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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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Shimazaki Y, Kishimoto K, Ishikawa J, Iwakiri R, Araki A, Imai S. Association between Cognitive Impairment Severity and Polypharmacy in Older Patients with Atrial Fibrillation: A Retrospective Study Using Inpatient Data from a Specialised Geriatric Hospital. Geriatrics (Basel) 2024; 9:15. [PMID: 38392102 PMCID: PMC10887641 DOI: 10.3390/geriatrics9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to investigate the association between cognitive impairment and polypharmacy in patients with atrial fibrillation prone to cognitive decline, and to elucidate if the Dementia Assessment Sheet for Community-based Integrated Care System 21-Items (DASC-21) severity classification indicates drug adjustment. This retrospective cohort study used the DASC-21 and Diagnosis Procedure Combination data at a specialised geriatric hospital with patients hospitalised between April 2019 and March 2022. The association between cognitive severity evaluated using the DASC-21 and polypharmacy was investigated using a multivariate logistic regression model. Data of 1191 inpatients (44.3% aged ≥85 years, 49.0% male) were analysed. Compared with severe cognitive impairment, mild (odds ratio [OR]: 3.33, 95% confidence interval [CI]: 1.29-8.57) and moderate (OR: 2.46, 95% CI: 1.06-5.72) impairments were associated with concurrent use of ≥6 medications. Antithrombotics were related to polypharmacy. The ORs did not change with 6, 8, or 10 medications (2.11 [95% CI: 1.51-2.95, p < 0.001], 2.42 [95% CI: 1.79-3.27, p < 0.001], and 2.01 [95% CI: 1.46-2.77, p < 0.001], respectively). DASC-21 severity was associated with polypharmacy in patients with atrial fibrillation, with a trend toward decreased polypharmacy from moderate to severe. The DASC-21 may serve as an indicator for drug adjustment in clinical practice.
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Affiliation(s)
- Yoshitomo Shimazaki
- Division of Pharmacy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Keiko Kishimoto
- Department of Social Pharmacy, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Rika Iwakiri
- Division of Elderly Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Atsushi Araki
- Frail Prevention Center, Training Center, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shinobu Imai
- Depertment of Pharmacoepidemiology, Showa University Graduate School of Pharmacy, 1-8-5, Hatanodai, Shinagawaku, Tokyo 142-8555, Japan
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Racsa PN, Booth TA, Chung LN, Dixon SW, Poonawalla IB. Association of medication adherence quality measures for diabetes, hypertension, and hyperlipidemia with cognitive decline. J Family Med Prim Care 2023; 12:2667-2675. [PMID: 38186814 PMCID: PMC10771214 DOI: 10.4103/jfmpc.jfmpc_935_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background While diabetes, hypertension, and hyperlipidemia each are associated with increased risk of cognitive decline, little is known regarding how nonadherence to medications for these conditions is associated with cognitive decline risk. Methods We identified patients enrolled in a Medicare Advantage Prescription Drug plan who were eligible for inclusion in the CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia in 2018, 2019, and 2020. To achieve an adherence quality measure, patients had to meet 80% of the proportion of days for the medication. We used propensity score with inverse probability of treatment weighting to balance outcomes for baseline characteristics and logistic regression models to compare odds of cognitive decline outcomes across patient groups. Results The study population of 99,774 individuals had a mean age of 71.0 years and was 49.1% female, 73.9% White, and 17.8% Black, with 62.0% living in an urban setting. Compared with patients who missed zero adherence measures, those who missed one measure had 23%-33% increased odds of cognitive decline (any decline OR = 1.23; dementia OR = 1.33; Alzheimer's disease OR = 1.27; all P values <0.01). Patients who missed 2-3 measures had 37%-96% increased odds of cognitive decline (any decline OR = 1.37; dementia OR = 1.58; Alzheimer's disease OR = 1.96; all P values <0.01). Patients who missed ≥4 adherence measures had the greatest odds of cognitive decline (any decline OR = 1.64; dementia OR = 2.05; Alzheimer's disease OR = 2.48; all P values <0.01). Conclusion Not achieving CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia therapies was associated with increased risk of cognitive decline outcomes.
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Affiliation(s)
- Patrick N. Racsa
- Affiliated with Humana at the Time of the Work, Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202 USA
| | - Tori A. Booth
- Humana Pharmacy Solutions, Humana Inc. 500 W Main Street Louisville, KY 40202, USA
| | - Linda N. Chung
- Humana Pharmacy Solutions, Humana Inc. 500 W Main Street Louisville, KY 40202, USA
| | - Suzanne W. Dixon
- Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202, USA
| | - Insiya B. Poonawalla
- Humana Healthcare Research, Inc., Humana Inc., 500 W Main Street Louisville, KY 40202, USA
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Davuluru SS, Jess AT, Kim JSB, Yoo K, Nguyen V, Xu BY. Identifying, Understanding, and Addressing Disparities in Glaucoma Care in the United States. Transl Vis Sci Technol 2023; 12:18. [PMID: 37889504 PMCID: PMC10617640 DOI: 10.1167/tvst.12.10.18] [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: 07/16/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide, currently affecting around 80 million people. Glaucoma prevalence is rapidly rising in the United States due to an aging population. Despite recent advances in the diagnosis and treatment of glaucoma, significant disparities persist in disease detection, management, and outcomes among the diverse patient populations of the United States. Research on disparities is critical to identifying, understanding, and addressing societal and healthcare inequalities. Disparities research is especially important and impactful in the context of irreversible diseases such as glaucoma, where earlier detection and intervention are the primary approach to improving patient outcomes. In this article, we first review recent studies identifying disparities in glaucoma care that affect patient populations based on race, age, and gender. We then review studies elucidating and furthering our understanding of modifiable factors that contribute to these inequities, including socioeconomic status (particularly age and education), insurance product, and geographic region. Finally, we present work proposing potential strategies addressing disparities in glaucoma care, including teleophthalmology and artificial intelligence. We also discuss the presence of non-modifiable factors that contribute to differences in glaucoma burden and can confound the detection of glaucoma disparities. Translational Relevance By recognizing underlying causes and proposing potential solutions, healthcare providers, policymakers, and other stakeholders can work collaboratively to reduce the burden of glaucoma and improve visual health and clinical outcomes in vulnerable patient populations.
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Affiliation(s)
- Shaili S. Davuluru
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alison T. Jess
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Kristy Yoo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Van Nguyen
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Benjamin Y. Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Brimavandi M, Abbasi P, Khaledi‐Paveh B, Salari N. Examining the relationship between depression and medication adherence among elderlies suffering from cardiovascular disease referring to the clinics affiliated with Kermanshah University of Medical Sciences: A cross-sectional study. Health Sci Rep 2023; 6:e1503. [PMID: 37599664 PMCID: PMC10435705 DOI: 10.1002/hsr2.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background In recent years, around 30% of all mortalities worldwide has been related to cardiovascular disease (CVD). The most important predictor solution of cardiovascular events is enhancing medication adherence. Meanwhile, the main reason behind development of physical disorders among the elderly is depression. In this regard, the present research was performed to determine the relationship between depression and medication adherence among the elderly suffering from CVD. Methods A cross-sectional study was done via an analytical approach on 188 elderlies fulfilling the inclusion criteria. The participants were chosen through convenience nonrandomized sampling from March to July 2022. The data were collected through demographic and healthcare information form plus Madanloo chronic disease medication adherence and geriatric depression scale. The analysis of the data was done by SPSS 26 plus Stata 14.2. Results The mean depression score was 5.6(4.3) and the mean score of medication adherence in the elderlies was 168.03(23.85). The prevalence of depression was higher in women than in men (p = 0.015), and the elderlies differing from heart failure reported the minimum extent of medication adherence. The findings obtained from analysis of variance showed that age, level of education, and monthly level of income were among the effective demographic factors in the extent of depression and medication adherence (p < 0.05). Meanwhile, 26% of changes in medication adherence can be attributed to depression. Further, the results of the multiple linear regression model reported that depression, age, and polypharmacy are among the predictors of medication adherence. Discussion and Conclusion A weak to moderate relationship existed between depression and medication adherence among these elderlies. Given the growing elderly population, the importance of depression, and lack of medication adherence in incidence of CVD events, it is recommended to train the healthcare team to monitor the elderly regarding depression symptoms.
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Affiliation(s)
- Mina Brimavandi
- Department of Nursing, Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Parvin Abbasi
- Department of Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Behnam Khaledi‐Paveh
- Department of Psychiatry Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Nader Salari
- Department of Biostatics, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
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K J, Rao M, YN S, Thunga G, N R, Sudhakar C, Sanatombi Devi E. Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Patient Prefer Adherence 2023; 17:1641-1656. [PMID: 37465058 PMCID: PMC10351531 DOI: 10.2147/ppa.s380784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India. Patients and Methods This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics. Results The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ2) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments. Conclusion Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.
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Affiliation(s)
- Jeyalakshmi K
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shashidhara YN
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravishankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Christopher Sudhakar
- Department of Mental Health Nursing & Director - Quality, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Soraci L, Cherubini A, Paoletti L, Filippelli G, Luciani F, Laganà P, Gambuzza ME, Filicetti E, Corsonello A, Lattanzio F. Safety and Tolerability of Antimicrobial Agents in the Older Patient. Drugs Aging 2023; 40:499-526. [PMID: 36976501 PMCID: PMC10043546 DOI: 10.1007/s40266-023-01019-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug-drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.
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Affiliation(s)
- Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Luca Paoletti
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Filippo Luciani
- Infectious Diseases Unit of Annunziata Hospital, Cosenza, Italy
| | - Pasqualina Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Dai M, Song Q, Wang X, Li Y, Lin T, Liang R, Jiang T, Shu X, Ge N, Yue J. Combined associations of vitamin D and cognitive function with all-cause mortality among older adults in Chinese longevity areas: A prospective cohort study. Front Public Health 2023; 11:1024341. [PMID: 37206876 PMCID: PMC10189877 DOI: 10.3389/fpubh.2023.1024341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/20/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives While both vitamin D deficiency and cognitive impairment have individually been linked to a greater risk of all-cause mortality, the combined effects of these two different conditions have not previously been explored in this context. We aimed to investigate the combined impact of vitamin D concentration and cognitive impairment on all-cause mortality in older adults. Methods The analyzed data were collected from community-dwelling adults ≥65 years of age that were enrolled in the Chinese Longitudinal Healthy Longevity Survey (n = 1,673). The Mini-Mental Status Examination (MMSE) was used to assess cognitive function, while the plasma 25-hydroxyvitamin D [25(OH)D] test was used to assess vitamin D status. The associations between vitamin D concentration, cognitive function, and all-cause mortality were assessed with Cox proportional hazards models. We used restricted cubic splines to examine the dose-response relationship between vitamin D and the risk of all-cause mortality and used joint effect testing to explore interactions between vitamin D concentration and cognitive function. Results During a mean (SD) follow-up of 3.8 (1.9) years, 899 (53.7%) deaths occurred. A negative dose-response relationship was observed between 25(OH)D concentration and cognition impairment at baseline, as well as the odds of all-cause mortality during follow-up. Similarly, cognitive impairment was significantly related to all-cause mortality risk (HR 1.81, 95% CI: 1.54 to 2.12). The combined analyses showed positive associations, with the highest mortality risk observed in older adults with both low vitamin D and cognitive impairment (HR 3.04, 95% CI: 2.40 to 3.86). Moreover, the interaction between 25(OH)D concentration and cognitive function was found to be significant in relation to the risk of mortality (p for interaction <0.001). Conclusion Lower plasma 25(OH)D and cognitive impairment were, respectively, associated with increased all-cause mortality risks. The 25(OH)D concentration and cognitive impairment exhibited a combined additive effect on all-cause mortality among older Chinese adults.
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Affiliation(s)
- Miao Dai
- Department of Geriatrics, Jiujiang First People’s Hospital, Jiujiang, Jiangxi, China
| | - Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiang Wang
- Department of Cardiology, Jiujiang First People’s Hospital, Jiujiang, Jiangxi, China
| | - Ying Li
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Rui Liang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tingting Jiang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyu Shu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ning Ge
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Ning Ge,
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Ye Q, Liu L, Wang Y, Li L, Wang Z, Liu G, Lin P, Li Q. Association of Type D personality and mild cognitive impairment in patients with hypertension. Front Psychol 2022; 13:974430. [PMID: 36467148 PMCID: PMC9709486 DOI: 10.3389/fpsyg.2022.974430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the association between Type D personality and mild cognitive impairment (MCI) in patients with hypertension. METHODS A total of 324 subjects with hypertension were included in the study. All of them completed questionnaires on demographic characteristics, Type D personality Scale, Montreal Cognitive Assessment (MoCA), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The Type D personality effect was analyzed as both dichotomous and continuous methods. RESULTS The incidence of MCI was 56.5% in hypertensive individuals. Type D personality presenting as a dichotomous construct was an independent risk factor of MCI (odds ratio [OR] = 2.814, 95% confidence interval [CI] = 1.577-5.021, p < 0.001), after adjusting for ages, sex and some clinical factors. Meanwhile, main effect of negative affectivity component was independently related to the prevalence of MCI (OR = 1.087, 95%CI = 1.014-1.165, p = 0.019). However, associations between the main effect of social inhibition component (OR = 1.011, 95%CI = 0.924-1.107, p = 0.811) as well as the interaction of negative affectivity and social inhibition (OR = 1.013, 95%CI = 0.996-1.030, p = 0.127) with MCI were not found. CONCLUSION The findings suggest that Type D personality is strongly associated with MCI in patients with hypertension. The negative affectivity component of the Type D appears to drive the correlations between Type D and MCI. These findings provide new ideas for studying the mechanisms underlying the relationship between personality and cognitive decline in hypertensive individuals.
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Affiliation(s)
- Qingfang Ye
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Basic Nursing, School of Nursing, Harbin Medical University, Daqing, China
| | - Li Liu
- Department of Basic Nursing, School of Nursing, Harbin Medical University, Daqing, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ling Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhengjun Wang
- Department of Basic Nursing, School of Nursing, Harbin Medical University, Daqing, China
| | - Guojie Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ping Lin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiujie Li
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Chan FHF, Newman S, Khan BA, Griva K. The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study. BMC Nephrol 2022; 23:363. [PMID: 36376848 PMCID: PMC9661809 DOI: 10.1186/s12882-022-02994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence. Methods A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence. Results Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence. Conclusions The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.
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Chapman KR, Tremont G. Dysexecutive Behaviors Mediate the Relationship Between Functional Impairment and Caregiver Burden in Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2022; 35:823-831. [PMID: 35088611 DOI: 10.1177/08919887211070261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mild cognitive impairment (MCI) is often accompanied by executive dysfunction (ED), dysexecutive behaviors (DB), and functional impairment (FI). The respective contributions of ED, DB, and FI to caregiver burden in MCI are not well understood. The present study hypothesized that while all factors would predict caregiver burden in MCI, ED and family-reported DB would account for greater variance in caregiver burden and mediate the relationship between FI and caregiver burden. In our sample (n = 94), linear regression revealed that FI and DB predicted caregiver burden, but that DB predicted caregiver burden above and beyond the contribution of FI. DB mediated the relationship between FI and caregiver burden. These results add to a body of work demonstrating that presence of DB and FI are distressing to family members, even in mild disease stages. Because DB may account for the relationship between FI and caregiver burden, early identification of family members reporting DB in the person with MCI is imperative so that supports can be made available.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychiatry, 23325Rhode Island Hospital, Providence, RI, USA.,Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry, 23325Rhode Island Hospital, Providence, RI, USA.,Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
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12
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Irigaray TQ, Moret-Tatay C, Murphy M, de Oliveira CR. Editorial: Cognitive reserve, cognitive functioning, and mental health in elderly people. Front Hum Neurosci 2022; 16:1040675. [PMID: 36267348 PMCID: PMC9577465 DOI: 10.3389/fnhum.2022.1040675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tatiana Quarti Irigaray
- Pós-Graduate Program in Psychology, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Carmen Moret-Tatay
- Faculty of Psychology, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
- *Correspondence: Carmen Moret-Tatay
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
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13
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Sheets KM, Davey CS, St. Peter WL, Reule SA, Murray AM. Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis. Health Sci Rep 2022; 5:e697. [PMID: 35782299 PMCID: PMC9243633 DOI: 10.1002/hsr2.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims Reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) is a risk factor for cognitive impairment (CI) and medication nonadherence. However, the association between CI and medication adherence in adults with reduced eGFR has not been adequately examined. Our pragmatic objectives were to assess the cross-sectional relationship between CI and self-reported medication adherence, medication number, and use of potentially high-risk medications among adults with reduced eGFR. Methods An observational cohort study of the epidemiology of CI in community-dwelling adults aged 45 years or older with reduced eGFR. Results Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self-report of missing medications <4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI]: 1.62-10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86-16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high-risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities. Conclusion Given the well-documented association between CI and medication nonadherence, better self-reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high-risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self-reported medication adherence in reduced eGFR patients with CI.
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Affiliation(s)
- Kerry M. Sheets
- Department of Medicine, Division of Geriatrics and Palliative CareHennepin HealthcareMinneapolisMinnesotaUSA
| | - Cynthia S. Davey
- Biostatistical Design and Analysis CenterUniversity of Minnesota Clinical and Translational Science InstituteMinneapolisMinnesotaUSA
| | | | - Scott A. Reule
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- Department of MedicineNephrology Division, Minneapolis Veterans Affairs Health Care SystemMinneapolisMinnesotaUSA
| | - Anne M. Murray
- Department of Medicine, Division of Geriatrics and Palliative CareHennepin HealthcareMinneapolisMinnesotaUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- The Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
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14
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Jia Q, Wang H, Wang L, Wang Y. Association of Health Literacy With Medication Adherence Mediated by Cognitive Function Among the Community-Based Elders With Chronic Disease in Beijing of China. Front Public Health 2022; 10:824778. [PMID: 35558542 PMCID: PMC9086678 DOI: 10.3389/fpubh.2022.824778] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although health literacy was considered to play a crucial role in non-communicable chronic disease (NCD) prevention and control, the relationship of health literacy and medication adherence has rarely given attention among older adult Chinese population in previous studies, especially considered that they might be with cognitive impairment. Purpose This study aimed to investigate the association between health literacy and medication adherence and mediation by cognitive ability among community-based older adults with chronic disease in Beijing of China. Methods The older adults aged 60 years old or over were recruited in a cross-sectional survey conducted in Beijing of China by using multistage, stratified sampling method. Of those, the participants with chronic disease and need to take long-term medicine were included in our study. The information about sociodemographic characteristics, health literacy, cognition ability, and medication adherence was collected by the questionnaire. The univariate and multiple logistic regression analysis were used to measure the association of health literacy and adherence medication, and mediate effect by cognitive ability. Results The total of 4,166 older adult populations (average age: 70.61 ± 7.38 years) was included in this study, 1,395 participants (33.49%) were non-adherence, 1,983 participants (47.60%) had two chronic conditions or more, and 1,459 participants (35.02%) screened as cognitive impairment. The health literacy was negatively associated with medication adherence. The lower total scores of health literacy were found with a high risk of non-adherence [p < 0.01, adjusted odds ratio (OR) = 0.988 per one point increase, 95% CI: 0.982–0.993] controlling other covariates. However, their association tended to be weakened or even disappeared among the older adults with cognitive impairment compared with the populations with normal cognitive. Conclusion Improving health literacy might be a public health strategy to increase the medication adherence of older adults, but need to first identify the potential target population based on their cognitive ability.
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Affiliation(s)
- Qiaoling Jia
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Haiyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
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15
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Resciniti NV, Hong Y, McDermott S. Factors contributing to antihypertensive medication adherence among adults with intellectual and developmental disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:137-148. [PMID: 33140659 DOI: 10.1177/1744629520961958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adults with intellectual or developmental disabilities often have hypertension and mental illness, and are prescribed medications for treatment. This study examined psychotropic medication adherence as a mediator between the association of residence type and antihypertensive medication adherence for adults with intellectual or developmental disabilities. We used Medicaid data of adults with intellectual or developmental disabilities who had hypertension and prescribed antihypertensive medication (N = 1,201) to measure the direct effect, indirect effect, and total effect of residence type (home vs. supervised setting) and antihypertensive medication adherence, with a mediator of psychotropic medication adherence. The indirect effect of psychotropic medication adherence on antihypertensive medication adherence was 1.26 (OR = 1.26, CI: 1.08-1.52), holding residency constant. The direct effect of residential type on antihypertensive medication adherence was 3.75 (OR = 3.75, CI: 1.61-8.75). This association may be due to some features of having a mental illness or maybe the result of being prescribed more than one medication.
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16
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Yamamoto K, Akasaka H, Yasunobe Y, Shimizu A, Nomoto K, Nagai K, Umegaki H, Akasaki Y, Kojima T, Kozaki K, Kuzuya M, Ohishi M, Akishita M, Takami Y, Rakugi H. Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment. Hypertens Res 2022; 45:612-619. [PMID: 35210565 DOI: 10.1038/s41440-022-00861-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/09/2022]
Abstract
To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.
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Affiliation(s)
- Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Yasunobe
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuya Shimizu
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Kumiko Nagai
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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17
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Yuan S, Zhang W, Yao Q, Lü W, Yu W, Zhong F, Wang Y, Xing D, Wang X, Song J, Huang H, Chen C, Liu J, Yu W, Lü Y. The Neuropsychiatric Changes After COVID-19 Quarantine in Patients With Cognitive Impairment and Their Caregivers in Chongqing, China: A Cohort Study. Front Aging Neurosci 2022; 13:762907. [PMID: 35221981 PMCID: PMC8868570 DOI: 10.3389/fnagi.2021.762907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe follow-up study on neuropsychiatric changes after the lifting of coronavirus disease 2019 (COVID-19) quarantine in patients with cognitive impairment and their caregivers is still lacking, and relative information is needed to formulate more comprehensive healthcare prevention measures worldwide.AimsTo provide data on the changes in neuropsychiatric performance after the lifting of COVID-19 quarantine in patients with cognitive disorders and their caregivers.MethodsTwo surveys in Chongqing, China were conducted via telephonic interview with 531 patients and their caregivers. The baseline survey was performed from February 11 to 23, 2020, and the follow-up was from October 24 to November 9, 2020. The data of neuropsychiatric symptoms (NPSs), sleep, nutrition, and chronic diseases of patients, as well as the burden of care, anxiety, and depression of caregivers were evaluated.ResultsSignificant alleviation of NPSs after the lifting of COVID-19 quarantine was observed in patients with mild cognitive impairment (MCI) and dementia (both P < 0.05). Compared with baseline, the prevalence for NPSs of all participants dropped from 57.94 to 38.82%. Among NPS subdomains, apathy displayed the biggest decline at follow-up by 10.72%, followed by nighttime behavior by 8.65%. Mixed effect generalized estimation equation analysis showed significant amelioration in hallucination, depression, apathy, irritability, aberrant motor behavior, and nighttime behavior (all P < 0.05), with the most prominent changes in nighttime behavior and apathy. Among the patients with unsatisfactory control of chronic disease, the medication adherence rate dropped by approximately 30% after the lifting of quarantine. More importantly, around 13% increase of care burden was observed among the caregivers at follow-up, with both depression and anxiety rising by nearly 4%.ConclusionThe prolonged quarantine may exacerbate NPS in patients with memory disorders, while the care burden and mental stability of the caregivers after the pandemic should also be concerned.
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Affiliation(s)
- Shiyun Yuan
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenbo Zhang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Wenqi Lü
- Department of Psychiatry, West China Hospital, Sichuan University, Sichuan, China
| | - Wuhan Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fuxin Zhong
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Yan Wang
- Foreign Language College, Chongqing Medical University, Chongqing, China
| | - Dianxia Xing
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqin Wang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaqi Song
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Hong Huang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenxi Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junjin Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihua Yu
- Institutes of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yang Lü,
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18
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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19
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Zhang B, Jiang S. Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: Growth mixture modeling across an 8-year cohort study. Hypertens Res 2021; 45:1037-1046. [PMID: 34952952 DOI: 10.1038/s41440-021-00829-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/06/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022]
Abstract
Hypertension is one of the most prevalent chronic conditions and has been proven to be related to cognitive function. However, there is no evidence regarding the heterogeneity in cognitive trajectories among persons with hypertension. The aims of the current study were to characterize the heterogeneity in longitudinal trajectories of cognitive performance among Chinese middle-aged and older individuals with hypertension and to explore the potential determinants of trajectory memberships. Data from the 2011 to 2018 Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. Two cognitive measures of executive function and episodic memory were assessed, and conditional growth mixture modeling (GMM) was performed to identify the trajectories of cognitive performance and explore the related factors of cognitive change. The findings revealed three trajectory classes of executive function (stable, sharp decline, smooth decline) and two trajectory classes of episodic memory (stable, decline). Individuals with hypertension who had a higher educational level, moderate nighttime sleep duration, and lower depressive symptoms as well as those who reported consuming alcohol at least once a month were more likely to belong to the optimal stable executive function group. Subjects with a higher educational level, adequate daytime napping duration, and higher BMI were more likely to exhibit stable episodic memory over time. Other factors, including age, sex, community type, marital status, and hypertension treatment, exhibited class-specific effects on growth parameters of cognitive trajectory. Targeting intervention designation is proposed to ameliorate the burdens of cognitive impairment among individuals with hypertension.
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Affiliation(s)
- Baiyang Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
| | - Shaohua Jiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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20
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Chou CC, Chien LY, Liaw JJ, Wang CJ, Liu PY. Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women. J Clin Nurs 2021; 31:2839-2849. [PMID: 34723423 DOI: 10.1111/jocn.16106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Abstract
DESIGN This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.
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Affiliation(s)
- Cheng-Chen Chou
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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21
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The Interplay between Anticholinergic Burden and Anemia in Relation to 1-Year Mortality among Older Patients Discharged from Acute Care Hospitals. J Clin Med 2021; 10:jcm10204650. [PMID: 34682773 PMCID: PMC8539729 DOI: 10.3390/jcm10204650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 01/15/2023] Open
Abstract
Anticholinergic burden (ACB) and anemia were found associated with an increased risk of death among older patients. Additionally, anticholinergic medications may contribute to the development of anemia. Therefore, we aimed at investigating the prognostic interplay of ACB and anemia among older patients discharged from hospital. Our series consisted of 783 patients enrolled in a multicenter observational study. The outcome of the study was 1 year mortality. ACB was assessed by an Anticholinergic Cognitive Burden score. Anemia was defined as hemoglobin < 13 g/dL in men and <12 g/dL in women. The association between study variables and mortality was investigated by Cox regression analysis. After adjusting for several potential confounders, ACB score = 2 or more was significantly associated with the outcome in anemic patients (HR = 1.93, 95%CI = 1.13–3.40), but not non anemic patients (HR = 1.51, 95%CI = 0.65–3.48). An additive prognostic interaction between ACB and anemia was observed (p = 0.02). Anemia may represent a relevant effect modifier in the association between ACB and mortality.
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22
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Qin J, He Z, Wu L, Wang W, Lin Q, Lin Y, Zheng L. Prevalence of mild cognitive impairment in patients with hypertension: a systematic review and meta-analysis. Hypertens Res 2021; 44:1251-1260. [PMID: 34285378 DOI: 10.1038/s41440-021-00704-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Mild cognitive impairment (MCI) is common in patients with hypertension. Prevalence estimates of MCI in hypertensive patients are needed to guide both public health and clinical decision making. A literature search was conducted in four databases, including PubMed, Embase, Cochrane Library, and Web of Science, from their inception to February 2021. The methodological quality assessment used the risk of bias tool. The pooled prevalence of MCI in hypertensive patients was determined by a random-effects model. Heterogeneity was explored using sensitivity analysis, subgroup analysis, and random effects meta-regression. Of 2314 references, 11 studies (47,179 participants) were included in the meta-analysis. The overall pooled prevalence of MCI in patients with hypertension was 30% (95% CI, 25-35), with significant heterogeneity present (I2 = 99.3%, p < 0.001). In subgroup analyses, Asian and European samples had a prevalence of 26% (95% CI, 20-31) and 40% (95% CI, 14-66), respectively; cross-sectional and cohort studies had a prevalence of 28% (95% CI, 24-32) and 38% (95% CI, -5-81); age older than 60 years had a prevalence of 28% (95% CI, 23-33); community-based and clinic-based samples had a prevalence of 17% (95% CI, 15-19) and 42% (95% CI, 23-62); and MCI diagnosis using the MoCA, NIA-AA, MMSE, and Peterson criteria had a prevalence of 64% (95% CI, 59-68), 18% (95% CI, 16-19), 19% (95% CI, 15-23), and 13% (95% CI, 9-17). Meta-regression analysis showed that different MCI diagnostic criteria could be the source of heterogeneity in the pooled results. MCI is common in patients with hypertension, with an overall prevalence of 30%. Earlier cognitive screening and management in hypertensive patients should be advocated.
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Affiliation(s)
- Jiawei Qin
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
| | - Zexiang He
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Lijian Wu
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wanting Wang
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Qiuxiang Lin
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Yiheng Lin
- Department of Rehabilitation Medicine, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Liling Zheng
- Department of Cardiovascular Surgery, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
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Kim SJ, Kwon OD, Choi HC, Lee EJ, Cho B, Yoon DH. Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study. BMC Neurol 2021; 21:349. [PMID: 34507550 PMCID: PMC8431917 DOI: 10.1186/s12883-021-02384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. METHODS Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. RESULTS Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17-3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31-1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15-1.72). Rural residency (aOR 1.36, 95% CI 1.14-1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05-1.47), lower income (aOR 1.20, 95% CI 1.03-1.40 for middle income class and OR 1.21, 95% CI 1.02-1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00-1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. CONCLUSIONS The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.
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Affiliation(s)
- Seung Jae Kim
- International Healthcare Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | | | - Ho Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea.
- Nuvizen, Palo Alto, California, 94303, USA.
| | - Eung-Joon Lee
- Institute of Public Health and Medical Care, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
- Department of Neurology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Dae Hyun Yoon
- Department of Psychiatry, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea
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Corsonello A, Soraci L, Di Rosa M, Bustacchini S, Bonfigli AR, Lisa R, Liperoti R, Tettamanti M, Cherubini A, Antonicelli R, Pelliccioni G, Postacchini D, Lattanzio F. Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital. J Am Med Dir Assoc 2021; 23:499-506.e1. [PMID: 34384766 DOI: 10.1016/j.jamda.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals. DESIGN A prospective multicenter observational study. SETTING AND PARTICIPANTS Our series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project. METHODS After signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell's C-index and categorical Net Reclassification Index (NRI). RESULTS Functional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65-0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53-0.56), and Charlson score (C-index 0.58, 95% CI 0.56-0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14-0.31) or Charlson score (NRI 0.13, 95% CI 0.03-0.20) to functional cluster model slightly improved the accuracy of prediction. CONCLUSIONS AND IMPLICATIONS Functional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals' needs and to design tailored preventive interventions.
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Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy; Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy.
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | | | | | | | - Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Tettamanti
- Geriatric Epidemiology Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Demetrio Postacchini
- Geriatrics Operative Unit, Italian National Research Centre on Aging (IRCCS INRCA), Fermo, Italy
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Liu Z, Li C. A Predictive Model for the Risk of Cognitive Impairment in Patients with Gallstones. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3792407. [PMID: 34337006 PMCID: PMC8313337 DOI: 10.1155/2021/3792407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Gallstones can cause malnutrition in patients and further lead to cognitive impairment. This study is aimed at constructing a validated clinical prediction model for evaluating the risk of developing cognitive impairment from gallstones. METHODS The study was a single-centre crosssectional study. Four models or methods (SVM-RFE, random forest model, Lasso model, and logistics analysis) were analyzed and compared regarding their predictive performance. The model with the best classification performance and predictive power was selected. The AUC index, C-index, and calibration curves were applied to the chosen model to further evaluate its classification and prediction performance. Finally, the nomogram was plotted, and the clinical usability, efficacy, and safety of the nomogram were assessed using decision curve analysis (DCA). RESULTS This study included a total of 294 patients with gallstones, of which 110 had cognitive impairment. Factors such as gender, age, education, place of birth, history of alcohol consumption, abdominal circumference, sarcopenia, diabetes, anaemia, depression, and Pittsburgh Sleep Quality Index (PSQI) were incorporated into the model for nomogram construction. The calibration curve showed that the nomogram had good classification performance. Furthermore, the C-index of the model was 0.778 (95% CI, 0.674-0.882) in the test group. The DCA curves indicated that the constructed model had strong clinical applicability, efficacy, and safety. CONCLUSIONS This study constructed a cognitive impairment risk prediction model for patients with gallstones with good classification and predictive power. The constructed predictive model allows us to screen patients with gallstones and at high risk of cognitive impairment. These efforts might also help to further increase patient compliance, assist healthcare professionals to better manage patients with gallstones, and ultimately improve their overall health status and quality of life. Future clinical studies should further evaluate the accuracy and clinical usability of this model.
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Affiliation(s)
- Zhaofang Liu
- Department of General Surgery, The First Affiliated Hospital of USTC, China
| | - Chuanyan Li
- Department of General Surgery, The First Affiliated Hospital of USTC, China
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26
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Kim SJ, Kwon OD, Choi HC, Lee EJ, Cho B. Effect of antiplatelet persistence on long-term mortality and predictors of non-persistence in ischemic stroke patients 75 years and older: a nationwide cohort study. BMC Geriatr 2021; 21:232. [PMID: 33827445 PMCID: PMC8028245 DOI: 10.1186/s12877-021-02171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background We aimed to provide real-world evidence on the benefit of persistence with antiplatelet therapy (APT) on long-term all-cause mortality (ACM) in ischemic stroke patients aged 75 years and older. Methods Newly diagnosed ischemic stroke patients aged 75 years and older who initiated aspirin or clopidogrel for the first time were chosen from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea (n = 887), a random cohort sample accounting for 2.2% (n = 1,017,468) of total population (n = 46,605,433). Then subjects were divided into persistent (n = 556) and non-persistent (n = 321) groups according to the persistent status at 6 months. Survivor analysis was performed between the two groups and predictors of non-persistence were analyzed by multivariate logistic regression analysis. Patients were followed up until death or December 31, 2013. Results Non-persistence with APT was significantly associated with increased risk of ACM (adjusted hazard ration [aHR] 2.13, 95% confidence interval [CI] 1.72–2.65), cerebro-cardiovascular disease (CVD) mortality (aHR 2.26, 95% CI 1.57–3.24), and non-CVD mortality (aHR 2.06, 95% CI 1.5702.70). More comorbidities (Charlson comorbidity index score ≥ 6) (adjusted odds ratio [aOR], 2.56, 95% CI 1.43–4.55), older age (aOR 1.52, 95% CI 1.11–2.09 for 80–84 years, aOR 1.73, 95% CI 1.17–2.57 for ≥85 years), and less than 4 total prescribed drugs (aOR 1.54, 95% CI 1.08–2.21) were independent predictors of non-persistence. Conclusions Persistent with APT after ischemic stroke featured long-term mortality benefit even in patients aged 75 years and older. Thus, improving APT persistence for ischemic stroke patients in this age group is also recommended by understanding factors associated with non-persistence.
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Affiliation(s)
- Seung Jae Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,International Healthcare Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Oh Deog Kwon
- Republic of Korea Navy 2nd Fleet Medical Corps, Pyeongtaek-si, Gyeonggi-do, Republic of Korea
| | - Ho Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 39th Floor, Gangnam Finance Center, 152 Teheran-ro, Gangnam-gu, Seoul, 06236, Republic of Korea.
| | - Eung-Joon Lee
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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27
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Smith PJ, Potter G, Manson M, Martin M, Cendales LC. Psychosocial considerations in the assessment of hand transplant candidates: A single-center experience and brief literature review. Clin Transplant 2021; 35:e14268. [PMID: 33615558 DOI: 10.1111/ctr.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
Vascularized composite allograft, including hand transplantation (HT), has gained wider usage as a reconstructive treatment over the past 30 years. HT recipients face unique psychosocial challenges compared to their solid organ and/or bone marrow transplant counterparts. Accordingly, the psychosocial evaluation among HT candidates continues to evolve, leaving a lack of consensus as to the critical psychosocial domains and psychometric testing instruments to help evaluate individuals considering HT. The present manuscript describes the psychosocial evaluation process within the Duke HT program, which been contacted by 80 potential candidates since 2014. The Duke HT evaluation process incorporates a comprehensive psychosocial assessment within domains including personality, cognitive function, mood, behavioral adherence, social support, and substance use history, among others. Our experience underscores the potential utility of collecting thorough psychosocial evaluations, supplemented by psychometric test data, to comprehensively assess potential HT candidates.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Maria Manson
- Duke Office of Clinical Research, Duke School of Medicine, Durham, NC, USA
| | - Michael Martin
- Atlanta VA Healthcare System, Mental Health Service Line, Decatur, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Linda C Cendales
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Wheat HL, Irani E, Hughes J, Josephson R, Dolansky MA. Insights from Monitoring Aspirin Adherence: A Medication Adherence Cascade Tool. Patient Prefer Adherence 2021; 15:1639-1646. [PMID: 34345165 PMCID: PMC8325059 DOI: 10.2147/ppa.s315296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adherence to recommended medications is a key issue in the care of patients with cardiovascular disease (CVD) and barriers to adherence are well established during the medication adherence cascade, the processes of prescribing, obtaining, taking, and maintaining medication use. Aspirin avoids many of the barriers in the medication adherence cascade as it does not require a prescription (prescribing) and is inexpensive, easily accessible (obtaining), prescribed once-daily (taking) as an over-the-counter medication and is generally perceived by patients as safe (maintaining). The purpose of this paper is to report aspirin adherence and propose the Medication Adherence Cascade Tool to assist clinicians to consider all aspects of medication adherence. METHODS Adherence to aspirin was monitored with an electronic pillbox. Frequency analysis, independent T-tests, and ANOVA were completed on 151 patients with underlying heart failure who were prescribed aspirin within a larger parent study. Chi-square tests were completed to assess differences in baseline demographic characteristics. FINDINGS Mean aspirin adherence was 82.2% overall, with 11.9% of sample with adherence 50%, 18.5% with adherence 50-80%, and 69.5% with adherence ≥80%. Greater adherence was observed in self-identified White as compared to Black patients (84.47% vs 73.53%; p = 0.014), and patients ≥70 years of age compared to <70 years (87.00% vs 77.49%; p = 0.009). INTERPRETATION Aspirin adherence was suboptimal despite the fact that it addresses most of the barriers on the medication adherence cascade (ie, relatively easy access, low cost, and low risk). A Medication Adherence Cascade Tool (MACT) is proposed as a clinical guide to facilitate patient-provider co-production of strategies to address medication adherence. The tool can assist patients and providers to co-produce adherence to achieve optimal medication benefits.
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Affiliation(s)
- Heather L Wheat
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Correspondence: Heather L Wheat Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USATel +1 216 844-8447 Email
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joel Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, Division of Cardiology, Case Western Reserve University, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Feldman R. Physicians Treating Alzheimer's Disease Patients Should Be Aware that Televised Direct-to-Consumer Advertising Links More Strongly to Drug Utilization in Older Patients. J Alzheimers Dis 2021; 81:1169-1179. [PMID: 33843688 PMCID: PMC8293633 DOI: 10.3233/jad-210294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND US direct-to-consumer advertising spending for medicine has soared in recent decades. Advertising has been shown to impact drug utilization. Most Alzheimer's disease patients are above age 65 and may take a range of prescription medications for various disease states. OBJECTIVE To investigate how direct-to-consumer advertising is associated with the drug utilization of patients ≥65 years old. METHODS Using advertising expenditure data and Medicare Part D drug purchase claims, we performed regression analyses for each of the highest-spending drugs and age group, with cumulative monthly spending as the predictor variable and drug utilization as the response variable. For each drug, we ran a second set of regression analyses to determine if the spending-utilization correlation showed a significant difference between the two patient age groups (older than 65, younger than 65). RESULTS For all 14 drugs in our study, advertising spending is positively correlated with utilization (p < 0.01) in both age groups. For seven of the 14 drugs studied, the difference in the utilization of patients older than 65 and the utilization of patients younger than 65 is statistically significant at a p < 0.01 level. The 65-and-older age bracket exhibits significantly greater utilization for all seven of these drugs. CONCLUSION We find televised advertising for certain drugs to be associated with significantly stronger drug utilization among seniors, as compared to younger patients. Alzheimer's disease physicians should be aware of this result, in light of the medications that patients may take for other disease states, particularly mood and mental health medications.
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Affiliation(s)
- Robin Feldman
- Arthur J. Goldberg Distinguished Professor of Law and Director of the Center for Innovation at University of California, Hastings Law, San Francisco, CA, USA
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30
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Amini R, Kawser B. Impact of the interaction between mild and mild‐to‐moderate cognitive impairment with chronic health problems on hospital admission among community‐dwelling older adults. Geriatr Gerontol Int 2020; 20:1213-1220. [DOI: 10.1111/ggi.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Reza Amini
- Department of Public Health and Health Sciences University of Michigan‐Flint Flint Michigan USA
| | - Bushra Kawser
- Department of Public Health and Health Sciences University of Michigan‐Flint Flint Michigan USA
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Kalaitzidis RG, Balafa O, Dounousi E, Stagikas D, Tsimihodimos V. Adherence to Treatment, Arterial Stiffness and Cognitive Function in Irbesartan- Treated Newly Diagnosed Hypertensive Patients. Curr Vasc Pharmacol 2020; 19:565-571. [PMID: 33222674 DOI: 10.2174/1570161119666201120160104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Non-adherence to antihypertensive agents leads to reduced blood pressure (BP) control. Data supporting the correlation of adherence with arterial stiffness (AS) are few. Furthermore, the causal relationship between AS and cognitive dysfunction (CO/DY) has not been clearly established. It is suggested that angiotensin II receptor blockers (ARBs) exhibit the lowest discontinuation rate among antihypertensive drugs. DESIGN AND METHODS We followed up with patients receiving monotherapy with irbesartan. CO/DY was assessed with the Mini-Mental State Examination (MΜSE) and other tests. RESULTS Patients [n=77; mean age: 56±11 years; 39 men (50.6%)] were followed-up for 16.1±10.9 months. At the end of follow up, significant reductions were observed in mean peripheral systolic BP (135±117 vs 153±11 mmHg; p<0.005), mean peripheral diastolic BP (85±11 vs 95±10 mmHg; p<0.005), mean central systolic BP (130±11 vs 142±12 mmHg; p<0.005) as well as in mean central diastolic BP (85±8 vs 95±97 mmHg; p<0.005). AS indices [carotid-femoral pulse wave velocity and augmentation index] also improved significantly: 7.7±1.4 vs 8.2±1.4 m/sec (p<0.005), and 29.1±8.3 vs 32.3±9.1 (p<0.005), respectively. At the end of the study, a significant improvement was observed in the MMSE test (29.7±0.7 vs. 29.2±0.9; p<0.02), as well as a significant reduction in 24h urine albumin (94±82 vs. 204±112 mg/24h, p<0.005). The level of adherence was high in 60/77 (77.9%), medium in 9/77 (11.6%) and low in 8/77 (10.38%) patients. CONCLUSION Hypertensive patients receiving mono-therapy with an ARB showed reduced AS, cognitive improvement, significant reductions in BP (peripheral and central) and decreased 24h urinary albumin excretion.
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Affiliation(s)
- Rigas G Kalaitzidis
- Hypertension Excellence Centre, Division of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Olga Balafa
- Hypertension Excellence Centre, Division of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Hypertension Excellence Centre, Division of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Stagikas
- Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
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Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. Front Cardiovasc Med 2020; 7:49. [PMID: 32318584 PMCID: PMC7154079 DOI: 10.3389/fcvm.2020.00049] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertension is highly prevalent after the age of 65 years affecting more than 60% of individuals in developed countries. Today, there is sufficient evidence from clinical trials that treating elderly subjects with hypertension with antihypertensive medications has a positive benefit/risk ratio even in very elderly patients (>80 years). In recent years, partial or total non-adherence has been recognized as major issues in the long-term management of hypertension in all age categories. However, whether non-adherence is more frequent in hypertensive patients older than 65 years or not is still a matter of debate and the common belief is that adherence is lower in older than in younger patients. Are clinical data supporting this belief? In this brief review, we discuss the topic of drug adherence in elderly in the context of the medical treatment of hypertension. Studies show that drug adherence is actually better in patients aged 65 to 80 years when compared to younger hypertensive patients (<50 years). However, in very old patients (>80 years) the prevalence of non-adherence does increase. In this patients' group, there are specific risk factors for non-adherence such as cognitive ability, depression, and health believes, in addition to classical risk factors for non-adherence. One important aspect in the elderly is the prescription of potentially inappropriate medications that will interfere with the adherence to necessary treatments. In this context, an interesting new concept was developed few years ago, i.e., the process of deprescribing. Thus, today, in addition to conventional guidelines recommendations (use of single pill combinations, individualization of treatments), the evaluation of cognitive abilities, the regular assessment of potentially inappropriate medications, and the process of deprescribing appear to be three new additional steps to improve drug adherence in the elderly and thereby ameliorate the global management of hypertension.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
| | - Erietta Polychronopoulou
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
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Zanatta F, Nissanova E, Świątoniowska-Lonc N, Pierobon A, Callegari G, Olmetti F, Felicetti G, Karniej P, Polański J, Giardini A, Jankowska-Polańska B. Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study. Patient Prefer Adherence 2020; 14:1709-1718. [PMID: 33061314 PMCID: PMC7524841 DOI: 10.2147/ppa.s258999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Non-adherence to clinical prescriptions is widely recognized as the most common cause of uncontrolled hypertension, contributing to develop acute and chronic cardiovascular diseases. Specifically, patients' unintentional non-adherence is related to psychosocial factors as beliefs about medications, perceived physician's communication effectiveness and medication-specific social support. The aim of this study was to observe the impact of these factors on self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence among older chronic patients with hypertension. PATIENTS AND METHODS This research had a cross-sectional, observational and multicentre study design. Italian inpatients under rehabilitation, and Polish inpatients/outpatients were recruited. Following a cognitive screening, socio-demographic and clinical characteristics were obtained. Data on clinical and behavioral adherence (i.e., pharmacological adherence, adherence to refill medicines, intentional non-adherence) and psychosocial factors related to treatment adherence (i.e., beliefs about medicines, physician's communication skills, medication-specific social support, psychological antecedents and self-efficacy) were collected with self-report questionnaires. RESULTS A total of 458 patients were recruited. Fischer's LSD post hoc test revealed significant differences between Italian and Polish samples in all measures (p<0.001). Multiple linear regression analysis showed low self-reported intentional non-adherence (β = -.02, p=0.031), high self-reported adherence to refill medications (β=-.05, p=0.017), high levels of perceived physician's communication effectiveness (β=0.11, p<0.001), positive beliefs about medications (β=0.13, p<0.001), and high perceived medication-specific social support (β=0.05, p<0.001) to predict significantly high patients' self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence. CONCLUSION The observed psychosocial and behavioral factors revealed to positively impact on self-efficacy in relation to treatment adherence among older chronic patients dealing with hypertension. In a prevention framework, future studies and clinical practice may consider these factors in order to improve assessment and intervention on adherence in this population.
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Affiliation(s)
- Francesco Zanatta
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Ekaterina Nissanova
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | | | - Antonia Pierobon
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
- Correspondence: Antonia Pierobon Istituti Clinici Scientifici Maugeri IRCCS, Via S. Maugeri, 4, Pavia27100, ItalyTel +39 385 247255Fax +39 385 61386 Email
| | - Giovanna Callegari
- Respiratory Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Francesca Olmetti
- Cardiological Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Guido Felicetti
- Neuromotor Rehabilitation Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - Piotr Karniej
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Polański
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Jiang P, Babazono A, Fujita T. Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan. Popul Health Manag 2019; 23:264-270. [PMID: 31657660 PMCID: PMC7301321 DOI: 10.1089/pop.2019.0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).
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Affiliation(s)
- Peng Jiang
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Introduction: Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction. Areas covered: The recently published AHA/ACC and ESC/ESH guidelines for the management of hypertension in adult populations modified their approach towards hypertension in the elderly, particularly in those older than 85 years. The new concepts presented in these guidelines are discussed. They recommend a less conservative threshold and lower blood pressures targets; an emphasis on considering the biological rather than chronological age for patients >85 years, and the use of single-pill combinations to simplify treatment algorithms and increase long-term drug adherence. Expert opinion: Considering the high prevalence of hypertension in the elderly and the negative impact of untreated hypertension, early detection of hypertension in patients over 60 years old is crucial. The screening of hypertension should be reinforced in patient populations using out-of-office BP measurements. The author supports the latest ESC/ESH guidelines, which define a threshold at >140 mmHg for patients aged 65 to 79 years and >160 mmHg for those >85 years and propose a target BP of 130-140 mmHg, while considering patient frailty and the tolerability of the treatment.
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Affiliation(s)
- Michel Burnier
- Hypertension Research Foundation , Saint-Légier , Switzerland
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Prevalence of drug-related problems using STOPP/START and medication reviews in elderly patients with dementia. Res Social Adm Pharm 2019; 16:308-314. [PMID: 31176652 DOI: 10.1016/j.sapharm.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are common among elderly patients with dementia. STOPP/START is an explicit tool that has been used to detect DRPs among elderly patients. OBJECTIVES The objective of this study was to compare prevalence and type of DRPs identified by STOPP/START with DRPs identified by clinical pharmacists among the same population. Secondary objectives were to investigate factors associated with the use of DRPs using the two methods. METHOD Extracts from medical records were used to identify DRPs in 212 patients by using STOPP/START. The patients were ≥65 years of age with dementia or cognitive impairment. An earlier study was performed in the same study population in 2012-2014, where DRPs were identified by clinical pharmacists in order to decrease the number of rehospitalizations. RESULTS STOPP/START identified DRPs in 72.2% of the patients compared with 66.0% identified by the clinical pharmacists. The numbers of DRPs identified by the different methods were 326 and 310, respectively. Different types of DRPs were identified with the different tools. STOPP/START mainly identified DRPs in the categories "ineffective/inappropriate drug" and "needs additional drug therapy", whereas the clinical pharmacists identified DRPs in several categories. CONCLUSION Even though STOPP/START was able to identify a similar number of DRPs compared with DRPs identified by clinical pharmacists, STOPP/START failed to identify DRPs in several important categories. To cover all DRPs, STOPP/START might be used as a complement to implicit criteria.
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