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Miller MJ, Cenzer I, Barnes DE, Ankuda C, Covinsky KE. Prevalence of cognitive impairment in home health physical therapy. J Am Geriatr Soc 2024; 72:802-810. [PMID: 38152855 PMCID: PMC10947939 DOI: 10.1111/jgs.18715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics. METHODS For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression. RESULTS The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]). CONCLUSION There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.
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Affiliation(s)
- Matthew J. Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
| | - Irena Cenzer
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah E. Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Claire Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth E. Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
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Chen Y, Li Y, Li W, Tian Y, Yang H. Physical activity trajectories and their associations with health outcomes in older adults with mild cognitive impairment or dementia: a national cohort study. Aging Clin Exp Res 2024; 36:15. [PMID: 38291179 PMCID: PMC10827827 DOI: 10.1007/s40520-023-02667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/17/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Physical activity (PA) is a promising non-pharmacological intervention for this population. However, few studies have investigated their PA trajectories, influencing factors, and their relationship with health outcomes. AIMS The aim was to identify latent trajectories in PA and their determinants in older adults with mild cognitive impairment (MCI) or dementia, as well as to assess the associations between PA trajectories and health outcomes based on the capability-opportunity-motivation behavior model. METHODS This is a cohort study. Data were obtained from a national cohort study and included participants aged 60 years and older with MCI or dementia. PA trajectories were identified using group-based trajectory modelling. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Linear regression models were used to assess the associations between PA trajectories and health outcomes. This study adhered to the STROBE checklist for reporting. RESULTS Three distinct PA trajectories were identified: high-decreasing and rebound class (9.34%), moderate-decreasing class (10.31%), and low-increasing class (80.34%). The logistic regression showed that age, sex, education level, body mass index, residence, depressive symptoms, mobility activities of daily life score, frequency of social activities score were PA predictors. Adjusting for sociodemographic variables, only the high-decreasing and rebound class remained significantly associated with worse self-rated health. DISCUSSION This study revealed three PA trajectories among older adults with MCI/dementia. Besides sociodemographic variables, addressing physical function and mental health, providing social support are vital for promoting PA in this population.
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Affiliation(s)
- Yiping Chen
- Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yao Li
- Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Wei Li
- Peking Union Medical College Hospital, Beijing, China
| | - Yuling Tian
- First Hospital of Shanxi Medical University, No.56, Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China.
| | - Hui Yang
- First Hospital of Shanxi Medical University, No.56, Xinjian South Road, Yingze District, Taiyuan, Shanxi Province, China.
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Chen Y, Li W, Yang H. Determinants of physical activity behavior among older adults with subjective cognitive decline based on the capability, opportunity, motivation, and behavior model: mediating and moderating effects. Front Public Health 2024; 11:1338665. [PMID: 38264244 PMCID: PMC10805022 DOI: 10.3389/fpubh.2023.1338665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Background PA is vital for secondary prevention in older adults with subjective cognitive decline (SCD), but their physical activity (PA) levels are low, and the underlying interaction pathways among associated factors are poorly understood. This study aims to identify mediating and moderating effects of determinants on PA behavior in older adults with SCD using the capability, opportunity, motivation, and behavior model. Methods Following the STROBE checklist, we conducted a cross-sectional survey among 289 older adults with SCD. Path regression, mediation effects, and moderation effects were used to explore the associated factors of PA behavior and the associations among these variables. Results The prevalence of physical inactivity among older adults with SCD was high (40.3%). The path model fit indices were χ2/df = 1.145, GFI = 0.968, CFI = 0.988, and RMSEA = 0.022. Path regression revealed that frailty, physical and social support, PA motivation, and fall history had significant direct association with PA behavior. PA motivation not only partially mediates between frailty and PA behavior but also partially mediates between physical and social support and PA behavior. Additionally, fall history moderated the relationship between frailty and PA behavior. Conclusion PA behavior in older adults with SCD requires improvement. Healthcare professionals should devise more effective interventions to boost PA behavior by enhancing motivation. Screening for frailty and addressing fall history, while providing sufficient physical and social support, is crucial.
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Affiliation(s)
- Yiping Chen
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wei Li
- International Medical Department, Peking Union Medical College Hospital (CAMS), Beijing, China
| | - Hui Yang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
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Ahn S, Cobb SJ, Crouter SE, Lee CE, Crane MK, Anderson JG. Physical activity together for couples living with mild cognitive impairment (PAT-MCI): A feasibility study. Geriatr Nurs 2024; 55:221-228. [PMID: 38035459 DOI: 10.1016/j.gerinurse.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
Mild cognitive impairment is a prodromal phase of Alzheimer's disease and related dementias. Cognitive and/or neuropsychiatric symptoms that could worsen over time cause challenges for patients and romantic partners, who often assume the role of informal caregivers. Although physical activity is beneficial, older adults with mild cognitive impairment and their romantic care partners are generally physically inactive. Our 16-week study was performed to see whether physical activity together is feasible to increase physical activity among four dyads (individuals with mild cognitive impairment and their spouses). Our dyadic intervention was feasible given more than 70 % of participants self-reported adherence to physical activity based on the guidelines for adults in the United States. In exit interviews, togetherness was highlighted as one of the biggest strengths of this study. Future studies with more representative samples are needed, as well as adopting a more tailored approach that accounts for individuals' levels of physical fitness.
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Affiliation(s)
- Sangwoo Ahn
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States.
| | - Sandra J Cobb
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, Tennessee, United States
| | - Chung Eun Lee
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, New York, New York, United States
| | - Monica K Crane
- Genesis Neuroscience Clinic, Knoxville, Tennessee, United States
| | - Joel G Anderson
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States
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Miller MJ, Cenzer I, Barnes DE, Kelley AS, Covinsky KE. The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy. Phys Ther 2024; 104:pzad115. [PMID: 37615482 PMCID: PMC10822773 DOI: 10.1093/ptj/pzad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice. METHODS This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression. RESULTS Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance. CONCLUSION One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity. IMPACT Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Irena Cenzer
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California, USA
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Kenneth E Covinsky
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
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Wegener EK, Kayser L. Smart health technologies used to support physical activity and nutritional intake in fall prevention among older adults: A scoping review. Exp Gerontol 2023; 181:112282. [PMID: 37660762 DOI: 10.1016/j.exger.2023.112282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Falls are the second leading cause of accidental injury deaths globally. Older age is a key risk factors for falls. Besides older age, physical inactivity and malnutrition are identified risk factors for falls. Smart health technologies might offer a sustainable solution to prevent falls by supporting physical activity and nutritional status. OBJECTIVE The aim is to identify, describe, and synthesize knowledge, and identify knowledge gaps on the use of existing smart health technologies to support health behaviour in relation to physical activity and nutrition, among older (65+) in risk of falling. METHODS A scoping review was conducted following the PRISMA-ScR. Searches were carried out in PubMed, Scopus, and Embase using search strings on the themes; smart health technology, physical activity, nutrition, behaviour, falls and older. Identified literature was screened. Data from the included studies was extracted and synthesized. RESULTS 2948 studies were obtained through searches. 18 studies were included. Various smart health technologies are used for fall prevention to support physical activity among older, including software and applications for smart phones, TV, and tablet. Three gaps were identified: use of smart health technologies to support nutrition in fall prevention. Inclusion of relevant stakeholders and fall prevention in low-and middle-income countries. CONCLUSIONS Smart health technology can offer sustainable and cost-effective fall prevention in the future. More knowledge is needed on the use of smart health technologies to support nutritional status for fall prevention, and studies involving older with physical and cognitive conditions, and studies on measures for fall prevention in low- and middle-income countries is needed.
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Affiliation(s)
- Emilie Kauffeldt Wegener
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
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