been adequately validated. Methods: The Erlangen Test of Activities of Daily Living in Mild Dementia (ETAM) was developed in a 4-phase process that was based on the International Classification of Functioning, Disability, and Health (ICF). A pilot study was conducted on 30 subjects with mild dementia with a mean age of 80 years. The subjects' mean score on the MMSE was 21.5. Twenty-one of the 30 subjects were women. Results: Ten items were developed and tested in the pilot study. The mean time required to complete the test was 26 min. The item analysis showed difficulties that ranged primarily from r = 0.28 to r = 0.79. The ETAM had a moderate correlation with the MMSE (r_MMSE = 0.310) and a low correlation with the Geriatric Depression Scale-15 (GDS-15; r_GDS-15 = 0.149). Conclusion: The preliminary version of the ETAM is quick and easy to use and has predominantly satisfactory item characteristics. There still is the need to revise the items ‘giving directions' and ‘making tea' with regard to standardisation.

Validation of the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM)

“…In a review of performance-based measures of functional living skills, Moore et al suggested that the development of new measures should focus on brevity, should include items determined by patients or caregivers and selected by an empirical procedure, and should be comprised of tasks with “real world functioning” [ 19 ]. We tried to follow these recommendations in the development and validation of the ETAM [ 31 ].…”

“…The ICF domain “Communication” was represented on the ETAM only by the “Phone call” item, which had already demonstrated satisfactory psychometric characteristics in the pilot study [ 31 ]. Handling phone calls is highly relevant in practice and more future-oriented than, for example, writing a letter.…”

“…The acceptance and item characteristics of the resulting items and the time required for administration were investigated in 30 persons. For a more detailed description see [ 31 ]. The results of this study provided some initial indications of positive psychometric characteristics and economy in terms of the amount of resources required and a short administration time.…”

“…Making a call with a mobile phone for older adults, listening to and reporting the text of a voicemail. Chapter 4 Mobility Traffic situations (6 points) Understanding basic rules in road traffic situations on the basis of example situations (e.g., traffic lights) Train timetable (3 points) Calculating the time before the train comes and the duration of the train ride Chapter 5 Self-care Medication indication (6 points) Assigning a particular medication to an indication (pain killers, cough medicine, for stomach problems) Medication expiry (6 points) Checking how long a medication can still be used (using the expiry date) Pill organiser (6 points) a Placing medications in a pill organiser according to a predefined schedule, for 4 different times of day for a particular day Chapter 6 Domestic life Making tea (3 points) Making a cup of tea with a kettle Alarm clock (3 points) Reading and setting times Washing the dishes (6 points) Washing and drying the teacups that have been used Chapter 8 Major life areas – economic life Finances (6 points) Comparing offers, adding up sums of money, counting money a This item was formerly called “medication box” in the pilot study [ 31 ] …”

“…The research version of the ETAM consisted of 10 items (see Table 1 ) specifically developed for MCI/mild dementia [ 31 ]. The ETAM addresses the capacity to accomplish complex activities of daily living that cover the areas of living relevant to older adults living alone, i.e., communication, mobility, self-care, domestic life, and economic life (a major life area) from the ICF domain “Activities and Participation” [ 5 ].…”