Assessments of instrumental activities of daily living in low‐middle income countries: A systematic review

Abstract

AbstractBackgroundDementia prevalence in low‐middle income countries (LMIC) is projected to rise exponentially by 2050. However, less than 10% of people with dementia have a formal diagnosis, partially due to difficulties in clinically recognizing and diagnosing dementia. Culturally‐appropriate screening tools for dementia are needed. As functional impairments are fundamental elements of dementia diagnosis, assessments of instrumental activities of daily living (IADLs) may be appropriate screening tools. IADLS are complex daily tasks required to maintain functional independence (e.g. managing finances). They are susceptible to cultural variation, such as differences in gender roles cultural responsibilities of older adults in LMICs (e.g. social‐orientated activities). IADL assessments validated in high‐income countries may not be appropriate for LMICs. The aim of this systematic review is to identify IADL assessments which have been developed, validated or adapted for use in LMICs, and report how accurate, valid and reliable these tools are for identifying dementia.Method2,507 articles were systematically reviewed during title and abstract screen. 46 full‐text articles were reviewed for inclusion, with 16 English‐language articles confirmed and 13 currently undergoing final adjudication.ResultsFrom the confirmed 16 articles, 10 LMIC countries are represented (Figure 1). 16 different IADL assessments were investigated; two studies compared two different IADL tools. Eight (50%) were existing tools translated from their original language into a target language (in Brazil (n=4), Turkey (n=2), Iran (n=1), Argentina (n=1)), three (19%) were existing scales culturally adapted and translated to a target language (Brazil (n=3)), and six (38%) were novel tools developed for specific cultures (in Tanzania (n=1), India (n=2), Thailand (n=1), Nigeria (n=1), Republic of Congo and Central African Republic (n=1)). Eight studies (50%) reported accuracy of tools to correctly identify dementia. Sensitivity ranged between 63‐97% and specificity between 69‐100%.ConclusionFrom preliminary trends, bespoke culturally‐specific tools are more likely to be investigated in African and South Asian countries, while translated Western tools are more likely to be investigated in South American and West Asian countries. It is currently unclear which approach is best, but further synthesis will lead to recommendations regarding future validation and adoption of valid, reliable IADL tools in LMICs.