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Sadarangani T, Perissinotto C, Boafo J, Zhong J, Yu G. Multimorbidity patterns in adult day health center clients with dementia: a latent class analysis. BMC Geriatr 2022; 22:514. [PMID: 35733122 PMCID: PMC9216285 DOI: 10.1186/s12877-022-03206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background Persons living with dementia (PLWD) in adult day centers (ADCs) represent a complex and vulnerable population whose well-being is at risk based on numerous factors. Greater knowledge of the interaction between dementia, chronic conditions, and social determinants of health would enable ADCs to identify and target the use of their resources to better support clients in need of in-depth intervention. The purpose of this paper is to (a) classify PLWD in ADCs according to their level of medical complexity and (b) identify the demographic, functional, and clinical characteristics of those with the highest degree of medical complexity. Methods This was a secondary data analysis of 3052 clients with a dementia diagnosis from 53 ADCs across the state of California between 2012 and 2019. The most common diagnosis codes were organized into 28 disease categories to enable a latent class analysis (LCA). Chi-square test, analysis of variance (ANOVA), and Kruskal-Wallis tests were conducted to examine differences among latent classes with respect to clinical and functional characteristics. Results An optimal 4-class solution was chosen to reflect chronic conditions among PLWD: high medical complexity, moderate medical complexity, low medical complexity, and no medical complexity. Those in the high medical complexity were taking an average of 12.72 (+/− 6.52) medications and attending the ADC an average of 3.98 days (+/− 1.31) per week—values that exceeded any other class. They also experienced hospitalizations more than any other group (19.0%) and met requirements for the nursing facility level of care (77.4%). In addition, the group experienced the greatest frequency of bladder (57.5%) and bowel (15.7%) incontinence. Conclusions Our results illustrate a high degree of medical complexity among PLWD in ADCs. A majority of PLWD not only have multimorbidity but are socially disadvantaged. Our results demonstrate that a comprehensive multidisciplinary approach that involves community partners such as ADCs is critically needed that addresses functional decline, loneliness, social isolation, and multimorbidity which can negatively impact PLWD.
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Affiliation(s)
- Tina Sadarangani
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA.
| | - Carla Perissinotto
- University of California San Francisco School of Medicine, Division of Geriatrics, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Jonelle Boafo
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
| | - Jie Zhong
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
| | - Gary Yu
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
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2
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Oliveira AM, Radanovic M, Mello PCHD, Buchain PC, Vizzotto ADB, Harder J, Stella F, Gitlin LN, Piersol CV, Valiengo LLC, Forlenza OV. Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program. J Alzheimers Dis 2021; 83:475-486. [PMID: 34334394 DOI: 10.3233/jad-210142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. OBJECTIVE Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. METHODS This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. RESULTS 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. CONCLUSION The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.
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Affiliation(s)
- Alexandra Martini Oliveira
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.,Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Patricia Cardoso Buchain
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Janaína Harder
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Florindo Stella
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA.,Drexel College of Nursing and Health Professions, Philadelphia, PA, USA
| | | | - Leandro L C Valiengo
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Orestes Vicente Forlenza
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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3
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Gabriel MO, Nikou M, Akinola OB, Pollak DD, Sideromenos S. Western diet-induced fear memory impairment is attenuated by 6-shogaol in C57BL/6N mice. Behav Brain Res 2019; 380:112419. [PMID: 31816337 DOI: 10.1016/j.bbr.2019.112419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 01/23/2023]
Abstract
Dementia is a progressive cognitive diminution impeding with normal daily activities that is constantly on the increase. Currently, the estimated prevalence is 50 million affected people worldwide, a figure expected to triple within the next 30 years. While the pathophysiology of the different types of dementia is complex, likely involving the interplay between multiple genetic and environmental factors, strong evidence points towards an important link between diet and cognitive health. Here we examined the consequences of high-fat, high-sugar Western diet (HFSD)-induced obesity on cognitive performance in the fear conditioning task in mice and explored a possible beneficial effect of 6-shogaol (6S), an active constituent of ginger, in this model. Chronic exposure to HFSD significantly enhanced body weight gain in C57BL/6N mice and this effect was prevented by treatment with 6S. HFSD + vehicle-treated mice presented with a selective deficit in cued fear memory, which was not observed in HFSD + 6S-treated animals. The findings of this study provide first evidence for a beneficial effect of 6S on HFSD-induced obesity and emotional memory deficit in mice.
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Affiliation(s)
- Michael O Gabriel
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Edo University Iyamho, Edo State, Nigeria; Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Maria Nikou
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Oluwole B Akinola
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Daniela D Pollak
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Spyridon Sideromenos
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria.
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4
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Shelton W, Tenenbaum E, Costello K, Hoffman D. Empowering Patients with Alzheimer's Disease To Avoid Unwanted Medical Care: A Look At The Dementia Care Triad. Am J Alzheimers Dis Other Demen 2018; 34:1533317518817614. [PMID: 30541327 PMCID: PMC10852523 DOI: 10.1177/1533317518817614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with Alzheimer's disease and other types of dementia with acute medical problems, who have lost capacity and are without advance directives, are at risk of being over treated inhospitals. To deal with this growing demographic and ethical crisis, patients with dementia need to plan for their future medical care while they have capacity to do so. This article will examine the role of each member of the dementia care triad and how to empower the patient to participate in planning future medical care. A case will be made that physicians have the same professional disclosure obligations to dementia patients as they do to all other capable patients with terminal illnesses. Because there is little consensus about what facts should be included in a diagnostic disclosure, this article will offer a proposal to empower newly diagnosed patients with dementia with capacity to plan for their future medical care.
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Affiliation(s)
- Wayne Shelton
- Alden March Bioethics Institute, Albany Medical College, Albany, NY, USA
| | - Evelyn Tenenbaum
- Albany Law School, Alden March Bioethics Institute, Albany, NY, USA
| | - Kevin Costello
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - David Hoffman
- New York State Department of Health, Albany, NY, USA
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5
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Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:661-668. [PMID: 30560199 PMCID: PMC6288458 DOI: 10.1016/j.trci.2018.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction There is scant literature on the use of opioids among community-dwelling elderly with Alzheimer's disease and related dementias (ADRD). Methods We adopted a retrospective, cross-sectional study design using Medicare Current Beneficiary Survey data from 2006 to 2013. The study sample included elderly community-dwelling Medicare beneficiaries who were diagnosed with chronic pain conditions and had Medicare fee-for-service plans for the entire year. We conducted bivariate χ2 test and multivariate logistic regression to examine the relationship between opioid use and ADRD status. Results The study sample included 19,347 Medicare beneficiaries; 7.7% of them had ADRD. We found no statistically significant difference in opioid use by ADRD status in the unadjusted analysis; however, controlling for various factors, those with ADRD had lower odds of opioid use (adjusted odds ratio = 0.81, 95% confidence interval = 0.71, 0.93) than those without ADRD. Discussion This population-based study suggests that elderly Medicare beneficiaries with ADRD and chronic pain conditions may have undertreatment of pain.
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6
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Schulte PJ, Martin DP, Deljou A, Sabov M, Roberts RO, Knopman DS, Petersen RC, Weingarten TN, Hanson AC, Schroeder DR, Warner DO, Sprung J. Effect of Cognitive Status on the Receipt of Procedures Requiring Anesthesia and Critical Care Admissions in Older Adults. Mayo Clin Proc 2018; 93:1552-1562. [PMID: 30274907 DOI: 10.1016/j.mayocp.2018.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether older adults with mild cognitive impairment (MCI) or dementia have higher rates of procedures requiring general anesthesia or intensive care unit (ICU) admissions compared with cognitively normal (CN) patients. PATIENTS AND METHODS A population-based cohort, 70 to 89 years old at enrollment, underwent clinical and longitudinal neurocognitive testing to identify those with MCI and dementia. We analyzed the effects of cognitive status (CN, MCI, or dementia) at entry into the study from October 1, 2004, through December 31, 2014, on the risk of receiving procedures requiring surgical anesthesia and ICU admission. RESULTS Of 2436 participants, 1977 (81%) were CN, 387 (16%) had MCI, and 72 (3%) had dementia. Cognitively impaired individuals were sicker. Compared with CN individuals, the likelihood of receiving a procedure requiring anesthesia was similar in participants with MCI (adjusted hazard ratio [aHR]=0.98; P=.78). Participants with dementia were less likely to receive these procedures (aHR=0.50; P=.02). Compared with CN participants, the likelihood of ICU admission for any indication was increased for those with MCI (aHR=1.24; P=.03) and dementia (aHR=1.59; P=.04). Admissions to the ICU after procedures were not different in patients with either MCI or dementia (aHR=0.96; P=.83 and aHR=1.01; P=.98, respectively). CONCLUSION Patients with MCI or dementia are not more likely to undergo surgery, and neither are they more likely to require ICU admission after procedures. An increased rate of nonsurgical ICU admissions requires vigilance to prevent deterioration of nonsurgical diseases that may lead to ICU admissions.
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Affiliation(s)
- Phillip J Schulte
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - David P Martin
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Atousa Deljou
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Moldovan Sabov
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Rosebud O Roberts
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | - Andrew C Hanson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Darrell R Schroeder
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - David O Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN.
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Thorpe CT, Gellad WF, Mor MK, Cashy JP, Pleis JR, Van Houtven CH, Schleiden LJ, Hanlon JT, Niznik JD, Carico RL, Good CB, Thorpe JM. Effect of Dual Use of Veterans Affairs and Medicare Part D Drug Benefits on Antihypertensive Medication Supply in a National Cohort of Veterans with Dementia. Health Serv Res 2018; 53 Suppl 3:5375-5401. [PMID: 30328097 DOI: 10.1111/1475-6773.13055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia. DATA SOURCES/STUDY SETTING National, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension. STUDY DESIGN We used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives. DATA COLLECTION/EXTRACTION METHODS Veterans Affairs and Part D prescription records were used to classify patients as VA-only, Part D-only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply. PRINCIPAL FINDINGS Dual prescription users were more likely than VA-only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18-1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15-2.64), and concurrent under- and oversupply (aOR = 2.89; 95 percent CI = 2.53-3.29), versus appropriate supply of all classes. CONCLUSIONS Obtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under- and oversupply. Efforts to understand how best to coordinate dual-system prescription use are critically needed.
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Affiliation(s)
- Carolyn T Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Maria K Mor
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - John P Cashy
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - John R Pleis
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Courtney H Van Houtven
- Durham Veterans Affairs Health Care System, VA Medical Center (152), Durham, NC.,Duke University School of Medicine, VA Medical Center (152), Durham, NC
| | - Loren J Schleiden
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Joseph T Hanlon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joshua D Niznik
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA.,Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ronald L Carico
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA
| | - Chester B Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,Center for High Value Pharmaceutical Purchasing, UPMC Health Plan, Pittsburgh, PA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.,UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
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8
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Petersen JD, Siersma VD, Christensen RD, Storsveen MM, Nielsen CT, Waldorff FB. The risk of fall accidents for home dwellers with dementia-A register- and population-based case-control study. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:421-428. [PMID: 30151421 PMCID: PMC6107894 DOI: 10.1016/j.dadm.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Institutionalized people with dementia have an increased risk of fall accidents, but little is known about whether this increased risk holds for home dwellers. Methods This register- and population-based study comprised 115,584 cases and 394,679 controls. Cases were individuals with any fall between 2009 and 2014, and matched with up to six controls on age, sex, and geographic location. Individuals were excluded if they (1) had any fall in 2008, or (2) lived in a nursing home on the date of the fall. Dementia, other chronic diseases, and sedative medicines were assessed from Danish national registers. Results After adjusting for potential confounders, older people with dementia living at home had a 1.89-fold higher risk of fall (odds ratio = 1.89, 95% confidence interval [1.84–1.94], P < .001). Discussion Dementia almost doubles the risk of fall for older Danish people living at home. This highlights the need for effective fall preventions that target people with dementia.
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Affiliation(s)
- Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
- Corresponding author. Tel.: +45 6550 9531; Fax: +45 6591 8296.
| | - Volkert Dirk Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René dePont Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Maria Munch Storsveen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Connie Thurøe Nielsen
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Zimmerman S, Sloane PD, Ward K, Beeber A, Reed D, Lathren C, Matchar B, Gwyther L. Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource. Am J Alzheimers Dis Other Demen 2018; 33:176-183. [PMID: 29301414 PMCID: PMC6237200 DOI: 10.1177/1533317517749466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND/RATIONALE Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated. METHODS Family caregivers (143 website and 51 book) used an educational resource that provides information on medical problems, vital signs, pain, dehydration, and the healthcare system. Data were collected at baseline, 3 months, and 6 months regarding confidence in sign/symptom management, burden, depression, and anxiety. RESULTS Caregivers reported significantly improved confidence and (for website users) decreased role strain. Anxiety and depression also decreased, although not significantly. Improved confidence related to a reduction in role strain and anxiety, and care recipients did not experience adverse events. CONCLUSION An educational resource focusing on care of comorbid illness may benefit caregiver outcomes.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- Schools of Social Work and Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kimberly Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Beeber
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Christine Lathren
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Bobbi Matchar
- Duke Family Support Program, Duke University, Durham, NC, USA
| | - Lisa Gwyther
- Duke Family Support Program, Duke University, Durham, NC, USA
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10
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Fowler NR, Shaaban CE, Torke AM, Lane KA, Saba S, Barnato AE. "I'm Not Sure We Had A Choice": Decision Quality and The Use of Cardiac Implantable Electronic Devices In Older Adults With Cognitive Impairment. ACTA ACUST UNITED AC 2018. [PMID: 29521380 PMCID: PMC5839643 DOI: 10.26502/fccm.92920032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The decision to implant a cardiac device in a person with Alzheimer’s disease or related dementia requires considering the possible trade-offs of quality of life (QOL) and quantity of life. This study measured the decision-making experience of patients with and without cognitive impairment (CI) who received a cardiac device and their family members who were involved in the decision. Methods and Results Semi-structured interviews and questionnaires were administered with 15 patient-family member dyads. Interviews revealed few conversations between physicians, patients and family members about the patient’s cognitive status or about the benefits, risks, and long-term implications of the device for someone with CI. Participants largely stated that the decision to get the device was based on the patient’s functional status at the time of the implant, and not on expectations about future functioning. Patients with CI had more regret, measured with the Decision Regret Scale (DRS), (p=0.037) and family members of patients without CI reported more decisional conflict, measured with the Decisional Conflict Scale (p=0.057). Conclusions Although CI impacts life expectancy and QOL, cognitive status was largely not discussed prior to device implant. Few differences were found between the experiences of dyads that included patients with or without CI.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Corresponding Author: Nicole R. Fowler, Indiana University School of Medicine, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202, USA, Telephone: (317) 274-9021;
| | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexia M. Torke
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen A. Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samir Saba
- Division of Cardiology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amber E. Barnato
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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11
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Kunschmann R, Busse S, Frodl T, Busse M. Psychotic Symptoms Associated with Poor Renal Function in Mild Cognitive Impairment and Dementias. J Alzheimers Dis 2017; 58:243-252. [DOI: 10.3233/jad-161306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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12
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Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, Chen TF, Lin KN, Tang LY, Lin CC, Wang PN. Comorbidity and dementia: A nationwide survey in Taiwan. PLoS One 2017; 12:e0175475. [PMID: 28403222 PMCID: PMC5389824 DOI: 10.1371/journal.pone.0175475] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/14/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Comorbid medical diseases are highly prevalent in the geriatric population, imposing hardship on healthcare services for demented individuals. Dementia also complicates clinical care for other co-existing medical conditions. This study investigated the comorbidities associated with dementia in the elderly population aged 65 years and over in Taiwan. METHODS We conducted a nationwide, population-based, cross-sectional survey; participants were selected by computerized random sampling from all 19 Taiwan counties between December 2011 and March 2013. After exclusion of incomplete or erroneous data, 8,456 subjects were enrolled. Of them, 6,183 were cognitively normal (control group), 1,576 had mild cognitive impairment (MCI), and 697 had dementia. We collected information about types of comorbidities (i.e., vascular risk factors, lung diseases, liver diseases, gastrointestinal diseases, and cancers), Charlson comorbidity index score, and demographic variables to compare subjects with normal cognition, MCI, and dementia. RESULTS Regardless of the cognitive condition, over 60% of the individuals in each group had at least one comorbid disease. The proportion of subjects possessing at least three comorbidities was higher in those with cognitive impairment (MCI 20.9%, dementia 27.3%) than in control group (15%). Hypertension and diabetes mellitus were the most common comorbidities. The mean number of comorbidities and Charlson comorbidity index score were greater in MCI and dementia groups than in control group. Logistic regression demonstrated that the comorbidities significantly associated with MCI and dementia were cerebrovascular disease (OR 3.35, CI 2.62-4.28), cirrhosis (OR 3.29, CI 1.29-8.41), asthma (OR 1.56, CI 1.07-2.27), and diabetes mellitus (OR 1.24, CI 1.07-1.44). CONCLUSION Multiple medical comorbid diseases are common in older adults, especially in those with cognitive impairment. Cerebrovascular disease, cirrhosis, asthma, and diabetes mellitus are important contributors to cognitive deterioration in the elderly. Efforts to lower cumulative medical burden in the geriatric population may benefit cognitive function.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Yu Yiao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Yu Sun
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | | | - Ming-Jang Chiu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ker-Neng Lin
- Department of Psychology, Soo-Chow University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Yu Tang
- Taiwan Alzheimer’s Disease Association, Taipei, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chung Gung University, Tao-Yuan, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
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Sloane PD, Schifeling CH, Beeber AS, Ward KT, Reed D, Gwyther LP, Matchar B, Zimmerman S. New or Worsening Symptoms and Signs in Community-Dwelling Persons with Dementia: Incidence and Relation to Use of Acute Medical Services. J Am Geriatr Soc 2017; 65:808-814. [PMID: 28152160 DOI: 10.1111/jgs.14672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD). DESIGN Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical service use. SETTING Community-based sample of volunteers from multiple states. PARTICIPANTS A total of 136 patient-caregiver dyads with a range of dementia severity. MEASUREMENTS Forty four symptoms and signs common in older persons and/or persons with dementia; frequency of emergency department visits, hospitalizations, and death; and associations between reported symptoms and acute medical care. RESULTS During a mean of 5.7 months' follow-up, new or worsening organ-specific (90% of participants), nonspecific (89%), and behavioral (88%) symptoms were common, with the average caregiver reporting seven new or worsening symptoms. Most common were worsening confusion (74%), decreased activity (64%), agitation (57%), hallucinations/delusions (45%), voice and speaking problems (45%), not eating or drinking (44%), and stress/anxiety (41%). Hospitalization and emergency department use occurred respectively in 19% and 20% of participants, and were associated with organ-specific symptoms (OR 3.15, P = .02), less so with nonspecific symptoms (OR 2.27, P = .07), and very little with behavioral symptoms (OR 1.44, P = .38). Within each symptom category, certain symptoms were significantly associated with acute medical service use. CONCLUSION Family caregivers of persons with ADRD must respond to a variety of medical, nonspecific, and behavioral symptoms. The high incidence of new or worsening symptoms and of acute medical care use suggests a need to better target symptom evaluation and management in caregiver education.
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Affiliation(s)
- Philip D Sloane
- Department of Family Medicine, School of Medicine, Denver, Colorado.,Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | | | - Anna S Beeber
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly T Ward
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - David Reed
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Lisa P Gwyther
- Duke Family Support Program, Duke University, Durham, North Carolina
| | - Bobbi Matchar
- Duke Family Support Program, Duke University, Durham, North Carolina
| | - Sheryl Zimmerman
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Cavallo M, Signorino A, Perucchini ML. Benefits of Cognitive Treatments Administered to Patients Affected by Mild Cognitive Impairment/Mild Neurocognitive Disorder. Drug Dev Res 2016; 77:444-452. [DOI: 10.1002/ddr.21339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Cavallo
- Faculty of Psychology; eCampus University; Novedrate (Como) Italy
- Azienda Sanitaria Locale Torino 3, Department of Mental Health; Collegno Torino Italy
| | - Arianna Signorino
- Azienda Sanitaria Locale Torino 3, Department of Mental Health; Collegno Torino Italy
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15
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Abstract
As the population ages and the number of people living with a long-term condition grows, it is likely that community nurses may be presented with increasing numbers of people requiring assessment, support, and advice for complex needs. Many of the long-term conditions affect the patient's ability to live and manage aspects of daily life independently and may affect the ability to manage a stoma. The purpose of this article is to consider how long-term conditions affect daily living and stoma care, and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma (ostomates) and a long-term condition have also been included. It is hoped that by reading this article, the nurse will become more familiar with the difficulties with dexterity associated with long-term conditions experienced by ostomates, and how they can be assisted in managing and living as independently as possible.
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17
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Abstract
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
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Affiliation(s)
- Helen C Kales
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, USA
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18
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Horr T, Messinger-Rapport B, Pillai JA. Systematic review of strengths and limitations of randomized controlled trials for non-pharmacological interventions in mild cognitive impairment: focus on Alzheimer's disease. J Nutr Health Aging 2015; 19:141-53. [PMID: 25651439 DOI: 10.1007/s12603-014-0565-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-pharmacological interventions may improve cognition and quality of life, reduce disruptive behaviors, slow progression from Mild Cognitive Impairment (MCI) to dementia, and delay institutionalization. It is important to look at their trial designs as well as outcomes to understand the state of the evidence supporting non-pharmacological interventions in Alzheimer's disease (AD). An analysis of trial design strengths and limitations may help researchers clarify treatment effect and design future studies of non-pharmacological interventions for MCI related to AD. METHODS A systematic review of the methodology of Randomized Controlled Trials (RCTs) targeting physical activity, cognitive interventions, and socialization among subjects with MCI in AD reported until March 2014 was undertaken. The primary outcome was CONSORT 2010 reporting quality. Secondary outcomes were qualitative assessments of specific methodology problems. RESULTS 23 RCT studies met criteria for this review. Eight focused on physical activity, fourteen on cognitive interventions, and one on the effects of socialization. Most studies found a benefit with the intervention compared to control. CONSORT reporting quality of physical activity interventions was higher than that of cognitive interventions. Reporting quality of recent studies was higher than older studies, particularly with respect to sample size, control characteristics, and methodology of intervention training and delivery. However, the heterogeneity of subjects identified as having MCI and variability in interventions and outcomes continued to limit generalizability. CONCLUSIONS The role for non-pharmacological interventions targeting MCI is promising. Future studies of RCTs for non-pharmacological interventions targeting MCI related to AD may benefit by addressing design limitations.
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Affiliation(s)
- T Horr
- J.A. Pillai, MBBS, PhD, Staff Neurologist, Lou Ruvo Center for Brain Health, Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Ave / U10, Cleveland, OH 44195, Tel: 216 636 9467, Fax: 216 445 7013, E-mail:
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19
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Fowler NR, Barnato AE, Degenholtz HB, Curcio AM, Becker JT, Kuller LH, Lopez OL. Effect of dementia on the use of drugs for secondary prevention of ischemic heart disease. J Aging Res 2014; 2014:897671. [PMID: 24719764 PMCID: PMC3955600 DOI: 10.1155/2014/897671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/06/2014] [Indexed: 01/19/2023] Open
Abstract
Background. Dementia and cardiovascular disease (CVD) are frequently comorbid. The presence of dementia may have an effect on how CVD is treated. Objective. To examine the effect of dementia on the use of four medications recommended for secondary prevention of ischemic heart disease (IHD): angiotensin-converting enzyme inhibitors, beta-blockers, lipid-lowering medications, and antiplatelet medications. Design. Retrospective analysis of data from the Cardiovascular Health Study: Cognition Study. Setting and Subjects. 1,087 older adults in four US states who had or developed IHD between 1989 and 1998. Methods. Generalized estimating equations to explore the association between dementia and the use of guideline-recommended medications for the secondary prevention of IHD. Results. The length of follow-up for the cohort was 8.7 years and 265 (24%) had or developed dementia during the study. Use of medications for the secondary prevention of IHD for patients with and without dementia increased during the study period. In models, subjects with dementia were not less likely to use any one particular class of medication but were less likely to use two or more classes of medications as a group (OR, 0.60; 95% CI, 0.36-0.99). Conclusions. Subjects with dementia used fewer guideline-recommended medications for the secondary prevention of IHD than those without dementia.
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Affiliation(s)
- Nicole R. Fowler
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Amber E. Barnato
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Howard B. Degenholtz
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Angela M. Curcio
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - James T. Becker
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lewis H. Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Oscar L. Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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20
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Abstract
AIMS AND OBJECTIVES To examine cognitive function and its relationships to demographic characteristics and social support among elders in central China. BACKGROUND Cognitive decline is prevalent among elders. Few studies have explored the relationship between social support and cognitive function among elders. DESIGN A cross-sectional, descriptive correlational study. METHODS A quasi-random, point of reference sample of 120 elders residing in central China was recruited for study. Instruments used included a: Socio-demographic Questionnaire, the Multidimensional Scale on Perceived Social Support and the Mini-Mental State Examination. Hierarchical multiple regression was performed to examine the relationships among demographic variables, social support and cognitive function. RESULTS Age, education and social support accounted for 45·2% of the variance in cognitive function. Family support was the strongest predictor of cognitive function. Elders who had higher educational levels and more family support had better cognitive function. Relevance to clinical practice. Community healthcare providers should consolidate social support among elders in China and use family support interventions to reduce or delay cognitive decline, especially among those of increased age who are illiterate. CONCLUSION Elders who had higher educational level and more family support had better cognitive function levels. Interventions that include family support are needed to improve cognitive function among elders in China.
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Affiliation(s)
- Shuzhen Zhu
- Wuhan University HOPE School of Nursing, Wuhan City and Hubei Medical University, Shiyan City, Hubei Province, China
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21
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Grober E, Sanders A, Hall CB, Ehrlich AR, Lipton RB. Very mild dementia and medical comorbidity independently predict health care use in the elderly. J Prim Care Community Health 2011; 3:23-8. [PMID: 23804851 DOI: 10.1177/2150131911412783] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine whether dementia status and medical burden were independent predictors of emergency department (ED) visits and hospitalizations in older patients from an urban geriatric practice participating in a primary care based cognitive screening program. PARTICIPANTS AND METHODS A comprehensive chart review was conducted for 300 African American and Caucasian patients, including 46 with prevalent dementia and 28 with incident dementia using the Cumulative Illness Burden Scale. Hospital-based claims data was used to retrieve ED visits and hospital admissions for 5 years following baseline assessment. RESULTS Patients with dementia had a 49% higher rate of ED visits (IRR = 1.49; 95% CI = 1.06, 2.09) and an 83% higher risk of death than patients without dementia (HR = 1.83; 95% CI = 3.07, 0.03). Dementia status predicted hospital admissions after adjustment for medical burden (IRR = 1.37; 95% CI = 0.99, 1.89). For each one point increase in medical burden, there was an 11% increase in ED visits (IRR = 1.11; 95% CI = 1.06, 1.16), a 13% increase in hospital admissions (IRR = 1.13; 95% CI = 1.09, 1.17), and an 11% higher risk of death (HR = 1.11; 95% CI = 1.04, 1.17). Age did not predict utilization. CONCLUSION Dementia status and medical burden were independent predictors of ED visits and death in patients with clinically diagnosed dementia followed from the early stage of disease.
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Affiliation(s)
- Ellen Grober
- Albert Einstein College of Medicine and Montefiore Medical Center, Department of Neurology, Bronx, NY, USA
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22
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Hodgson N, Gitlin LN, Winter L, Czekanski K. Undiagnosed illness and neuropsychiatric behaviors in community residing older adults with dementia. Alzheimer Dis Assoc Disord 2011; 25:109-15. [PMID: 20921879 PMCID: PMC3035741 DOI: 10.1097/wad.0b013e3181f8520a] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective analysis was to examine prevalence of undiagnosed acute illness and characteristics including neuropsychiatric symptoms associated with illness in community residing older adults with Alzheimer disease or related disorders. Subjects included 265 community residing older adults with dementia who participated in 1 of 2 interventions being tested in randomized clinical trials. Measures included a brief nursing assessment and laboratory evaluations including complete blood count, blood chemistry (Chem 7), and thyroid function tests of serum samples and culture and sensitivity tests of urine samples. Undiagnosed illness was identified according to currently published criteria. Neuropsychiatric behaviors were assessed using 21 behaviors derived from standard measures. Thirty-six percent (N=96) of patients had clinical findings indicative of undetected illness. Conditions most prevalent were bacteriuria (15%), followed by hyperglycemia (6%) and anemia (5%). The behavior most often demonstrated among those with detected illness was resisting or refusing care (66% vs. 47% for those without detected illness). Individuals with detected illness had significantly lower functional status scores [3.8 vs. 4.4, t(275)=7.01, P=0.01], lower cognitive status scores [10.5 vs. 14.4, t(275)=12.1, P<0.01], and were more likely to be prescribed psychotropic medications for behavior (41% vs. 26%, χ=3.67, P<0.05) than those without illness. Findings suggest that challenges of diagnosing acute illness with atypical presentation must be addressed to promote quality of care and the specialized needs for this vulnerable population.
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Affiliation(s)
- Nancy Hodgson
- Corresponding Author; Research Scientist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice -215-955-2163; fax- 215-923-2475;
| | - Laura N. Gitlin
- Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 513, Philadelphia, PA, 19130
| | - Laraine Winter
- Assistant Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-503-4715; fax- 215-923-2475
| | - Kathleen Czekanski
- Nurse Interventionist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-951-1322
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23
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Callahan CM, Boustani M, Sachs GA, Hendrie HC. Integrating care for older adults with cognitive impairment. Curr Alzheimer Res 2009; 6:368-74. [PMID: 19689236 DOI: 10.2174/156720509788929228] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The number of older adults with Alzheimer's disease and related disorders is expected to triple over the next 50 years. While we may be on the cusp of important therapeutic advances, such advances will not alter the disease course for millions of persons already affected. Hoping for technology to spare the health care system from the need to care for older adults with dementia is no longer tenable. Most older adults with dementia will receive their medical care in the primary care setting and this setting is not prepared to provide for the complex care needs of these vulnerable elders. With an increasing emphasis on earlier diagnosis of dementia, primary care in particular will come under increasing strain from this new care responsibility. While primary care may remain the hub of care for older adults, it cannot and should not be the whole of care. We need to design and test new models of care that integrate the larger health care system including medical care as well as community and family resources. The purpose of this paper to describe the current health care infrastructure with an emphasis on the role of primary care in providing care for older adults with dementia. We summarize recent innovative models of care seeking to provide an integrated and coordinated system of care for older adults with dementia. We present the case for a more aggressive agenda to improving our system of care for older adults with dementia through greater training, integration, and collaboration of care providers. This requires investments in the design and testing of an improved infrastructure for care that matches our national investment in the search for cure.
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Affiliation(s)
- Christopher M Callahan
- Indiana University Center for Aging Research, Indiana University School of Medicine, HITS Building Suite 2000, 410 West 10th Street, Indianapolis, IN 46202-3012, USA.
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Caspi E, Silverstein NM, Porell F, Kwan N. Physician outpatient contacts and hospitalizations among cognitively impaired elderly. Alzheimers Dement 2009; 5:30-42. [DOI: 10.1016/j.jalz.2008.05.2493] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 02/26/2008] [Accepted: 05/09/2008] [Indexed: 01/08/2023]
Affiliation(s)
- Eilon Caspi
- Gerontology Institute and DepartmentMcCormack Graduate School of Policy StudiesUniversity of Massachusetts BostonBostonMAUSA
| | - Nina M. Silverstein
- Gerontology Institute and DepartmentMcCormack Graduate School of Policy StudiesUniversity of Massachusetts BostonBostonMAUSA
| | - Frank Porell
- Gerontology Institute and DepartmentMcCormack Graduate School of Policy StudiesUniversity of Massachusetts BostonBostonMAUSA
| | - Ngai Kwan
- Gerontology Institute and DepartmentMcCormack Graduate School of Policy StudiesUniversity of Massachusetts BostonBostonMAUSA
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Adler G, Silverstein NM. At-risk drivers with Alzheimer's disease: recognition, response, and referral. TRAFFIC INJURY PREVENTION 2008; 9:299-303. [PMID: 18696385 DOI: 10.1080/15389580801895186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimer's disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services? METHODS To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature. RESULTS Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities. CONCLUSIONS The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly-none should "look the other way." The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.
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Affiliation(s)
- Geri Adler
- Graduate College of Social Work, University of Houston, Houston, Texas 77204-4013, USA.
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Rentz CA. Alzheimer's disease: an elusive thief. Nurs Manag (Harrow) 2008; 39:33-39. [PMID: 18536588 DOI: 10.1097/01.numa.0000320636.73812.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Clarissa A Rentz
- Alzheimer's Association of Greater Cincinnati, Cincinnati, Ohio, USA
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Abstract
Enhanced life expectancy and the aging of society have conspired with rising rates of obesity and physical inactivity to cause an unprecedented increase in diabetes prevalence worldwide. The disease and its chronic complications have unique presentations and challenges in the elderly. Postprandial hyperglycemia may be the predominant manifestation, comorbid health conditions are often present, and the risk of cardiovascular disease is vastly increased. Periodic screening is essential for early diagnosis and proper treatment. The principles of multidisciplinary management emphasizing nutrition, exercise, education, psychosocial care, attention to concomitant metabolic risk factors, and prudent use of pharmacologic agents are the mainstay of therapy for older adults. Treatment should be tailored to the individual patient, and the assistance of family and caregivers should be combined with rational utilization of community resources. An evidence-based, comprehensive, and proactive approach is needed to reduce the burden of morbidity and mortality from diabetes in the elderly.
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Affiliation(s)
- Ali A Rizvi
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
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Noale M, Limongi F, Minicuci N. Identification of factorial structure of MMSE based on elderly cognitive destiny: the Italian Longitudinal Study on Aging. Dement Geriatr Cogn Disord 2006; 21:233-41. [PMID: 16465051 DOI: 10.1159/000091341] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2005] [Indexed: 11/19/2022] Open
Abstract
The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status, but only few studies have investigated the relationship among its components in terms of factorial structure. We have considered data from the Italian Longitudinal Study on Aging (ILSA), carried out in Italy in 1992 on a sample of 5,632 subjects aged 65-84 years, and followed up in 1996. The aim of our study was to investigate static factorial structure in three groups of elderly (subjects with a diagnosis of dementia at baseline; subjects free of dementia at baseline, but incident cases at follow-up; subjects who never developed dementia during the 4-year follow-up). Considering our results, we could hypothesize that MMSE static structure reflects the cognitive profile of elderly, and is thus influenced by subjects' potential to develop dementia.
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Affiliation(s)
- M Noale
- National Research Council, Institute of Neuroscience, Padova Aging Section, Italy.
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