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Monin JK, Mroz E, Bonds Johnson K, Samper-Ternent R, Vu T, Tinetti M. Clinicians' perceptions of care partner involvement in health priorities identification for people living with dementia. J Am Geriatr Soc 2024. [PMID: 38709115 DOI: 10.1111/jgs.18937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Joan K Monin
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Emily Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Rafael Samper-Ternent
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
| | - Thi Vu
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Mary Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Song Y, Liu Y, Bai X, Yu H. Effects of neighborhood built environment on cognitive function in older adults: a systematic review. BMC Geriatr 2024; 24:194. [PMID: 38408919 PMCID: PMC10898015 DOI: 10.1186/s12877-024-04776-x] [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: 08/27/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults. METHODS Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool. RESULTS A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored. CONCLUSION Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.
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Affiliation(s)
- Yiling Song
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Yunxi Liu
- Graduate School of Commerce, Waseda University, Tokyo, 169-8050, Japan
| | - Xiaotian Bai
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, 100084, China.
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3
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Koroukian SM, Douglas SL, Vu L, Fein HL, Gairola R, Warner DF, Schiltz NK, Cullen J, Owusu C, Sajatovic M, Rose J. Aggressive end-of-life care across gradients of cognitive impairment in nursing home patients with metastatic cancer. J Am Geriatr Soc 2023; 71:3546-3553. [PMID: 37515440 PMCID: PMC10907987 DOI: 10.1111/jgs.18526] [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: 02/01/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care. METHODS Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, >1 emergency department visit, or >1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG-I severity and receipt of aggressive EOL care. RESULTS Of the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG-I; 19.7% had moderate COG-I; and 6.7% had severe COG-I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG-I, respectively. Compared with cognitively intact patients, those with severe COG-I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70-2.04)), which were primarily associated with higher odds of in-hospital death. The odds of in-hospital death associated with severe COG-I were higher among those with short- than with long-term stays (aOR:2.58 (2.35-2.84) and aOR:1.40 (1.17-1.67), respectively). CONCLUSIONS Contrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFS was highest among those suffering severe COG-I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population.
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Affiliation(s)
- Siran M. Koroukian
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
| | - Sara L. Douglas
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Frances Payne Bolton School of Nursing, Case Western
Reserve University, Cleveland, OH
| | - Long Vu
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
| | - Hannah L. Fein
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
| | - Richa Gairola
- Department of Epidemiology, School of Public Health, Brown
University, Providence, RI; she was at Case Western Reserve University at the time
this study was conducted
| | - David F. Warner
- Department of Sociology, University of Alabama at
Birmingham, Birmingham, AL
- Center for Family & Demographic Research, Bowling Green
State University, Bowling Green, OH
| | - Nicholas K. Schiltz
- Frances Payne Bolton School of Nursing, Case Western
Reserve University, Cleveland, OH
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Department of Internal Medicine, University Hospitals
Cleveland Medical Center, Cleveland, OH
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland
Medical Center, Cleveland, OH
| | - Johnie Rose
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Center for Community Health Integration, School of
Medicine, Case Western Reserve University, Cleveland, OH
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4
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Alqahtani HM, Koroukian SM, Stange KC, Schiltz NK, Bissada NF. Investigating the Influence of Periodontal Disease on the Association Between Complex Multimorbidity and Health: A Cross-Sectional Study. J Int Soc Prev Community Dent 2023; 13:247-257. [PMID: 37564165 PMCID: PMC10411292 DOI: 10.4103/jispcd.jispcd_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 08/12/2023] Open
Abstract
Aims and Objectives The aim of this study was to evaluate whether periodontal disease (PD) moderates the association between complex multimorbidity (MM) and fair/poor general health in a US representative sample of older individuals. Materials and Methods This study identified 937 participants who were at least 60 years of age from the 2013-2014 National Health and Nutrition Examination Survey. A multivariable logistic regression model was used to estimate the association between complex MM (including chronic conditions, functional limitations, and geriatric syndromes) and self-reported fair/poor general health. Subsequently, we specified interactions between complex MM and PD to determine whether PD moderates the effect of complex MM on fair/poor general health. Results Nineteen percent of participants reported fair/poor general health. Complex MM was associated with 2.2 times greater odds of self-reported fair/poor health. However, PD was neither independently associated with fair/poor health nor an effect modifier for the association between complex MM and fair/poor general health. Age, white race, those with at least a high-school education level, a family income-to-poverty ratio of at least 2, former smoking status, and being married were significantly associated with fair/poor general health. Conclusion Complex MM, but not PD, was associated with greater odds to report fair/poor general health, and PD did not moderate the association between complex MM and fair/poor general health. People with complex MM are more likely to have worse general health; however, PD did not strengthen this association. Further studies are needed to evaluate whether treatment for PD for people vulnerable to the development of complex MM has a positive effect on their general health.
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Affiliation(s)
- Hussam M Alqahtani
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Preventive Dental Science, College of Dentistry, King Saud Bin Abdelaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nicholas K Schiltz
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nabil F Bissada
- Department of Periodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Safi D, Barreto Abrams J, Rios M, Rodés E, Díaz-Santos M, Suárez P. Culturally Competent Assessment of Neurocognitive Functioning in Latinos with Complex Multimorbidity: A Case Study. Geriatrics (Basel) 2022; 7:geriatrics7050093. [PMID: 36136802 PMCID: PMC9498523 DOI: 10.3390/geriatrics7050093] [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: 06/22/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Multimorbidity—the coexistence of multiple chronic conditions within an individual—is the new normal in hospital settings. Individuals with higher levels of multimorbidity require a multidisciplinary and holistic approach to meet their needs, though the complexity of their neurocognitive profiles is still poorly researched. This study reported on the neurocognitive profile of a 69-year-old, left-handed, Latino cisgender male with 10 years of education. He was deemed to have a short-term mortality in 2018, yet is still enjoying a good quality of life in 2022. This case report illustrated (a) a rather common neurocognitive profile of a patient with complex multimorbidity, (b) the advantages of being served in a center of excellence with linguistically and culturally appropriate services that evaluate patients’ cognitive functioning and inform and provide continuity of care, and (c) the benefits of a holistic and multidisciplinary approach to the care of the multimorbidity population.
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Affiliation(s)
- Diomaris Safi
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
- Correspondence:
| | - Jesús Barreto Abrams
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
| | - Melissa Rios
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
- California School of Professional Psychology, Alliant International University, Alhambra, CA 91803, USA
| | - Elisenda Rodés
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
- Graduate School of Education and Psychology, Pepperdine University, Los Angeles, CA 90045, USA
| | - Mirella Díaz-Santos
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
- Department of Neurology, UCLA Mary S. Easton Center for Alzheimer’s Disease Research, Los Angeles, CA 90095, USA
| | - Paola Suárez
- Department of Psychiatry and Behavioral Sciences, UCLA Hispanic Neuropsychiatric Center of Excellence, 760 Westwood Plaza, C8-238, Los Angeles, CA 90095, USA
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Wittenberg GF, McKay MA, O’Connor M. Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211030468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.
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Shin O, Park S, Kang JY, Kwak M. Types of multidimensional vulnerability and well-being among the retired in the U.S. Aging Ment Health 2021; 25:1361-1372. [PMID: 32496813 DOI: 10.1080/13607863.2020.1768212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND An extensive study investigated the risk factors for low well-being in post-retirement. Most previous studies have taken a unidimensional perspective, focusing on single factors such as financial status, physical health, and mental health. OBJECTIVE Drawing on the vulnerability framework, we first identify and describe the empirical subgroups of vulnerability among retirees in the United States across four major domains of later life: material, physical, social, and mental vulnerability. Then, we investigate the association between vulnerability profiles and well-being. METHOD The sample included 3,158 retirees aged 65+ who participated in the Health and Retirement Study (HRS). Latent class analysis was utilized to identify the heterogeneous subgroups of vulnerability, and then a series of OLS regression analyses was conducted to examine the relationship between patterns of vulnerability and well-being. RESULTS Five vulnerability patterns were identified: material vulnerable (12%), health & social vulnerable (14%), material, health & social vulnerable (6%), least vulnerable (34%), and social vulnerable (35%). The health & social vulnerable group had the strongest negative influence on well-being among all subgroups. As the largest subgroup, the social vulnerable group's negative influence on well-being stood out, with a stronger effect than that of material privation experienced by those in the material vulnerable group. CONCLUSION By empirically identifying subgroups of differential vulnerability patterns among retirees, this study showed that post-retirement vulnerability reflects complex interactions among multiple disadvantages. Findings of this study enhance understanding of the disparities in well-being within the retired population, pointing to the possibility of targeted policy and program development.
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Affiliation(s)
- Oejin Shin
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Sojung Park
- Brown School of Social Work, Washington University, Saint Louis, MO, USA
| | - Ji Young Kang
- School of Social Work, Hannam University, Daejeon, Republic of Korea
| | - Minyoung Kwak
- Department of Social Welfare, Daegu University, Gyeongsan-si, Republic of Korea
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Abstract
Background Multimorbidity is gaining increasing attention due to its substantial medical, healthcare political and social challenges. So far, however, there have been only few studies attempting to characterize the underlying pathogenesis. Method A selective literature search was carried out in PubMed. Results There is no generally accepted definition of multimorbidity. In the studies published so far, attempts have mostly been made to identify frequent clusters of diseases. In order to prevent multimorbidity, however, it is necessary to characterize the underlying mechanisms of development in more detail. For this purpose, a concept is presented based on the previously published data, in particular from longitudinal studies showing the importance of known risk factors. Possible pathogenetic processes involving multimorbidity are briefly discussed. Conclusion For most pathogenetic processes leading to multimorbidity there is no suitable pharmacological treatment available; however, behavior such as lack of exercise, dietary habits, smoking and high alcohol consumption are of considerable importance for the development of multimorbidity and can in principle be influenced by treatment.
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Ishimaru D, Tanaka H, Nagata Y, Takabatake S, Nishikawa T. Physical Activity in Severe Dementia Is Associated With Agitation Rather Than Cognitive Function. Am J Alzheimers Dis Other Demen 2020; 35:1533317519871397. [PMID: 31533445 PMCID: PMC10624062 DOI: 10.1177/1533317519871397] [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: 11/17/2022]
Abstract
BACKGROUND The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia. METHODS A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home. RESULTS Sixty-three participants were assessed (mean age = 89.3 ± 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia. CONCLUSIONS Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.
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Affiliation(s)
- Daiki Ishimaru
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
- Department of Rehabilitation, Healthcare Corporation Seifuuen Imai Hospital, Kitataharaaza, Inagawacho, Kawabegun, Hyogo, Japan
| | - Hiroyuki Tanaka
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
| | - Yuma Nagata
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
- Department of Rehabilitation, Healthcare Corporation Seifuuen Imai Hospital, Kitataharaaza, Inagawacho, Kawabegun, Hyogo, Japan
| | - Shinichi Takabatake
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
| | - Takashi Nishikawa
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
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Schiltz NK, Warner DF, Sun J, Smyth KA, Gravenstein S, Stange KC, Koroukian SM. The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment. J Aging Health 2019; 31:1025-1042. [PMID: 29347865 PMCID: PMC6295271 DOI: 10.1177/0898264317751946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index (n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death. Results: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity. Discussion: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.
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Affiliation(s)
| | | | - Jiayang Sun
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Stefan Gravenstein
- Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, OH, USA
- Providence Veterans Administration Hospital, Providence, RI, USA
- Brown University, Providence, RI, USA
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Ploeg J, Northwood M, Duggleby W, McAiney CA, Chambers T, Peacock S, Fisher K, Ghosh S, Markle-Reid M, Swindle J, Williams A, Triscott JA. Caregivers of older adults with dementia and multiple chronic conditions: Exploring their experiences with significant changes. DEMENTIA 2019; 19:2601-2620. [PMID: 30841745 PMCID: PMC7925441 DOI: 10.1177/1471301219834423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Family caregiving is considered a social transition as changes in the health of the care recipient create a process of transition for the caregiver when they are more vulnerable to threats to their own health. Family and friend caregivers take on many responsibilities and experience high levels of burden when caring for community-dwelling older adults living with dementia and multiple chronic conditions. However, little is known about the changes they experience in their caring roles or how they cope with these changes. This qualitative descriptive study was part of a larger mixed methods randomized controlled trial evaluating a web-based caregiver support toolkit. Multiple semi-structured phone interviews were conducted with caregivers of older adults with dementia and multiple chronic conditions. Content analysis was used to generate thematic descriptions. Six themes were generated and grouped into two categories. Significant changes experienced by caregivers are described by the following themes: 'everything falls on you - all of the responsibilities,' 'too many feelings' and 'no time for me.' The themes describing how caregivers coped with these changes include: seeking support, self-caring, and adapting their caregiving approach. Study results indicate that caregivers of older adults with dementia and multiple chronic conditions experienced many changes in their caregiving journey resulting in increasing complexity as they tended to the care recipients' declining health and well-being. These caregivers used several creative strategies to cope with these changes. Health care providers should consider both the caregiver and care recipient as clients in the circle of care, and facilitate their linkage with health and community support services to help address the increasing complexity of care needs.
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Affiliation(s)
- Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Melissa Northwood
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Wendy Duggleby
- Innovation in Seniors Care Research Unit, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Carrie A McAiney
- School of Public Health and Health Systems, University of Waterloo, Schlegel-UW Research Institute for Aging, Waterloo Canada
| | - Tracey Chambers
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Canada
| | | | - Allison Williams
- School of Geography & Earth Sciences, McMaster University, Hamilton, Canada
| | - Jean Ac Triscott
- Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, Canada
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