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Melikyan ZA, Corrada MM, Dick MB, Whittle C, Paganini-Hill A, Kawas CH. Neuropsychological Test Norms in Cognitively Intact Oldest-Old. J Int Neuropsychol Soc 2019; 25:530-545. [PMID: 31122309 PMCID: PMC6538395 DOI: 10.1017/s1355617719000122] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Individuals aged 90 or older (oldest-old), the fastest growing segment of the population, are at increased risk of developing cognitive impairment compared with younger old. Neuropsychological evaluation of the oldest-old is important yet challenging in part because of the scarcity of test norms for this group. We provide neuropsychological test norms for cognitively intact oldest-old. METHODS Test norms were derived from 403 cognitively intact participants of The 90+ Study, an ongoing study of aging and dementia in the oldest-old. Cognitive status of intact oldest-old was determined at baseline using cross-sectional approach. Individuals with cognitive impairment no dementia or dementia (according to DSM-IV criteria) were excluded. Participants ranged in age from 90 to 102 years (mean=94). The neuropsychological battery included 11 tests (Mini-Mental Status Examination, Modified Mini-Mental State Examination, Boston Naming Test - Short Form, Letter Fluency Test, Animal Fluency Test, California Verbal Learning Test-II Short Form, Trail Making Tests A/B/C, Digit Span Forward and Backwards Test, Clock Drawing Test, CERAD Construction Subtests), and the Geriatric Depression Scale. RESULTS Data show significantly lower scores with increasing age on most tests. Education level, sex, and symptoms of depression were associated with performance on several tests after accounting for age. CONCLUSIONS Provided test norms will help to distinguish cognitively intact oldest-old from those with cognitive impairment. (JINS, 2019, 25, 530-545).
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Affiliation(s)
- Zarui A Melikyan
- 1Institute for Memory Impairments and Neurological Disorders,University of California,Irvine,California
| | - Maria M Corrada
- 1Institute for Memory Impairments and Neurological Disorders,University of California,Irvine,California
| | - Malcolm B Dick
- 1Institute for Memory Impairments and Neurological Disorders,University of California,Irvine,California
| | - Christina Whittle
- 1Institute for Memory Impairments and Neurological Disorders,University of California,Irvine,California
| | | | - Claudia H Kawas
- 1Institute for Memory Impairments and Neurological Disorders,University of California,Irvine,California
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Kumar H, Arokiasamy P, Selvamani Y. Socioeconomic Disadvantage, Chronic Diseases and their Association with Cognitive Functioning of Adults in India: A Multilevel Analysis. JOURNAL OF POPULATION AGEING 2019. [DOI: 10.1007/s12062-019-09243-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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53
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Liao H, Zhu Z, Wang H, Rong X, Young CA, Peng Y. Cognitive Performance Concomitant With Vision Acuity Predicts 13-Year Risk for Mortality. Front Aging Neurosci 2019; 11:65. [PMID: 30967772 PMCID: PMC6439522 DOI: 10.3389/fnagi.2019.00065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/06/2019] [Indexed: 01/04/2023] Open
Abstract
Objective: To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample. Methods: Data from National Health and Nutrition Examination Survey (NHANES) participants (≥18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders. Results: A total of 2,550 participants 60 years and older from two waves of (NHANES, 1999–2000, 2001–2002) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02–3.70; P < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30–6.00; P < 0.001) compared to having neither impairment. Conclusion: People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.
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Affiliation(s)
- Huan Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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54
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Besser J, Stropahl M, Urry E, Launer S. Comorbidities of hearing loss and the implications of multimorbidity for audiological care. Hear Res 2018; 369:3-14. [DOI: 10.1016/j.heares.2018.06.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022]
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55
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Leon M, Woo C. Environmental Enrichment and Successful Aging. Front Behav Neurosci 2018; 12:155. [PMID: 30083097 PMCID: PMC6065351 DOI: 10.3389/fnbeh.2018.00155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
The human brain sustains a slow but progressive decline in function as it ages and these changes are particularly profound in cognitive processing. A potential contributor to this deterioration is the gradual decline in the functioning of multiple sensory systems and the effects they have on areas of the brain that mediate cognitive function. In older adults, diminished capacity is typically observed in the visual, auditory, masticatory, olfactory, and motor systems, and these age-related declines are associated with both a decline in cognitive proficiency, and a loss of neurons in regions of the brain. We will review how the loss of hearing, vision, mastication skills, olfactory impairment, and motoric decline accompany cognitive loss, and how improved functioning of these systems may aid in the restoration of the cognitive abilities in older adults. The human brain appears to require a great deal of stimulation to maintain its cognitive efficacy as people age and environmental enrichment may aid in its maintenance and recovery.
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Affiliation(s)
- Michael Leon
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Cynthia Woo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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56
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Mudie LI, Varadaraj V, Gajwani P, Munoz B, Ramulu P, Lin FR, Swenor BK, Friedman DS, Zebardast N. Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function. PLoS One 2018; 13:e0199889. [PMID: 29979753 PMCID: PMC6034827 DOI: 10.1371/journal.pone.0199889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/15/2018] [Indexed: 12/03/2022] Open
Abstract
Background Hearing impairment, vision impairment, and dual impairment (both hearing and vision impairment), have been independently associated with functional and cognitive decline. In prior studies of dual impairment, vision impairment is generally not defined or defined by visual acuity alone. Glaucoma is a leading cause of blindness and does not affect visual acuity until late in the disease; instead, visual field loss is used to measure vision impairment from glaucoma. Objective To examine the effect of glaucomatous visual field loss and hearing impairment on function. Design Cross-sectional. Setting Hospital-based clinic in Baltimore, Maryland. Subjects 220 adults, ≥55 years presenting to the glaucoma clinic. Methods Vision impairment was defined as mean deviation on visual field testing worse than -5 decibels in the better eye, and hearing impairment was defined as pure tone average worse than 25 decibels on threshold audiometry testing in the better ear. Standardized questionnaires were used to assess functional status. Results Five participants were excluded for incomplete testing, leaving 32 with vision impairment only, 63 with hearing impairment only, 42 with dual impairment, and 78 controls with no hearing impairment or vision impairment. Participants with dual impairment were more likely to be older and non-White. Dual impairment was associated with significantly more severe driving limitation and more difficulty with communication compared to those without sensory impairment when adjusted for age, race, gender and number of comorbidities. Conclusion Older individuals with glaucoma and hearing loss seem to have generally poorer functioning than those with single sensory loss. Health professionals should consider visual field loss as a type of vision impairment when managing patients with dual impairment.
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Affiliation(s)
- Lucy I. Mudie
- Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Prateek Gajwani
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Beatriz Munoz
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Pradeep Ramulu
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Frank R. Lin
- Johns Hopkins University, Baltimore, MD, United States of America
| | | | - David S. Friedman
- Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Nazlee Zebardast
- Johns Hopkins University, Baltimore, MD, United States of America
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Visual Acuity and Cognition in Older Adults With and Without Hearing Loss: Evidence For Late-Life Sensory Compensation? Ear Hear 2018; 39:746-755. [DOI: 10.1097/aud.0000000000000531] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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58
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Wettstein M, Wahl HW, Heyl V. Four-year reciprocal relationships between personality and functional ability in older adults with and without sensory impairment: focus on neuroticism and agreeableness. Aging Ment Health 2018; 22:834-843. [PMID: 28447472 DOI: 10.1080/13607863.2017.1318259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Personality traits have been found to influence health and functional ability (FA) via multiple pathways. However, personality traits may also change in reaction to constraints in FA, particularly in more vulnerable individuals with high risk of decline in independent functioning in daily life (e.g. older adults with sensory impairment). Therefore, conceptually anchored in the World Health Organization's International Classification of Functioning, Disability and Health (ICF model), this study investigated reciprocal relationships between personality, focusing on neuroticism and agreeableness, and indicators of FA (i.e. activities of daily living and subjective autonomy) as well as the potentially moderating role of sensory impairment status. METHOD The study sample consisted of 387 older adults (mean age at T1: M = 82.50 years, SD = 4.71 years) who were either sensory impaired (SI; i.e. visually or hearing impaired) or sensory unimpaired (UI). A total of 168 individuals were reassessed four years later. RESULTS Depending on sensory status, personality acted both as predictor and as outcome of FA. Neuroticism was more strongly related with later FA outcomes in SI than in UI individuals. FA variables, in turn, were significant predictors of later neuroticism in UI older adults only and of later agreeableness in SI individuals only. CONCLUSION These findings suggest that the late-life personality-FA interplay needs to be considered bidirectional, and the direction of associations varies systematically as a function of sensory impairment status.
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Affiliation(s)
- Markus Wettstein
- a Department of Psychological Aging Research , Heidelberg University , Germany
| | - Hans-Werner Wahl
- a Department of Psychological Aging Research , Heidelberg University , Germany
| | - Vera Heyl
- b Institute of Special Education, University of Education , Heidelberg , Germany
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Guthrie DM, Davidson JGS, Williams N, Campos J, Hunter K, Mick P, Orange JB, Pichora-Fuller MK, Phillips NA, Savundranayagam MY, Wittich W. Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: Analysis of interRAI data for home care and long-term care recipients in Ontario. PLoS One 2018; 13:e0192971. [PMID: 29447253 PMCID: PMC5814012 DOI: 10.1371/journal.pone.0192971] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 02/01/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada. METHODS Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments. RESULTS The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group. CONCLUSIONS The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.
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Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jacob G. S. Davidson
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Nicole Williams
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jennifer Campos
- Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Medicine/Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph B. Orange
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | | | | | | | - Walter Wittich
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
- CRIR/MAB-Mckay Rehabilitation Centre of West-Central Montreal Health, Montreal, Quebec, Canada
- CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Montreal, Quebec, Canada
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60
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Wittich W, Höbler F, Jarry J, McGilton KS. Recommendations for successful sensory screening in older adults with dementia in long-term care: a qualitative environmental scan of Canadian specialists. BMJ Open 2018; 8:e019451. [PMID: 29374673 PMCID: PMC5829854 DOI: 10.1136/bmjopen-2017-019451] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care homes who have dementia. SETTING An environmental scan of healthcare professionals took place via telephone interviews between December 2015 and March 2016. All interviews were audio recorded, transcribed, proofed for accuracy, and their contents thematically analysed by two members of the research team. PARTICIPANTS A convenience sample of 11 professionals from across Canada specialising in the fields of vision and hearing healthcare and technology for older adults with cognitive impairment were included in the study. OUTCOME MEASURES As part of a larger mixed-methods project, this qualitative study used semistructured interviews and their subsequent content analysis. RESULTS Following a two-step content analysis of interview data, coded citations were grouped into three main categories: (1) barriers, (2) facilitators and (3) tools and strategies that do or do not work for sensory screening of older adults with dementia. We report on the information offered by participants within each of these themes, along with a summary of tools and strategies that work for screening older adults with dementia. CONCLUSIONS Recommendations from sensory specialists to nurses working in long-term care included the need for improved interprofessional communication and collaboration, as well as flexibility, additional time and strategic use of clinical intuition and ingenuity. These suggestions at times contradicted the realities of service provision or the need for standardised and validated measures.
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Affiliation(s)
- Walter Wittich
- Centre de réadaptation MAB-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Centre de recherche interdisciplinaire en réadaptation du Montréal metropolitain, Montreal, Quebec, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Centre de recherche interdisciplinaire en réadaptation du Montréal metropolitain, Montreal, Quebec, Canada
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Fiona Höbler
- Department of Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Jarry
- Centre de réadaptation MAB-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Centre de recherche interdisciplinaire en réadaptation du Montréal metropolitain, Montreal, Quebec, Canada
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Katherine S McGilton
- Department of Research, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Luo Y, He P, Guo C, Chen G, Li N, Zheng X. Association Between Sensory Impairment and Dementia in Older Adults: Evidence from China. J Am Geriatr Soc 2018; 66:480-486. [PMID: 29319875 DOI: 10.1111/jgs.15202] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the association between sensory impairment and dementia in Chinese older adults. DESIGN Cross-sectional. SETTING Older adults in 31 provinces of China. PARTICIPANTS Individuals aged 65 and older (N = 250,752). MEASUREMENTS Psychiatrists ascertained dementia based on the International Classification of Diseases, 10th Revision. Sensory impairment was measured as only hearing impairment, only vision impairment, and combined sensory impairment (combined hearing and vision impairment). Hearing impairment was defined as greater than 40 dB loss in the better ear according to the standard of the World Health Organization (WHO) Prevention of Deafness and Hearing Impairment (PDH) standard 97.3. Ophthalmologists assessed vision impairment according to the WHO best-corrected visual acuity (BCVA) criteria (low vision: 0.05≤BCVA ≤0.29; blindness: no light perception ≤ BCVA <0.05, visual field less than 10 degrees; the better-seeing eye). RESULTS The prevalence of dementia was 0.41% (95% CI = 0.39-0.44%) without sensory impairment, 0.83% (95% CI = 0.70-0.99%) with only visual impairment, 0.61 (95% CI = 0.53-0.71%) with only hearing impairment, and 1.27% (95% CI = 1.00-1.61%) with combined sensory impairments. After adjusting for sociodemographic characteristics, vision impairment (odds ratio (OR) = 1.58, 95% CI = 1.28-1.96) and combined sensory impairments (OR = 1.64, 95% CI = 1.23-2.20) were associated with greater risk of severe to extremely severe dementia. Hearing impairment was not significantly associated with dementia. CONCLUSION Sensory impairments are associated with greater risk of dementia in Chinese older adults. Studies are needed to further explore the pathway of this association in Chinese elderly adults and to provide suggestions to improve health status for this population.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Ping He
- Institute of Population Research, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
| | - Ning Li
- Institute of Population Research, Peking University, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China.,APEC Health Science Academy, Peking University, Beijing, China
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Regan J, Dawes P, Pye A, Armitage CJ, Hann M, Himmelsbach I, Reeves D, Simkin Z, Yang F, Leroi I. Improving hearing and vision in dementia: protocol for a field trial of a new intervention. BMJ Open 2017; 7:e018744. [PMID: 29187416 PMCID: PMC5719288 DOI: 10.1136/bmjopen-2017-018744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Quality of life and other key outcomes may be improved by optimising hearing and vision function in people living with dementia. To date, there is limited research assessing the efficacy of interventions aimed at improving hearing and vision in people with dementia. Here, we outline a protocol to field test a newly developed home-based intervention, designed to optimise sensory functioning in people with dementia in three European sites. The results of this study will inform the design and conduct of a full-scale randomised controlled trial (RCT) in five European sites. METHODS AND ANALYSIS In this multisite, single arm, open label, feasibility study, participants with dementia (n=24) will be assessed for hearing and vision impairments and be prescribed a hearing aid and/or glasses. Each participant will have a study partner ('dyads'). A subset of dyads will receive 'sensory support' from a 'sensory support therapist', comprising home visits over 12 weeks. The therapist will offer the following intervention: adherence support for corrective devices; adaptations to the home environment to facilitate sensory function; communication training; and referral to community-based support services. The primary outcomes will be process measures assessing the feasibility, tolerability and acceptability of: (1) the intervention components; (2) the method of implementation of the intervention and (3) the study procedures, including outcome assessment measures. Quantitative data will be collected at baseline and follow-up. Qualitative data using semistructured interviews will be collected postintervention and weekly, using participant diaries. Finally, we will explore a model of cost-effectiveness to apply in the subsequent full-scale trial. This feasibility study is a necessary step in the development of a complex, individualised, psychosocial intervention. The data gathered will allow logistical and theoretical processes to be refined in preparation for a full-scale RCT. ETHICS AND DISSEMINATION Ethical approval was obtained in all three participating countries. Results of the field trial will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Jemma Regan
- Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, U.K
| | - Annie Pye
- Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Ines Himmelsbach
- Institute of Applied Research, Development and Continuing Education, Catholic University of Applied Sciences, Freiburg, Germany
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Zoe Simkin
- Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Fan Yang
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
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Pinto JM, Wroblewski KE, Huisingh-Scheetz M, Correia C, Lopez KJ, Chen RC, Kern DW, Schumm PL, Dale W, McClintock MK. Global Sensory Impairment Predicts Morbidity and Mortality in Older U.S. Adults. J Am Geriatr Soc 2017; 65:2587-2595. [PMID: 28942611 DOI: 10.1111/jgs.15031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate global sensory impairment (GSI, an integrated measure of sensory dysfunction) as a predictor of physical function, cognition, overall health, and mortality. DESIGN Prospective study. SETTING The National Social Life, Health, and Aging Project. PARTICIPANTS A national probability sample of 3,005 home-dwelling older U.S. adults assessed at baseline (2005-06) and 5-year follow-up (2010-11). MEASUREMENTS Gait speed, activity, disability, cognition, overall health, 5-year mortality. RESULTS At baseline, older adults with worse GSI were slower (Timed Up and Go times: odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.17-1.50) and had more activity of daily living deficits (≥2: OR = 1.26, 95% CI = 1.10-1.46). Five years later, they were still slower (timed walk: OR = 1.22, 95% CI = 1.05-1.42), had more disabilities (≥2 instrumental activities of daily living; OR = 1.45, 95% CI = 1.23-1.70), were less active (daytime activity according to accelerometry: β = -2.7, 95% CI = -5.2 to -0.2), had worse cognitive function (Montreal Cognitive Assessment; β = -0.64, 95% CI = -0.84 to -0.44), more likely to have poorer overall health (OR = 1.16, 95% CI = 1.03-1.31) and lose weight (>10%: OR = 1.31, 95% CI = 1.04-1.64), and have died (OR = 1.45, 95% CI = 1.19-1.76). All analyses were adjusted for relevant confounders at baseline, including age, sex, race and ethnicity, education, smoking, problem drinking, body mass index, comorbidities, and cognitive function. CONCLUSION GSI predicts impaired physical function, cognitive dysfunction, significant weight loss, and mortality 5 years later in older U.S. adults. Multisensory evaluation may identify vulnerable individuals, offering the opportunity for early intervention to mitigate adverse outcomes.
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Affiliation(s)
- Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois.,Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | | | - Megan Huisingh-Scheetz
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Camil Correia
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | - Kevin J Lopez
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois
| | - Rachel C Chen
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - David W Kern
- Department of Psychology, Northeastern Illinois University, Chicago, Illinois
| | - Philip L Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - William Dale
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Martha K McClintock
- Center on Demography and Economics of Aging, University of Chicago, Chicago, Illinois.,Department of Comparative Human Development, University of Chicago, Chicago, Illinois.,Institute for Mind and Biology, University of Chicago, Chicago, Illinois
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64
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Korall AMB, Godin J, Feldman F, Cameron ID, Leung PM, Sims-Gould J, Robinovitch SN. Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey. BMC Geriatr 2017; 17:103. [PMID: 28468679 PMCID: PMC5415742 DOI: 10.1186/s12877-017-0493-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool. METHODS We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, "Do you think of yourself as a champion of hip protectors", rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn't. RESULTS Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach's alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home. CONCLUSIONS We offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.
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Affiliation(s)
- Alexandra M B Korall
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.
| | - Judith Godin
- Geriatric Medicine Research Unit, Nova Scotia Health Authority, 5955 Veteran's Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Fabio Feldman
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, 2065, Australia
| | - Pet-Ming Leung
- Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada.,New Vista Care Home, 7550 Rosewood Street, Burnaby, BC, V5E 3Z3, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.,Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Stephen N Robinovitch
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada
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Takahashi K, Saito M, Inaba S, Morofuji T, Aisu H, Sumimoto T, Ogimoto A, Ikeda S, Higaki J. Contribution of the long-term care insurance certificate for predicting 1-year all-cause readmission compared with validated risk scores in elderly patients with heart failure. Open Heart 2016; 3:e000501. [PMID: 27933194 PMCID: PMC5133414 DOI: 10.1136/openhrt-2016-000501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives Readmission is a common and serious problem associated with heart failure (HF). Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF. Methods We investigated 452 patients with HF who were followed up for 1 year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit. Results Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (≥50%) but not in the subgroup with reduced ejection fraction (<50%). Conclusions Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.
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Affiliation(s)
- Kayo Takahashi
- Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | | | | | | | - Hiroe Aisu
- Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | | | | | - Shuntaro Ikeda
- Ehime University Graduate School of Medicine , Toon , Japan
| | - Jitsuo Higaki
- Ehime University Graduate School of Medicine , Toon , Japan
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