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Denche-Zamorano Á, Salas-Gómez D, Franco-García JM, Adsuar JC, Parraca JA, Collado-Mateo D. Associations between Physical Activity Frequency in Leisure Time and Subjective Cognitive Limitations in Middle-Aged Spanish Adults: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1056. [PMID: 38891131 PMCID: PMC11171578 DOI: 10.3390/healthcare12111056] [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: 05/06/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
There is a global ageing of the world's population. Ageing is associated with multiple pathologies, reductions in physical activity, and losses in cognitive function. This study aimed to analyse the associations between the frequency of leisure-time physical activity (PAF) in middle-aged Spaniards and subjective cognitive limitations (SCLs): self-reported problems for remembering or concentrating (data extracted from the 2017 National Health Survey and the 2020 European Health Survey in Spain). Furthermore, the study aimed to evaluate risk factors that could be related to a higher probability of developing SCLs. This was a cross-sectional study with 15,866 middle-aged Spaniards. The associations between FAP and SCLs were analysed using chi-square. Also, the risk factors for SCLs were evaluated using binary multiple logistic regression. The median age of participants was 55 years, with 49% men and 51% women. Associations were found between PAF and SCLs (p < 0.001). The highest prevalence of SCLs was found in physically inactive people and the lowest in very active people (13.7% vs. 5.8%, p < 0.05), and people with SCLs had a higher prevalence of inactivity than those without SCLs (47.2% vs. 33.8%, p < 0.05). Physical inactivity, low educational level, low social class, and being female were the main risk factors for SCLs. Among the actions to prevent cognitive limitations, as well as interventions in people with cognitive limitations, it would be advisable to include physical activity programmes, both as a preventive measure to delay cognitive limitations and to reduce the risk of other pathologies in people who already have them.
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Affiliation(s)
- Ángel Denche-Zamorano
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain; (Á.D.-Z.)
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
| | - Diana Salas-Gómez
- Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, University of Cantabria, 39300 Torrelavega, Spain
| | - Juan Manuel Franco-García
- Health Economy Motricity and Education (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - José Carmelo Adsuar
- Promoting a Healthy Society Research Group (PHeSO), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain; (Á.D.-Z.)
- CIPER, Faculty of Human Kinetics, University of Lisbon, 1649-004 Lisbon, Portugal
| | - José A. Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Evora, 7004-516 Evora, Portugal
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Halloway S, Wagner M, Tangney C, Lange‐Maia BS, Bennett DA, Arvanitakis Z, Schoeny ME. Profiles of lifestyle health behaviors and cognitive decline in older adults. Alzheimers Dement 2024; 20:472-482. [PMID: 37676928 PMCID: PMC10840675 DOI: 10.1002/alz.13459] [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: 04/27/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION We aimed to identify profiles of modifiable, late-life lifestyle health behaviors related to subsequent maintenance of cognition and explore sociodemographics and health characteristics as effect modifiers. METHODS Analyses used data from 715 older adults without baseline dementia from the Rush Memory and Aging Project and with lifestyle health behaviors (physical activity, cognitive activity, healthy diet, social activity) at baseline and ≥ 2 annual assessments of cognition. We used latent profile analysis to group participants based on behavior patterns and assessed change in cognition by group. RESULTS Three latent profiles were identified: high (n = 183), moderate (n = 441), and low (n = 91) engagement in health behaviors. Compared to high engagement, the moderate (mean difference [MD] = -0.02, 95% CI = [-0.03;-0.0002], p = 0.048) and low (MD = -0.06, 95% CI = [-0.08;-0.03], p < 0.0001) groups had faster annual rates of decline in global cognition, with no significant effects modifiers (vascular risk factors, apolipoprotein E [APOE] ε4, motor function). DISCUSSION Avoiding low levels of lifestyle health behaviors may help maintain cognition. HIGHLIGHTS Latent profile analysis (LPA) captures lifestyle health behaviors associated with cognitive function. Such behavior include physical activity, cognitive activity, healthy diet, social activity. We used LPA to examine associations of behaviors and cognitive function over time. Older adults with low lifestyle health behaviors showed more rapid decline. To a lesser degree, so did those with moderate lifestyle health behaviors. Vascular conditions and risks, APOEε4, or motor function did not modify the effect.
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Affiliation(s)
- Shannon Halloway
- Department of Biobehavioral Nursing ScienceCollege of NursingUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Maude Wagner
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- University of BordeauxBordeauxFrance
| | - Christy Tangney
- Department of Clinical NutritionRush College of Health SciencesChicagoIllinoisUSA
- Department of Family and Preventive MedicineRush Medical CollegeChicagoIllinoisUSA
| | - Brittney S. Lange‐Maia
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Family and Preventive MedicineRush Medical CollegeChicagoIllinoisUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Michael E. Schoeny
- Department of CommunitySystemsand Mental Health NursingRush University College of NursingChicagoIllinoisUSA
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Victor CR, Gamble LD, Pentecost C, Quinn C, Charlwood C, Matthews FE, Clare L. Living well with dementia: An exploratory matched analysis of minority ethnic and white people with dementia and carers participating in the IDEAL programme. Int J Geriatr Psychiatry 2024; 39:e6048. [PMID: 38180319 PMCID: PMC10952883 DOI: 10.1002/gps.6048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The increasing heterogeneity of the population of older people is reflected in an increasing number of people with dementia and carers drawn from minority ethnic groups. Data from the IDEAL study are used to compare indices of 'living well' among people with dementia and carers from ethnic minority groups with matched white peers. METHODS We used an exploratory cross-sectional case-control design to compare 'living well' for people with dementia and carers from minority ethnic and white groups. Measures for both groups were quality of life, life satisfaction, wellbeing, loneliness, and social isolation and, for carers, stress, relationship quality, role captivity and caring competence. RESULTS The sample of people with dementia consisted of 20 minority ethnic and 60 white participants and for carers 15 and 45 respectively. People with dementia from minority ethnic groups had poorer quality of life (-4.74, 95% CI: -7.98 to -1.50) and higher loneliness (1.72, 95% CI: 0.78-2.66) whilst minority ethnic carers had higher stress (8.17, 95% CI: 1.72-14.63) and role captivity (2.00, 95% CI: 0.43-3.57) and lower relationship quality (-9.86, 95% CI: -14.24 to -5.48) than their white peers. CONCLUSION Our exploratory study suggests that people with dementia from minority ethnic groups experience lower quality of life and carers experience higher stress and role captivity and lower relationship quality than their white peers. Confirmatory research with larger samples is required to facilitate analysis of the experiences of specific minority ethnic groups and examine the factors contributing to these disadvantages.
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Affiliation(s)
- Christina R. Victor
- Department of Health SciencesCollege of Health, Medicine and Life SciencesBrunel University LondonLondonUK
| | - Laura D. Gamble
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Catherine Quinn
- Centre for Applied Dementia StudiesFaculty of Health StudiesUniversity of BradfordBradfordUK
| | | | - Fiona E. Matthews
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Linda Clare
- University of Exeter Medical SchoolUniversity of Exeter, and NIHR Applied Research Collaboration South‐West PeninsulaExeterUK
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Corney KB, Pasco JA, Stuart AL, Kavanagh BE, Mohebbi M, Sui SX, Williams LJ. Social determinants of health and cognitive function: A cross-sectional study among men without dementia. Brain Behav 2023; 13:e3235. [PMID: 37652752 PMCID: PMC10636419 DOI: 10.1002/brb3.3235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Certain age-related and medical factors have been associated with cognitive dysfunction; however, less is known regarding social determinants of health. The current study aimed to investigate associations between social determinants of health and cognitive function in a population-based sample of men without dementia. METHODS Data were drawn from the ongoing Geelong Osteoporosis Study (n = 536). Cognitive function was determined using the Cog-State Brief Battery. Area-based socioeconomic status (SES) was determined using the Index of Relative Socioeconomic Advantage and Disadvantage, marital status by self-report, and social support by the Multidimensional Scale of Perceived Social Support, which considers family, friends, and significant others. RESULTS Belonging to a higher SES group, being in a relationship (married/de-facto) and perceived social support from a significant other and friends were each associated with better overall cognitive function. In regard to the specific cognitive domains, higher SES was associated with better psychomotor function and visual learning, being in a relationship was associated with better working memory, and perceived social support from a significant other was associated with better attention and working memory, with perceived social support from friends associated with better psychomotor function. There were no associations detected between social support from family and any of the cognitive domains. CONCLUSION Higher SES, being in a relationship, and greater perceived social support from a significant other and friends were associated with better cognitive function. Further studies identifying underlying mechanisms linking social factors with cognition are needed to establish prevention strategies and enhance cognitive health.
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Affiliation(s)
- Kayla B. Corney
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Julie A. Pasco
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Barwon HealthUniversity Hospital GeelongGeelongAustralia
- Department of Medicine‐Western HealthThe University of MelbourneSt AlbansAustralia
| | - Amanda L. Stuart
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Bianca E. Kavanagh
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Deakin Rural Health, School of MedicineDeakin UniversityWarrnamboolAustralia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Faculty of Health, Biostatistics UnitDeakin UniversityGeelongAustralia
| | - Sophia X. Sui
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
| | - Lana J. Williams
- Deakin University, IMPACT – Institute for Mental and Physical Health and Clinical Translation, School of MedicineDeakin UniversityGeelongAustralia
- Barwon HealthUniversity Hospital GeelongGeelongAustralia
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Shi L, Tao L, Chen N, Liang H. Relationship between socioeconomic status and cognitive ability among Chinese older adults: the moderating role of social support. Int J Equity Health 2023; 22:70. [PMID: 37095501 PMCID: PMC10124054 DOI: 10.1186/s12939-023-01887-6] [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: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Understanding the causes and pathways of cognitive decline among older populations is of great importance in China. This study aims to examine whether the discrepancy in socioeconomic status (SES) makes a difference to the cognitive ability among Chinese older adults, and to disentangle the moderating role of different types of social support in the process in which SES influences cognition. METHODS We utilized a nationally representative sample from the 2018 Chinese Longitudinal Healthy Longevity Survey. A cumulative SES score was constructed to measure the combined effect of different socioeconomic statuses on the cognitive ability of the elderly. We further examined the moderating role of two types of social support, including emotional support, and financial support. Hierarchical regression analysis was applied to test the direct effect of SES on cognitive ability, and to investigate the moderating role of social support on the association of the SES with the dependent variables. RESULTS The results showed that the higher SES of older adults was significantly associated with better cognitive ability (β = 0.52, p < 0.001) after controlling for age, sex, marital status, living region, Hukou, health insurance, lifestyle factors, and physical health status. Emotional support and financial support were moderated the relationship between SES score and cognitive ability. CONCLUSION Our results reveal the importance of considering social support in buffering the effects of SES and the associated cognitive ability for aging populations. It highlights the importance of narrowing the socioeconomic gap among the elderly. Policymakers should consider promoting social support to improve the cognitive ability among older adults.
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Affiliation(s)
- Leiyu Shi
- Johns Hopkins Primary Care Policy Center, 624 N Broadway, Baltimore, USA
| | - Lei Tao
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong SAR, China
| | - Nanqian Chen
- Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hailun Liang
- School of Public Administration and Policy, Renmin University of China, 59 Zhongguancun, Beijing, China.
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Socio-Economic Disparities in Access to Diagnostic Neuroimaging Services in the United Kingdom: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010633. [PMID: 34682379 PMCID: PMC8535632 DOI: 10.3390/ijerph182010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
Socio-economic factors affecting health care can lead to delays in diagnosis of neurological conditions, consequentially affecting treatment and morbidity rates. This inequality in health care can leave patients from lower socio-economic backgrounds more vulnerable to a poorer quality of care from health care providers in the United Kingdom (U.K.). Aims: In this systematic review, we assess the impact of socio-economic status on the use of diagnostic neuroimaging in the U.K., measured by the timeliness, accessibility and appropriate use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, electroencephalography (EEG) and single-photon emission computed tomography (SPECT). We specifically evaluate the non-surgical use of neuroimaging techniques as this relies on the judgment of primary care-givers (e.g., doctors and radiologists), where health disparities are most common. This study includes the analysis of diagnostic imaging used for dementia, minor head injury, stroke, cancer, epilepsy, chronic inflammatory demyelinating polyneuropathy and Parkinson’s disease. With this study, we aim to assess the health inequalities at disease diagnosis. Methods: Using Medline (via Ovid), PubMed and Web of Science databases as sources of information, we critically appraise existing studies on neuroimaging use in the U.K. health care system, published between January 2010 and February 2021. Findings: A total of 18 studies were included in this research, revealing that there was an increase in patients of Black and Asian communities diagnosed with dementia and at an earlier age. There was little evidence to suggest that a lack of access to diagnostic imaging is associated with socio-economic status. However, there are data to suggest that people of a lower socio-economic background require more specialist services with diagnostic neuroimaging tools. In addition, there is evidence to suggest that diagnostic neuroimaging techniques could be utilised more effectively by health care workers to prevent unnecessary delays in diagnosis for patients in lower socio-economic areas.
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Petersen JD, Wehberg S, Packness A, Svensson NH, Hyldig N, Raunsgaard S, Andersen MK, Ryg J, Mercer SW, Søndergaard J, Waldorff FB. Association of Socioeconomic Status With Dementia Diagnosis Among Older Adults in Denmark. JAMA Netw Open 2021; 4:e2110432. [PMID: 34003271 PMCID: PMC8132141 DOI: 10.1001/jamanetworkopen.2021.10432] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Low socioeconomic status (SES) has been identified as a risk factor for the development of dementia. However, few studies have focused on the association between SES and dementia diagnostic evaluation on a population level. OBJECTIVE To investigate whether household income (HHI) is associated with dementia diagnosis and cognitive severity at the time of diagnosis. DESIGN, SETTING, AND PARTICIPANTS This population- and register-based cross-sectional study analyzed health, social, and economic data obtained from various Danish national registers. The study population comprised individuals who received a first-time referral for a diagnostic evaluation for dementia to the secondary health care sector of Denmark between January 1, 2017, and December 17, 2018. Dementia-related health data were retrieved from the Danish Quality Database for Dementia. Data analysis was conducted from October 2019 to December 2020. EXPOSURES Annual HHI (used as a proxy for SES) for 2015 and 2016 was obtained from Statistics Denmark and categorized into upper, middle, and lower tertiles within 5-year interval age groups. MAIN OUTCOMES AND MEASURES Dementia diagnoses (Alzheimer disease, vascular dementia, mixed dementia, dementia with Lewy bodies, Parkinson disease dementia, or other) and cognitive stages at diagnosis (cognitively intact; mild cognitive impairment but not dementia; or mild, moderate, or severe dementia) were retrieved from the database. Univariable and multivariable logistic and linear regressions adjusted for age group, sex, region of residence, household type, period (2017 and 2018), medication type, and medical conditions were analyzed for a possible association between HHI and receipt of dementia diagnosis. RESULTS Among the 10 191 individuals (mean [SD] age, 75 [10] years; 5476 women [53.7%]) included in the study, 8844 (86.8%) were diagnosed with dementia. Individuals with HHI in the upper tertile compared with those with lower-tertile HHI were less likely to receive a dementia diagnosis after referral (odds ratio, 0.65; 95% CI, 0.55-0.78) and, if diagnosed with dementia, had less severe cognitive stage (β, -0.16; 95% CI, -0.21 to -0.10). Individuals with middle-tertile HHI did not significantly differ from those with lower-tertile HHI in terms of dementia diagnosis (odds ratio, 0.92; 95% CI, 0.77-1.09) and cognitive stage at diagnosis (β, 0.01; 95% CI, -0.04 to 0.06). CONCLUSIONS AND RELEVANCE The results of this study revealed a social inequality in dementia diagnostic evaluation: in Denmark, people with higher income seem to receive an earlier diagnosis. Public health strategies should target people with lower SES for earlier dementia detection and intervention.
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Affiliation(s)
- Jindong Ding Petersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Aake Packness
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Nana Hyldig
- OPEN (Open Patient Data Explorative Network), Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Søren Raunsgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Merethe Kirstine Andersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stewart W. Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Section of General Practice, Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Co M, Couch E, Gao Q, Mac-Ginty S, Das-Munshi J, Prina M. Access to Health Services in Older Minority Ethnic Groups with Dementia: A Systematic Review. J Am Geriatr Soc 2020; 69:822-834. [PMID: 33230815 PMCID: PMC7984264 DOI: 10.1111/jgs.16929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES While it is acknowledged that minority ethnic (ME) groups across international settings face barriers to accessing care for dementia, it is not clear whether ME groups access services less frequently as a result. The objective of this review is to examine whether ME groups have longer delays before accessing dementia/memory services, higher use of acute care and crisis services and lower use of routine care services based on existing literature. We also examined whether ME groups had higher dementia severity or lower cognition when presenting to memory services. DESIGN Systematic review with narrative synthesis. SETTING Nonresidential medical, psychiatric, memory, and emergency services. PARTICIPANTS Twenty studies totaling 94,431 older adults with dementia or mild cognitive impairment. MEASUREMENTS We searched Embase, Ovid MEDLINE, Global Health, and PsycINFO from inception to November 2018 for peer-reviewed observational studies which quantified ethnic minority differences in nonresidential health service use in people with dementia. Narrative synthesis was used to analyze findings. RESULTS Twenty studies were included, mostly from the U.S. (n = 13), as well as the UK (n = 4), Australia (n = 1), Belgium (n = 1), and the Netherlands (n = 1). There was little evidence that ME groups in any country accessed routine care at different rates than comparison groups, although studies may have been underpowered. There was strong evidence that African American/Black groups had higher use of hospital inpatient services versus U.S. comparison groups. Primary care and emergency services were less well studied. Study quality was mixed, and there was a large amount of variability in the way ethnicity and service use outcomes were ascertained and defined. CONCLUSION There is evidence that some ME groups, such as Black/African American groups in the U.S., may use more acute care services than comparison populations, but less evidence for differences in routine care use. Research is sparse, especially outside the U.S.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Scarlett Mac-Ginty
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Gentry MT, Lapid MI, Syrjanen J, Calvert K, Hughes S, Brushaber D, Kremers W, Bove J, Brannelly P, Coppola G, Dheel C, Dickerson B, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova R, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Haley D, Heuer H, Hsiung GY, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Knopman D, Kornak J, Kramer J, Kukull W, Lucente D, Lungu C, Mackenzie I, Manoochehri M, McGinnis S, Miller B, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Sengdy P, Shaw L, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boeve BF, Boxer A, Rosen H. Quality of life and caregiver burden in familial frontotemporal lobar degeneration: Analyses of symptomatic and asymptomatic individuals within the LEFFTDS cohort. Alzheimers Dement 2020; 16:1115-1124. [PMID: 32656921 PMCID: PMC7534513 DOI: 10.1002/alz.12095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects evaluates familial frontotemporal lobar degeneration (FTLD) kindreds with MAPT, GRN, or C9orf72 mutations. Objectives were to examine whether health-related quality of life (HRQoL) correlates with clinical symptoms and caregiver burden, and whether self-rated and informant-rated HRQoL would correlate with each other. METHODS Individuals were classified using the Clinical Dementia Rating (CDR® ) Scale plus National Alzheimer's Coordinating Center (NACC) FTLD. HRQoL was measured with DEMQOL and DEMQOL-proxy; caregiver burden with the Zarit Burden Interview (ZBI). For analysis, Pearson correlations and weighted kappa statistics were calculated. RESULTS The cohort of 312 individuals included symptomatic and asymptomatic individuals. CDR® plus NACC FTLD was negatively correlated with DEMQOL (r = -0.20, P = .001), as were ZBI and DEMQOL (r = -0.22, P = .0009). There was fair agreement between subject and informant DEMQOL (κ = 0.36, P <.0001). CONCLUSION Lower HRQoL was associated with higher cognitive/behavior impairment and higher caregiver burden. These findings demonstrate the negative impact of FTLD on individuals and caregivers.
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Affiliation(s)
| | | | | | | | | | | | | | - Jessica Bove
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, Texas, USA
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | | | | | | - Ging-Yuek Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Columbia University, New York, New York, USA
| | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lynne Jones
- Washington University, St. Louis, Missouri, USA
| | | | | | | | | | | | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, Washington, USA
| | | | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, California, USA
| | | | | | - Bonnie Wong
- Harvard University/MGH, Boston, Massachusetts, USA
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Kohler C, Chang M, Allemann-Su YY, Vetter M, Jung M, Jung M, Conley Y, Paul S, Kober KM, Cooper BA, Smoot B, Levine JD, Miaskowski C, Katapodi MC. Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery. J Pain Symptom Manage 2020; 59:1172-1185. [PMID: 31953207 PMCID: PMC7239765 DOI: 10.1016/j.jpainsymman.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.
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Affiliation(s)
- Carmen Kohler
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ming Chang
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Yu-Yin Allemann-Su
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Marcus Vetter
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miyeon Jung
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Misook Jung
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA.
| | - Maria C Katapodi
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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11
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Smith SC, Hendriks AAJ, Cano SJ, Black N. Proxy reporting of health-related quality of life for people with dementia: a psychometric solution. Health Qual Life Outcomes 2020; 18:148. [PMID: 32448322 PMCID: PMC7245851 DOI: 10.1186/s12955-020-01396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background The growing move towards personalised health and social care systems means that every effort needs to be made to generate patient-reported outcome data. However, the deteriorating nature of dementia can make it difficult for people with dementia to complete self-reported questionnaires and it is often necessary to rely on a family member (proxy) to report on their behalf. There is little evidence to guide how the difference between self- and proxy-reports of health reported quality of life (HRQL) in dementia can be interpreted. Methods We recruited people with dementia and their family carers from 78 memory Assessment Services in the UK. We used Rasch measurement methods to investigate whether a HRQL questionnaire known as DEMQOL (self-reported by the person with dementia) and DEMQOL-Proxy (proxy-reported by a family carer) can be placed on the same continuum and whether a revised scoring algorithm, based on this equated model, can be developed that takes account of the relationship between self- and proxy-reports. Results In a sample of 1434 patients and 1030 carers, our findings supported equating DEMQOL/DEMQOL-Proxy (overall fit to the model; no mis-fitting items) after addressing specific issues (eight disordered items requiring re-scoring, four pairs locally dependent items, and five items showing DIF). Cross walk tables have been produced. Conclusions We have established for the first time that DEMQOL and DEMQOL-Proxy can be placed on the same continuum and that patients and carer proxies are reporting on the same construct when they complete these questionnaires. Where possible both DEMQOL and DEMQOL-Proxy should still be administered together, using the improved scoring algorithm reported here. Where only DEMQOL-Proxy is available, the cross walk tables provide an estimate of DEMQOL for a particular person from their DEMQOL-Proxy score.
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Affiliation(s)
- S C Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK.
| | - A A J Hendriks
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK
| | - S J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - N Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, WC1H 9SH, London, UK
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12
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Park MH, Smith SC, Hendriks AAJ, Black N. Caregiver burden and quality of life 2 years after attendance at a memory clinic. Int J Geriatr Psychiatry 2019; 34:647-656. [PMID: 30730066 DOI: 10.1002/gps.5060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/12/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to describe (1) the burden and health-related quality of life (HRQL) of informal caregivers of new patients attending a memory assessment service (MAS), (2) changes in these outcomes over 2 years, and (3) satisfaction with services. METHODS Informal caregivers of patients attending one of 73 MASs throughout England completed questionnaires at the patient's first appointment, and 6 and 12 months later. Participants from 30 of these MASs were also followed up at 24 months. Questionnaires covered caregivers' sociodemographic characteristics, Zarit Burden Interview, EQ-5D-3L, and satisfaction with services. We used multivariable linear regression to assess relationships between burden, HRQL, and caregiver and patient characteristics. RESULTS Of 1020 caregivers at baseline, 569 were followed up at 6 months, 452 at 12 months, and 187 at 24 months. There was a small increase in caregiver burden over 2 years (effect size 0.30 SD). These changes were not associated with most caregiver or patient characteristics, except socio-economic deprivation, which was associated with larger increases in burden at 2 years. Caregivers' HRQL was weakly associated with burden and showed a small reduction over time (0.2 SD). Most caregivers were satisfied with services, but caregivers who were not satisfied with the services they received reported greater increases in burden. CONCLUSIONS Increases in caregiver burden and reductions in HRQL appear to be small over the first 2 years after attending a MAS. However, the longer term impact on caregivers and those they care for needs investigating, as do strategies to reduce their burden.
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Affiliation(s)
- Min Hae Park
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah C Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - A A Jolijn Hendriks
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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13
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Lampshire Z, Tingley D, Jarvis A, Wernham C, Hughes JC, Welsh TJ. Fracture risk is under-recognised and under-treated in memory clinic attendees. Maturitas 2019; 123:37-39. [PMID: 31027675 DOI: 10.1016/j.maturitas.2019.02.004] [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: 01/08/2019] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 12/21/2022]
Abstract
UK national guidelines recommend that older people at risk of falling should have their fracture risk assessed and acted upon. People with cognitive impairment are more likely to sustain a fracture than their cognitively intact peers. We assessed the fracture risk of 79 memory clinic attendees and compared their actual management with guidelines. Despite reporting 57 falls in the last year, only 36% of those who would be recommended antiresportive treatment were prescribed it and a dual-energy X-ray absorptiometry (DEXA)scan was performed in only 13% where it would be recommended. These findings highlight an important deficit in fracture risk assessment which should inform future interventions.
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Affiliation(s)
- Z Lampshire
- Research Institute for the Care of Older People, Bath, United Kingdom; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - D Tingley
- Research Institute for the Care of Older People, Bath, United Kingdom
| | - A Jarvis
- Research Institute for the Care of Older People, Bath, United Kingdom
| | - C Wernham
- Research Institute for the Care of Older People, Bath, United Kingdom
| | - J C Hughes
- Research Institute for the Care of Older People, Bath, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom; University of Bristol, Bristol, United Kingdom
| | - T J Welsh
- Research Institute for the Care of Older People, Bath, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom; University of Bristol, Bristol, United Kingdom.
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14
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Alsumari SR, AlNouri DM, El-Sayed MMA, El-Din MFS, Arzoo S. The sociodemographic characteristics and dietary and blood plasma fatty acid profiles of elderly Saudi women with Alzheimer disease. Lipids Health Dis 2019; 18:77. [PMID: 30927917 PMCID: PMC6441169 DOI: 10.1186/s12944-019-1029-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background Alzheimer’s disease (AD) is a progressive neurodegenerative disease, and due to various physiological and psychological factors the patients are at risk of nutritional insufficiencies. The purpose of this study was to assess the dietary fatty acid intake and its effect on plasma fatty acids in elderly Saudi women and to compare the differences in their food and plasma fatty acid profile on the basis of their residence. Methods A total of 76 elderly women (50–100 years) were recruited through a random sampling method. A structured proforma was designed to gather information related to their age, income, dietary habits, and presence of any disease and awareness of AD. A 24-h dietary recall method for 3 days and food frequency questionnaire, concentrating on fish consumption and consumption of foods rich in ω-3 fatty acids, which was planned by dietitians, was used for dietary assessment. The gathered data were then analyzed using food processor software. The blood samples were collected to determine plasma fatty acids. Results The mean age of women diagnosed with AD was more than 75 years, and the prevalence of illiteracy was higher among AD subjects. As compared to the AD group, the concentration of LA and total ω-6 was significantly (p ≤ 0.05) higher in the control group from both recruitment sites [National Guard Health Affairs, King Abdulaziz Medical City, Riyadh (NGH) and Social Welfare Homes for the Elderly (SWH)]. Similarly, the concentrations of EPA, DHA, and ω-3 were also slightly higher in the control group at both sites, but the difference between the control and AD subjects was only significant (p ≤ 0.05) in subjects from NGH. We found no significant difference in the ω-6/ ω-3 ratio between groups. Also, no significant difference was found in the mean level of the plasma fatty acid when comparing the control and AD groups. The concentration of DHA in controls only and AA, EPA and ω-6 in both control and AD were significant (although weakly) correlated with their respective dietary intakes. No correlations were found between the intake of 18 C precursors (LA and ALA) and plasma levels of their long chain derivatives (AA, EPA, and DHA). Education, income, overall health status and the concentration of various fatty acids from food was higher and better in subjects from SWH than NGH. The lower plasma level indicates lower impaired systemic availability of several nutrients. Conclusion We found that dietary intervention might play a role in the prevention of AD.
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Affiliation(s)
- Samar Rashed Alsumari
- Department of Food and Nutrition Sciences, College of Food and Agriculture Sciences, King Saud University, Riyadh-11495, P.O. 11495, Riyadh, Saudi Arabia
| | - Doha Mustafa AlNouri
- Department of Food and Nutrition Sciences, College of Food and Agriculture Sciences, King Saud University, Riyadh-11495, P.O. 11495, Riyadh, Saudi Arabia.
| | - Mervat Mohamed Ali El-Sayed
- Department of Food and Nutrition Sciences, College of Food and Agriculture Sciences, King Saud University, Riyadh-11495, P.O. 11495, Riyadh, Saudi Arabia
| | - Mohamed Fekry Serag El-Din
- Department of Food and Nutrition Sciences, College of Food and Agriculture Sciences, King Saud University, Riyadh-11495, P.O. 11495, Riyadh, Saudi Arabia.,Department of Nutrition and Food Science, Faculty of Home Economics, Menoufia University, Shebin El Kom, Egypt
| | - Shaista Arzoo
- Department of Food and Nutrition Sciences, College of Food and Agriculture Sciences, King Saud University, Riyadh-11495, P.O. 11495, Riyadh, Saudi Arabia
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15
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Gomes M, Pennington M, Black N, Smith S. Cost-effectiveness analysis of English memory assessment services 2 years after first consultation for patients with dementia. Int J Geriatr Psychiatry 2019; 34:439-446. [PMID: 30474303 DOI: 10.1002/gps.5036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This paper aims to compare changes over 2 years in patients' health-related quality of life (HRQL) with the health and social care costs of diagnosis and treatment of people newly referred to memory assessment services (MAS). METHODS We analysed observational data from 1318 patients referred to 69 MAS who completed resource use and HRQL questionnaires at baseline 3, 6, 12, and 24 months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3 L), quality-adjusted life years (QALYs), costs and cost-effectiveness between baseline, and 2-year follow-up. RESULTS Two years after referral to MAS, patients reported a higher DEMQOL score (mean gain 4.47, 95% confidence interval, 3.08-5.90) and EQ-5D-3 L (0.014, -0.011 to 0.039). Mean total costs and QALYs over 24 months was £2411 (£1721-£2873) and 0.027 (0.003-0.051), respectively. Assuming that patients' HRQL would not have altered over the 2 years had they not attended MAS, these outcomes suggest an incremental cost-effectiveness ratio of £89 546 (£38 123-£145 864) based on changes in EQ-5D-3 L. If we assumed that patients' HRQL would have declined by about 10% over this period had they not attended MAS, the cost-effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost-effective than smaller ones (P < 0.01). CONCLUSIONS MAS are effective and can be cost-effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost-effectiveness.
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Affiliation(s)
- Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
| | | | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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16
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Alford K, Banerjee S, Nixon E, O'Brien C, Pounds O, Butler A, Elphick C, Henshaw P, Anderson S, Vera JH. Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV. Brain Sci 2019; 9:brainsci9020037. [PMID: 30744034 PMCID: PMC6406482 DOI: 10.3390/brainsci9020037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
As the HIV population ages, the prevalence of cognitive impairment (CI) is increasing, yet few services exist for the assessment and management of these individuals. Here we provide an initial description of a memory assessment service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen by the clinic. We present patient demographic data, assessment outcomes, diagnoses given and interventions delivered to those seen in the clinic. 41 patients (79%) of those seen in the clinic had objective CI: 16 (31%) met criteria for HIV-associated Neurocognitive Disorder (HAND), 2 (4%) were diagnosed with dementia, 14 (27%) showed CI associated with mental illness and/or drugs/alcohol, 7 (13%) had CI which was attributed to factors other than HIV and in 2 (4%) patients the cause remains unclear. 32 (62%) patients showed some abnormality on Magnetic Resonance Imaging (MRI) brain scans. Patients attending the clinic performed significantly worse than normative scores on all tests of global cognition and executive function. Interventions offered to patients included combination antiretroviral therapy modification, signposting to other services, case management, further health investigations and in-clinic advice. Our experience suggests that the need exists for specialist HIV memory services and that such a model of working can be successfully implemented into HIV patient care. Further work is needed on referral criteria and pathways. Diagnostic processes and treatment offered needs to consider and address the multifactorial aetiology of CI in HIV and this is essential for effective assessment and management.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Eileen Nixon
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Clara O'Brien
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Olivia Pounds
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Andrew Butler
- Department of Medicine, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
| | - Claire Elphick
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Phillip Henshaw
- Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, UK.
| | - Stuart Anderson
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 1ES, UK.
- Department of Medicine, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
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17
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Wu YT, Clare L, Jones IR, Martyr A, Nelis SM, Quinn C, Victor CR, Lamont RA, Rippon I, Matthews FE. Inequalities in living well with dementia-The impact of deprivation on well-being, quality of life and life satisfaction: Results from the improving the experience of dementia and enhancing active life study. Int J Geriatr Psychiatry 2018; 33:1736-1742. [PMID: 30246354 DOI: 10.1002/gps.4998] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/08/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Area level factors, such as deprivation and urban/rural settings, have been associated with variation in local resources and services and health inequality in later life. The aim of this study is to investigate the potential impact of deprivation and urban/rural areas on capability to live well with dementia and to examine whether availability of informal carers modified the associations. METHODS The analysis was based on a large cohort study of 1547 community-dwelling people with dementia across Great Britain. Quality of life, life satisfaction, and well-being were measured as indices of "living well." Multivariate modelling was used to investigate differences in living well measures across deprivation quintiles and urban/rural areas adjusting for sociodemographic factors and number of comorbidities and stratifying by three groups: those living with a carer, those with a noncoresident carer and those without a carer. RESULTS Negative dose-response relationships between deprivation and measures of quality of life (-2.12; 95% CI: -3.52, -0.73), life satisfaction (-1.27; 95% CI: -2.70, 0.16), and well-being (-5.24; 95% CI: -10.11, -0.36) were found in participants living with a carer. The associations were less clear in those with a noncoresident carer and those without a carer but these two groups generally reported lower scores on living well indicators than participants living with a carer. There was no urban/rural difference. CONCLUSIONS The findings suggest inequalities in living well with dementia according to levels of deprivation. Additional resources are needed to improve postdiagnostic care in highly deprived areas and support those who have no informal carer.
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Affiliation(s)
- Yu-Tzu Wu
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK
| | - Ian Rees Jones
- Wales Institute of Social and Economic Research, Data and Methods, Cardiff University, Cardiff, UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK
| | - Christina R Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, UK
| | - Ruth A Lamont
- REACH: The Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke's Campus, Exeter, UK
| | - Isla Rippon
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University, Newcastle, UK
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18
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Park MH, Smith SC, Ritchie CW, Hendriks AAJ, Black N. Memory assessment services and health-related quality of life: 1-year follow-up. Int J Geriatr Psychiatry 2018; 33:1220-1228. [PMID: 29851195 DOI: 10.1002/gps.4913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/17/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Our group has already demonstrated that patients' health-related quality of life (HRQL) improves in the first 6 months after their first appointment at memory assessment services (MASs), but the sustainability of such gains is unknown. We aimed to describe changes in patients' HRQL at 12 months after their first MAS appointment and to examine associations with patient and MAS characteristics. METHODS We collected data from 702 patients and 452 lay caregivers at the first appointment and 12 months later. Multivariable linear regression was used to examine the relationships of change in HRQL (self-reported and proxy-reported) with patients' characteristics and use of post-diagnostic interventions, and multilevel models were used to analyse the relationships of HRQL with MAS characteristics. RESULTS In the whole group, self-reported HRQL improved over 12 months (+3.5 points, 95% CI 2.7 to 4.2). Among people diagnosed with dementia, improvement in HRQL was more than double that among those with mild cognitive impairment or no diagnosis. Proxy-reported HRQL improved only in those diagnosed with dementia (+1.2 points, 95% CI 0.2 to 2.2). Changes in HRQL were not associated with any patient characteristics. The only feature of MASs associated with larger improvements in HRQL was the presence of advisory and support staff. CONCLUSIONS Improvements in HRQL observed at 6 months are maintained up to 1 year after the first MAS appointment, more so among those who receive a diagnosis of dementia. Continued follow-up will determine if the improvement is even longer lasting.
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Affiliation(s)
- Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah C Smith
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - A A Jolijn Hendriks
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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19
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Park MH, Black N, Ritchie CW, Hendriks AAJ, Smith SC. Is the effectiveness of memory assessment services associated with their structural and process characteristics? Int J Geriatr Psychiatry 2018; 33:75-84. [PMID: 28170105 DOI: 10.1002/gps.4675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/11/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether structural and process characteristics of memory assessment services (MASs) are associated with outcomes (changes in patients' health-related quality of life (HRQL), carers' HRQL and carers' burden) over the first 6 months following the first appointment. METHODS Data from 785 patients referred to 69 MASs and 511 of their lay carers, collected at the first appointment and 6 months later. Data on MAS characteristics were collected using a questionnaire at baseline. We used multilevel linear regression models to explore the associations of patients' HRQL and carers' outcomes with structural and process characteristics of MASs. Analyses were conducted on the full sample of patients and carers, and separately on those patients diagnosed with dementia. RESULTS None of the structural (skill mix, workload, volume, provision of clinical assessments and provision of psychosocial support) or process (waiting time, length and number of appointments, anti-dementia drug use and psychosocial interventions use) characteristics included in the analyses were associated with patients' or carers' outcomes at 6 months, apart from the presence of allied health professionals (AHPs), which was associated with a DEMQOL score 2.7 points higher. When only those with a diagnosis of dementia were considered, the association with presence of AHPs was no longer observed. CONCLUSIONS Apart from involving AHPs, alterations to the way MASs are structured or function appear unlikely to improve their effectiveness in improving patients' and carers' HRQL. It is possible that the characteristics of MASs may influence patients' and carers' experience, but this was not studied. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Min Hae Park
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - A A Jolijn Hendriks
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah C Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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20
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Pennington M, Gomes M, Chrysanthaki T, Hendriks J, Wittenberg R, Knapp M, Black N, Smith S. The cost of diagnosis and early support in patients with cognitive decline. Int J Geriatr Psychiatry 2018; 33:5-13. [PMID: 28004429 DOI: 10.1002/gps.4641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months. METHODS Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral. RESULTS Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130-220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non-pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months. CONCLUSIONS There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mark Pennington
- King's Health Economics, King's College London, London, UK.,Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Manuel Gomes
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Theti Chrysanthaki
- School of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Jolijn Hendriks
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Raphael Wittenberg
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Smith
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Hendriks AAJ, Smith SC, Chrysanthaki T, Cano SJ, Black N. DEMQOL and DEMQOL-Proxy: a Rasch analysis. Health Qual Life Outcomes 2017; 15:164. [PMID: 28830525 PMCID: PMC5567633 DOI: 10.1186/s12955-017-0733-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022] Open
Abstract
Background DEMQOL and DEMQOL-Proxy are widely used patient reported outcome measures (PROMs) of health related quality of life in people with dementia (PWD). Growing interest in routine use of PROMs in health care calls for more robust instruments that are potentially fit for reliable and valid comparisons at the micro-level (patients) and meso-level (clinics, hospitals, care homes). Methods We used modern psychometric methods (based on the Rasch model) to re-evaluate DEMQOL (1428 PWDs) and DEMQOL-Proxy (1022 carers) to ensure they are fit for purpose. We evaluated scale to sample targeting, ordering of item thresholds, item fit to the model, and differential item functioning (sex, age, relationship), local independence, unidimensionality and reliability on the full set of items and a smaller item set. Results For both DEMQOL and DEMQOL-Proxy the smaller item set performed better than the original item set. We developed revised scores using the items from the smaller set. Conclusions We have improved the scoring of DEMQOL and DEMQOL-Proxy using the Rasch measurement model. Future work should focus on the problems identified with content and response options.
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Affiliation(s)
- A A Jolijn Hendriks
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Sarah C Smith
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Theopisti Chrysanthaki
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Stefan J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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