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ObjectiveThis study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline.MethodsA total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored

ObjectivesTo investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes.DesignA comparative cross-sectional study.Setting and ParticipantsParticipants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China.MethodsNeuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating.ResultsThis study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent “very severe” symptom, while sleep disorders and agitation caused the most frequent “very severe” caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36–0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia.Conclusions and ImplicationsTailored management strategies to relieve family caregivers’ BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.

ObjectivesTo evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis.DesignA multi-country cross-sectional study.Setting and ParticipantsNineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included.MethodsUnidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated.ResultsItem reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The “mobility” was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients’ ability (person location = −2.27 logits). The “stairs climbing” and “mobility” showed narrow category thresholds (< 1.4 logits). The location of “controlling bladder” and “toilet use” overlapped. Removing “stairs climbing”, collapsing categories with narrow threshold widths in “mobility”, and combining “controlling bowel” and “controlling bladder” into one item, improved unidimensionality, and item fit of the scale. Only three items (“grooming”, “dressing”, and “toilet use”) were free from DIF across countries. The scores for “feeding” were negatively related to scores for “disinhibition” (r = −0.46, P < 0.01), and scores for “controlling bowel” were negatively related to scores for “disinhibition” (r = −0.44, P < 0.01), “agitation” (r = −0.32, P < 0.05), and “aggression” (r = −0.27, P < 0.01) in Japanese samples.Conclusions and ImplicationsThe performance of the BI for assessing patients with dementia might be compromised by misfit items, person–item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.