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Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study

Published online by Cambridge University Press:  01 May 2014

Clarissa M. Giebel*
School of Psychological Sciences, University of Manchester, Manchester, UK Personal Social Services Research Unit, University of Manchester, Manchester, UK
Caroline Sutcliffe
Personal Social Services Research Unit, University of Manchester, Manchester, UK
Minna Stolt
Department of Nursing Science, University of Turku, Turku, Finland
Staffan Karlsson
Department of Health Sciences, Lund University, Lund, Sweden
Anna Renom-Guiteras
School of Nursing Science, Faculty of Health, University of Witten/Herdecke, Witten, Germany
Maria Soto
Department of Geriatric Medicine, Gerontopole, INSERM 1027, University Hospital de Toulouse, Toulouse, France
Hilde Verbeek
Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
Adelaida Zabalegui
Hospital Clinic de Barcelona, Barcelona, Spain
David Challis
Personal Social Services Research Unit, University of Manchester, Manchester, UK
Correspondence should be addressed to: Clarissa M. Giebel, Personal Social Services Research Unit, University of Manchester, Dover Street Building, Oxford Road, M13 9PL Manchester, UK. Phone: +44-161-2755652; Fax: +44-161-2755790. Email:



Performing basic activities of daily living (ADLs) is one of the major difficulties encountered in dementia, which can have considerable negative impacts on the quality of life (QoL) of people with dementia (PwD). However, the extent to which basic ADL performance deteriorates across mild, moderate, and severe dementia is little examined and its impact, together with depression and neuropsychiatric behavior, upon QoL, is of considerable relevance across European countries.


Data were drawn from people living in the community who were participants in a large-scale European study on transition from community living to care homes of PwD. PwD completed measures on cognitive functioning and QoL, and informal carers reported upon QoL, depressive symptomatology, psychopathology, and functional ability of the PwD.


ADL performance deteriorated differently for each activity. In particular, toileting, transfer, and feeding remained relatively intact throughout, whereas performance on bathing and dressing deteriorated to a greater extent from mild to severe dementia. It appears that continence was not affected by the stage of dementia with similar levels of impairment. Basic ADL performance impacted to different degrees on QoL across dementia stages and countries.


Interventions aimed at maintaining independence or QoL need to target different ADLs across different dementia stages and perhaps also tailor interventions to the context of different countries. Findings contribute to the development of non-pharmaceutical interventions and governmental pledges to promote independence in dementia.

Research Article
Copyright © International Psychogeriatric Association 2014 

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