Screening for cognitive impairment among the elderly attending the noncommunicable diseases clinics in a rural area of Punjab, North India

Cross-sectional study of cognitive impairment and visual impairment among the elderly population in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

OBJECTIVE

To report the relationship between visual impairment (VI) and cognitive impairment (CI) among the older population living in residential care homes in Hyderabad, India.

STUDY DESIGN

Cross-sectional study.

SETTING

41 homes for the aged centres in the Hyderabad region.

PARTICIPANTS

965 participants aged ≥60 years from homes for the aged centres.

PRIMARY OUTCOME MEASURES

Visual impairment and cognitive impairment.

METHODS

The Hindi mini-Mental Status Examination (HMSE) questionnaire was used to assess the cognitive function. The final HMSE score was calculated after excluding vision-dependent tasks (HMSE-VI). A detailed eye examination was conducted, including visual acuity (VA) measurement for distance and near vision, using a standard logarithm of the minimum angle of resolution chart under good illumination. CI was defined as having a HMSE-VI score of ≤17. VI was defined as presenting VA worse than 6/12 in the better-seeing eye. Near VI (NVI) was defined as binocular presenting near vision worse than N8 and distance VA of 6/18 or better in the better-seeing eye. Multiple logistic regression was done to assess the association between VI and CI.

RESULTS

The mean age (±SD) was 74.3 (±8.3) years (range: 60-97 years). There were 612 (63.4%) women, and 593 (61.5%) had a school education. In total, 260 (26.9%; 95% confidence intervals: 24.2 to 29.9) participants had CI. The prevalence of CI among those with VI was 40.5% compared with 14.6% among those without VI (p<0.01). The logistic regression analysis showed that the participants with VI for distance vision had three times higher odds of having CI (OR 3.09; 95% confidence intervals: 2.13 to 4.47; p<0.01). Similarly, participants with NVI had two times higher odds of having CI (OR 2.11; 95% confidence intervals: 1.36 to 3.29; p<0.01) after adjusting for other covariates.

CONCLUSIONS

CI was highly prevalent among those with distance and near VI. VI was independently and positively associated with CI after adjusting for potential confounders. Interventions can be planned to address VI in this vulnerable population which could have a ripple effect in preventing cognitive decline.

Prevalence and correlates of cognitive impairment among an urban geriatric population of Haryana

Background

Severe Cognitive Impairment (CI) is a major cause of disability and dependency among the elderly worldwide, and it has a significant impact not only on individuals but also on families, communities, and societies. Early identification and management of CI are critical in geriatric medicine. Prevalence data is often scarce, and this hinders the ground-level implementation of preventive health programs.

Objectives

The objective was to find the prevalence of CI and its covariates among the urban geriatric population of Haryana.

Materials and Methods

This was a community-based cross-sectional study conducted among 300 geriatric participants residing in an urban area of Rohtak district, Haryana. Hindi Mental State Examination (HMSE) tool was used to assess CI. Data were analyzed using IBM Corp, released 2020, IBM SPSS statistics for windows Ver 20, Armonk, NY.

Results

The prevalence of geriatric CI was found to be 27.3% and was found to be significantly associated with age, female gender, scheduled and backward caste (BC), widowhood, and low educational status and is not engaged in any occupation, low socioeconomic status, teetotalism, economic dependency, physical dependency on others, and chronic morbidity.

Conclusion

Age, female gender, scheduled and backward caste, widowhood, low educational status, nil employment status, low socioeconomic status, teetotalism, economic dependency, physical dependency on others, and chronic morbidity were found to be important correlates of CI. Further analytical studies can focus on these aspects for an early targeted preventive approach.

Cognitive Rehabilitation Programme (CRP): An Effective Tool Against Mild Cognitive Impairment Among Elderly

BACKGROUND

With a steady increase in life expectancy seen worldwide, age-associated cognitive decline and mild cognitive impairment in old age are major public health challenges.

OBJECTIVE

To determine the effectiveness of the Cognitive Rehabilitation Program on cognition parameters in old age people with mild cognitive impairment.

MATERIALS AND METHODS DESIGN

This study was a quasi-experimental design using a non-equivalent control group pretest post-test design.

SETTING/LOCATION

Mullana and Adhoya villages of Ambala, Haryana.

SUBJECTS

Eighty old age people with mild cognitive impairment.

INTERVENTION

The pre- and post-interventional cognition parameters were assessed using Addenbrooke's cognitive examination on Day 1 and Day 29. The cognitive Rehabilitation Program was administered in the experimental group once a day for 28 days.

OUTCOME MEASURES

Dependent variables were cognition parameters.

RESULTS AND CONCLUSION

In the experimental group, a significant increase in cognition parameters score was observed from Day 1 (62.28 ± 6.23) to Day 29 (63.25 ± 5.10) after administration of the Cognitive Rehabilitation Program. In the comparison group, there was a non-significant decrease in cognition parameters score from Day 1 (56.73 ± 8.24) to Day 29 (55.85 ± 8.90). The post-implementation cognition parameters score of old age people in the experimental group (mean = 63.25) was significantly higher than in the comparison group (mean = 55.85). The mean gain in cognition scores was significantly higher in the experimental group than in the comparison group with a moderate effect size. It is concluded that the cognitive rehabilitation program is an effective tool in improving cognition parameters score among old age people with mild cognitive impairment.

A predictive model for the risk of cognitive impairment in community middle-aged and older adults

Identifying individuals at high risk of cognitive impairment is essential for treatment and prevention strategies. We aimed to develop and validate a prediction model for evaluating the risk of cognitive impairment. Data were from the China Family Panel Studies (CFPS) and China Health and Retirement Longitudinal Study (CHARLS). A total of 14,265 subjects were selected for model development. The area under the curve(AUC) for the training, internal, and external validation sets were 0.775, 0.920, and 0.727, respectively. This model could be used to identify middle-aged and older adults aged 45 years and older at high risk of cognitive impairment.

Cognitive Impairment and Associated Factors among Older Adults with Diabetes in a Suburban Primary Health Center in Thailand

INTRODUCTION

Thailand is a rapidly aging society. The percentage of older adults with diabetes has also been increasing. Since diabetes mellitus is documented as a risk factor for dementia, it is important to address cognitive impairment in older adults with diabetes. Thus, this study aimed to evaluate the prevalence and associated factors of cognitive impairment among older adults with diabetes in a suburban primary health center in Thailand.

METHODS

A cross-sectional study in 244 diabetic patients aged 60 years or older was conducted in a primary health care unit in Pathum Thani, Thailand. Cognitive function was assessed with the validated Thai version of the Mini-Addenbrooke's Cognitive Examination Test. Sociodemographic and health characteristic data were obtained.

RESULTS

The prevalence of cognitive impairment was 54.5% (133 out of 244). Multivariate logistic regression disclosed that factors significantly associated with cognitive impairment were ages 70-79 years compared to ages 60-69 years (odds ratio [OR] 1.90, 95% confidence interval [CI]: 1.01-3.62, p value 0.048), ages ≥80 years compared to ages 60-69 years (OR 3.65, 95% CI: 1.19-11.24, p value 0.024), education ≤ primary school (OR 7.28, 95% CI: 3.56-14.89, p value <0.001), and medication managed by caregiver compared to self-management of medication (OR 13.40, 95% CI: 1.55-116.10, p value 0.019).

CONCLUSION

We revealed that approximately half of older adults with diabetes had cognitive impairment. This finding strongly suggests the need to include cognitive assessment in a standard clinical practice guideline for diabetic patients and to focus more on individuals who are very old, have low education, or are unable to manage their drugs by themselves.

Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India

BACKGROUND

Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.

METHODS

This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.

RESULTS

About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.

CONCLUSION

About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.

Association between socioeconomic status and cognitive functioning among older adults in Ghana

OBJECTIVES

Extensive analysis of the associations between socioeconomic status and cognition has been conducted among older adults. However, it is not clear whether associations in high-income countries are similar in low-and middle-income countries. This research aims to investigate the association between the socioeconomic status of older adults in Ghana and their cognitive function by using a sample of older adults that is nationally representative.

METHODS

Data were obtained from a sample of older Ghanaian adults (50+) from the Study of Global AGEing and Adult Health Wave 1 (n = 3710) of the World Health Organization. Objectively, cognition was measured by verbal recall, verbal fluency, forward digit span, and backward digit span, while variations in cognition overall were evaluated against socioeconomic factors using linear regression.

RESULTS

Older age, older women, rural life, increasing memory difficulty, and being diagnosed with stroke were the most significant determinants of impaired cognitive function. Higher education and higher income were significantly associated with a better cognitive function than those with no formal education and low income.

CONCLUSIONS

These results provide new evidence for public health programs in Ghana and other low-and middle-income countries to tackle cognitive impairments in growing populations.

The state of psychiatric research in the Asia Pacific region

INTRODUCTION

This study aims to review recent scientific publications and research output in the field of psychiatry, from a series of countries in the Asia-Pacific region (Australia, India, Indonesia, Iran, Lebanon, Malaysia, and Nepal), with a view to identify themes and similarities across regions, as well as to examine the barriers and challenges in mental health research faced by countries in the region.

METHODS

Seven psychiatrists from seven countries reviewed recent published and ongoing research in psychiatry in their respective nations, with respect to themes, as well as any barriers or challenges faced by mental health researchers.

RESULTS

While the seven nations included in this review vary in terms of research capabilities and economic development level, they share many similarities both in terms of research direction, and with regards to challenges faced. Limitations in the form of sociocultural differences from the West, and a lack of funding were some of the barriers identified.

DISCUSSION

Mental health research in the region has been progressing well. However, more varied research in the form of qualitative or economic studies are lacking, as are multi-center studies. The similar issues that nations face with regards to research could perhaps benefit from collaborative efforts and initiatives for the furtherance of research in the region.

Estimates of malnutrition and risk of malnutrition among the elderly (≥60 years) in India: A systematic review and meta-analysis

BACKGROUND

Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India.

METHODS

PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010-2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions.

RESULTS

The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition.

CONCLUSION

The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended.