Annals of Long Term Care

BRIEF METHODOLOGICAL REPORTS
Mild Cognitive Impairment and Objective Instrumental Everyday Functioning: The Everyday Cognition Battery Memory Test
Jason C. Allaire, PhD, Alyssa Gamaldo, MS, Brian J. Ayotte, PhD, Regina Sims, PhD, and Keith Whitfield, PhD

OBJECTIVES: To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status.

DESIGN: Cross-sectional.

SETTING: Independent-living sample of urban dwelling elders in Baltimore Maryland.

PARTICIPANTS: The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 ± 9.6).

MEASUREMENTS: Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed.

RESULTS: No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F3, 507=21.88, P<.05, η2=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94–0.99) and financial management (OR=0.93, 95% CI=0.91–0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI.

CONCLUSION: This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency. J Am Geriatr Soc 2009;57(1):120-125.

Inappropriate Medication Use as a Risk Factor for Self-Reported Adverse Drug Effects in Older Adults
Elizabeth A. Chrischilles, PhD, Rachel VanGilder, PhD, Kara Wright, MS, Michael Kelly, PharmD, and Robert B. Wallace, MD, MS

OBJECTIVES: To determine the association between inappropriate medication use and self-reported adverse drug effects (ADEs).

DESIGN: Prospective cohort study with three annual mailed surveys.

SETTING: Population-based sample of Iowa Medicare beneficiaries.

PARTICIPANTS: Cohort members (n=626) with established mobility disability and complete pharmacy dispensing records, continuous Medicare eligibility, and survey data.

MEASUREMENTS: The number of unique drug ingredients dispensed and inappropriate use were assessed for the year before the ADE survey. Inappropriate medication use was defined according to published criteria: contraindicated drugs for elderly people, drug–disease interactions (constructed from linked Medicare claims), drug–drug interactions, and therapeutic duplications. An ADE was defined from the following question: "In the past 12 months, have you experienced an unwanted effect or side effect of a medication?"

RESULTS: Of respondents to the ADE survey, 22.0% reported having experienced an ADE in the past year, and 322 (51.4%) received at least one potential inappropriate medication. Factors associated univariately with ADE self-report were number of medications, number of mobility limitations, any inappropriate medication use, and each of the individual domain appropriateness indicators, as well as number of different domains of inappropriate use.