Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training

Stone, Lydia; Heward, Jessica; Paddick, Stella-Maria; Dotchin, Catherine; Walker, Richard; Collingwood, Cecilia; Thornton, Jessica; Yarwood, Vanessa; McCartney, Judith; Irwin, Charlotte; Mkenda, Sarah; Kissima, John; Swai, Bernadette; Gray, William K.

doi:10.1177/0891988718790400

Cited by 9 publications

(20 citation statements)

References 17 publications

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“…A brief version of the IDEA instrumental activities of daily living questionnaire (IDEA‐IADL) for Tanzania was also administered 29,30 . The brief questionnaire has three questions that are asked to an informant who knows the participant well.…”

Section: Phase I Cognitive Screeningmentioning

confidence: 99%

“…Screening performance was stratified according to the combined performance in the IDEA cognitive screen and the IDEA‐IADL questionnaire in those with an informant (score 0–10: classified as impaired ‘probable dementia', score 11–13:classified borderline ‘possible dementia', score 14–21: classified normal ‘no dementia') 29 . In those without an informant, stratification was based only on performance in the IDEA cognitive screen (score 0–7: ‘probable dementia', score 8–9: ‘possible dementia', score 10–15: ‘no dementia') (22,24).…”

Section: Phase II Assessmentmentioning

confidence: 99%

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Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Yoseph

Paddick

Gray

et al. 2021

Int J Geriat Psychiatry

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Introduction Although limited, existing epidemiological data on dementia in sub‐Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high‐income countries. We have previously reported the age‐adjusted prevalence of dementia in rural Tanzania in 2009–2010 as 6.4% (95% confidence interval [CI] 4.9–7.9) in individuals aged ≥70 years. We aimed to repeat a community‐based dementia prevalence study in the same setting to assess whether prevalence has changed. Methods This was a two‐phase door‐to‐door community‐based cross‐sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA‐Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand‐held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM‐5 criteria and diagnoses subsequently confirmed by consensus panel. Results Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM‐5 dementia criteria. The age‐adjusted prevalence of dementia was 4.6% (95% CI 2.9–6.4) in those aged ≥60 years and 8.9% (95% CI 6.1–11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. Conclusions The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.

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Section: Phase I Cognitive Screeningmentioning

confidence: 99%

Section: Phase II Assessmentmentioning

confidence: 99%

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Yoseph

Paddick

Gray

et al. 2021

Int J Geriat Psychiatry

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“…Paddick, et al [28] reported 26.9% of participants with a diagnosis of dementia, while in the longitudinal study by Stone, et al [10] had 25% with dementia at baseline (n=153), and 36.7% at follow-up (n=98). Additionally, 33.3% of participants at baseline and 29.6% at follow-up had no formal education; education and literacy rates were not specified in Paddick, et al [28].…”

Section: Idea-instrumental Activities Of Daily Living Scale (Idea-iadl)mentioning

confidence: 98%

“…All articles were published between 1999-2019. Only one study carried out longitudinal analysis [10]. In order of quantity, countries represented by this review include Brazil (41%; n=9), India (13%; n=3), Turkey (9%; n=2), Tanzania (9%; n=2), Argentina (5%; n=1), Nigeria (5%; n=1), Republic of Congo (5%; n=1), Central African Republic (5%; n=1), Iran (5%; n=1), Sri Lanka (5%; n=1) and Thailand (5%; n=1) (see Figure 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

Yemm

Robinson

Paddick

et al. 2021

JAD

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Background: The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.

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Dementia in Africa: Current evidence, knowledge gaps, and future directions

Akinyemi

Yaria

Ojagbemi

et al. 2021

Alzheimer's & Dementia

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In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes.Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.

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Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training

Abstract: A brief IDEA-IADLs scale was developed and worked well in some villages. However, our study highlights a training need if brief screening tools to assess IADLs are to be effectively used by nonspecialists in low-resource settings.

Cited by 9 publications

References 17 publications

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009–2010 and 2018–2019: is there evidence of changing prevalence?

Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review

Dementia in Africa: Current evidence, knowledge gaps, and future directions

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