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Wei X, Liu H, Yang L, Gao Z, Kuang J, Zhou K, Xu M. Joint developmental trajectories and temporal precedence of physical function decline and cognitive deterioration: A longitudinal population-based study. Front Psychol 2022; 13:933886. [PMID: 36312122 PMCID: PMC9597508 DOI: 10.3389/fpsyg.2022.933886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesPrevious studies primarily explored the unidirectional impact of cognition on physical function. However, the interplay between physical function and cognition and the temporal precedence in their predictive relationships have not been elucidated. We explored the bidirectional mechanism between physical function and cognition in a longitudinal dataset.Materials and methodsA total of 1,365 participants in the Chinese Longitudinal Healthy Longevity Survey assessed physical function and cognition in 2011 (T1), 2014 (T2), and 2018 (T3) by the Katz scale and the Chinese version of the Mini-Mental State Examination scale, respectively. Changes in the trajectories of physical function and cognition were examined using the latent growth model. The correlational and reciprocal relationships between physical function and cognition were examined using the parallel process latent growth model and autoregressive cross-lagged (ARCL) models.ResultsCognition and physical function decreased by an average of 0.096 and 0.017 points per year, respectively. Higher physical function was associated with better cognition at baseline (r = 0.237, p < 0.05), and longitudinal changes in physical function and cognition were positively correlated (r = 0.756, p < 0.05). ARCL analysis indicated that physical function at T1 positively predicted T2 cognitive function. However, this predictive relationship reversed between T2 and T3, whereby cognitive function at T2 predicted physical function at T3.ConclusionBoth physical function and cognition declined over time. Early identification and intervention in physical dysfunction among older adults could be critical to prevent further cognitive impairment and maintain functional independence. Hence, regular functional assessment and individualized care plans are required to achieve healthy aging.
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Santagata F, Massaia M, D'Amelio P. The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC Geriatr 2021; 21:545. [PMID: 34641791 PMCID: PMC8507228 DOI: 10.1186/s12877-021-02496-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial. Methods We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days. In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale. Results DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT. Conclusions We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium. Trial registration Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.
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Affiliation(s)
- Francesca Santagata
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Massimiliano Massaia
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy
| | - Patrizia D'Amelio
- Department of Medical Science, Geriatric and Bone Diseases Unit, University of Turin, corso Dogliotti 14, 10126, Torino, Italy. .,Department of Medicine, Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital (CHUV), Lausanne, Switzerland.
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Kraiwong R, Vongsirinavarat M, Rueankam M, Sumalrot T. Effects of physical-cognitive training on physical and psychological functions among older adults with type 2 diabetes and balance impairment: a randomized controlled trial. J Exerc Rehabil 2021; 17:120-130. [PMID: 34012938 PMCID: PMC8103183 DOI: 10.12965/jer.2142106.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Risks of falls among older adults are multifactorial in nature. A combined training program might be beneficial on fall-related outcomes. This study aimed to explore the effects of group-based physical-cognitive trainings on physical and psychological outcomes among older adults with type 2 diabetes mellitus (T2DM) and balance impairment. Fall incidence were also determined. Thirty-seven older adults with T2DM and balance impairment were randomly assigned to control and intervention groups. The intervention program comprised of 24 training sessions of 45–60 min exercise for 8 weeks. The exercise consisted of warm-up, aerobic exercise by nine square stepping, resistance exercise combined with cognitive training and cool down. All participants were assessed at baseline, 4 and 8 weeks after intervention, and 1-year follow-up. Both groups reported similar rates of falls. Global cognition, depressive symptoms, and fear of falling did not differ between groups at any time. The Timed Up & Go (TUG) test, alternate stepping test (AST), knee extensors, ankle plantarflexors, and dorsiflexors strength differed at 4 weeks. TUG, AST, hip abductors, knee flexors, ankle plantarflexors, and dorsiflexors strength differed at 8 weeks. The activity of daily living (ADL), TUG test (P=0.002) and AST, hip extensors and abductors, knee extensors and flexors, ankle plantarflexors and dorsiflexors were different at 1-year follow-up. The group-based physical-cognitive training could benefit older adults with T2DM in terms of maintaining ADL. The intervention could reduce fall risk factors by improving balance and lower limb muscle strength among older adults with T2DM and balance impairment.
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Affiliation(s)
- Ratchanok Kraiwong
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Mantana Vongsirinavarat
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Maliwan Rueankam
- Department of Occupational Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Thanayot Sumalrot
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Gedde MH, Husebo BS, Mannseth J, Kjome RLS, Naik M, Berge LI. Less Is More: The Impact of Deprescribing Psychotropic Drugs on Behavioral and Psychological Symptoms and Daily Functioning in Nursing Home Patients. Results From the Cluster-Randomized Controlled COSMOS Trial. Am J Geriatr Psychiatry 2021; 29:304-315. [PMID: 32753339 DOI: 10.1016/j.jagp.2020.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the impact of medication reviews using collegial mentoring and systematic clinical evaluation on psychotropic prescriptions, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADL). DESIGN Four-month multicenter, multicomponent, cluster-randomized, single-blinded controlled trial. SETTING Thirty-three Norwegian nursing homes including 67 nursing home wards (clusters). PARTICIPANTS A total of 723 enrolled patients, of which 428 participated in the study; 217 were randomized to the intervention and 211 to care as usual (control). INTERVENTION The COSMOS intervention consisted of Communication, Systematic pain management, Medication reviews, Organization of activities, and Safety. During medication review, the nursing home physician evaluated treatment with colleagues systematically using the results from validated clinical assessments. MEASUREMENTS Mean changes from baseline to month 4 in the number of prescribed psychotropic drugs (antipsychotics, anxiolytics, hypnotics or sedatives, antidepressants, and antidementia drugs); Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and Cornell Scale of Depression in Dementia (CSDD); Lawton and Brody's Physical Self Maintenance Scale (PSMS). RESULTS Compared to control, the mean change in prescribed psychotropic drugs was reduced both in total and regular number, while mean changes in NPI-NH and CSDD scores did not differ between the groups. Mean change in PSMS showed improvement in the intervention group, and deterioration in the control group. CONCLUSION Medication reviews using collegial mentoring and systematic clinical evaluation led to safe deprescribing, as the reductions in psychotropic drug use did not negatively affect BPSD, while ADL improved.
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Affiliation(s)
- Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; Municipality of Bergen, Bergen, Norway
| | - Janne Mannseth
- Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Reidun L S Kjome
- Centre for Pharmacy/Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line I Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
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Leung WY, Bhar S, Reilly A, Pedell S. Discrepancies Between Community-Dwelling Individuals with Dementia and Their Proxies in Completing the Cornell Scale for Depression in Dementia: A Secondary Data Analysis. Clin Interv Aging 2021; 16:281-289. [PMID: 33623378 PMCID: PMC7896738 DOI: 10.2147/cia.s289595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Depressive symptoms are common in people with dementia. Purpose This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia. Participants and Methods This study is a cross-sectional secondary analysis. Twenty-five people living with dementia (“participants”) and their family caregivers (“proxies”) participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall’s tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann–Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group. Results The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The “high functional impairment” group had larger discrepancy scores and a lower level of agreement than the “low functional impairment” group. Conclusion The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.
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Affiliation(s)
- Wing-Yin Leung
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ann Reilly
- Client Services Department, Dementia Australia, Melbourne, Victoria, Australia
| | - Sonja Pedell
- Centre for Design Innovation, Swinburne University of Technology, Melbourne, Victoria, Australia
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Aure CF, Kluge A, Moen A. Older Adults' Engagement in Technology-Mediated Self-Monitoring of Diet: A Mixed-Method Study. J Nurs Scholarsh 2020; 53:25-34. [PMID: 33316147 PMCID: PMC7839486 DOI: 10.1111/jnu.12619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 12/15/2022]
Abstract
Purpose This feasibility study explored older adults’ use of a nutrition app called Appetitus (https://apps.apple.com/us/app/appetitt/id1001936854?ign‐mpt=uo%3D2; https://play.google.com/store/apps/details?id=no.nr.appetitt&hl=e) and addressed their engagement in technology‐mediated self‐monitoring of diet. Undernutrition is a significant challenge among older adults and is associated with poorer health experiences. Digital health for self‐monitoring of diet has the potential to increase awareness of personal nutrition, and the scarcity of research reporting older adults’ ability and willingness to engage in technology‐mediated dietary self‐monitoring warranted this study. Design and Methods An explorative mixed‐methods design combining descriptive analysis of log data with qualitative analysis of interviews with Appetitus users was implemented. Findings Twenty‐five older adults self‐monitored their diet using Appetitus over an 8‐week trial period. Eighty percent of the participants used the app regularly in the trial period. The most engaged users recorded their food consumption daily for 8 weeks. Personal interest in nutrition and commitment to the project facilitated regular use of Appetitus. Poor health and the perception that using a nutrition app lacked personal relevance contributed to irregular self‐monitoring. For inexperienced technology users, participation in this project became a springboard to using tablet technology and the Internet beyond the Appetitus app. Conclusions The majority of the participants regularly used Appetitus for self‐monitoring of diet; they found the tablet technology and Appetitus app easy to use. Clinical Relevance Older adults are able and willing to use self‐monitoring tools. Nutrition apps can empower older adults to make better informed decisions about their diet. Patients’ self‐monitoring can provide valuable and detailed health‐related information to healthcare professionals and mediate patient‐centered care practices.
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Affiliation(s)
- Caroline Farsjø Aure
- PhD candidate, University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway
| | - Anders Kluge
- Senior researcher, University of Oslo, Faculty of Educational Sciences, Department of Education, Oslo, Norway
| | - Anne Moen
- Professor, University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway
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Clemmensen FK, Hoffmann K, Siersma V, Sobol N, Beyer N, Andersen BB, Vogel A, Lolk A, Gottrup H, Høgh P, Waldemar G, Hasselbalch SG, Frederiksen KS. The role of physical and cognitive function in performance of activities of daily living in patients with mild-to-moderate Alzheimer's disease - a cross-sectional study. BMC Geriatr 2020; 20:513. [PMID: 33246408 PMCID: PMC7693499 DOI: 10.1186/s12877-020-01926-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several factors may play a role in the ability of patients with Alzheimer's disease to perform activities of daily living (ADL). The aim of this study was to examine the impact of different aspects of physical performance and cognitive functions on ADL in patients suffering from mild-to-moderate Alzheimer's disease. METHODS We conducted secondary analyses on cross-sectional baseline data from the randomized controlled multicentre study "Preserving quality of life, physical health and functional ability in Alzheimer's Disease: The effect of physical exercise" (ADEX). In total, 185 AD patients (76 women and 109 men), with a mean age on 70,4 years, were included. Data from physical performance tests (Astrand cycle test, Timed up & Go (TUG), Sit to Stand test (STS)) and cognitive tests (Mini Mental Status Examination (MMSE), Symbol Digit Modalities Test (SDMT), Stroop Color and Word test (Stroop)) were used. Their associations with ADL, measured on the ADCS-ADL scale was assessed in multivariable regression analyses. RESULTS SDMT and MMSE had significant, moderate correlations with total ADL (SDMT: r = 0.33, MMSE: r = 0.42) and instrumental ADL (SDMT: r = 0.31, MMSE: r = 0.42), but not with basic ADL. Adjusting for age and sex, the associations between SDMT and MMSE to total ADL and instrumental ADL persisted. No significant associations were found between Astrand, TUG, STS or Stroop and total ADL, basic ADL or instrumental ADL. CONCLUSION Total ADL and instrumental ADL are associated with cognitive functions, including executive function. No significant association between examined physical performance parameters and ADL functions was observed, and consequently does not support an impact of physical function on ADL functions in patients with mild-to-moderate Alzheimer's disease and relatively well-preserved physical function. Strategies aimed to improve cognition may be better suited to improve ADL function in patients with mild-to-moderate Alzheimer's disease. TRIAL REGISTRATION NCT01681602 . Registered 10 September 2012, retrospectively registered.
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Affiliation(s)
- Frederikke K Clemmensen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark
| | - Kristine Hoffmann
- Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of public health, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Sobol
- Department of Physical and Occupational Therapy and Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy and Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte B Andersen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark
| | - Annette Lolk
- Dementia Clinic, Odense University Hospital, Odense, Denmark
| | - Hanne Gottrup
- Dementia Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Høgh
- Regional Dementia Research Centre, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark
| | - Steen G Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark
| | - Kristian S Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 - section 8025, 2100, Copenhagen, Denmark.
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Johansen RH, Olsen K, Bergh S, Benth JŠ, Selbæk G, Helvik AS. Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up. BMC Geriatr 2020; 20:488. [PMID: 33218298 PMCID: PMC7678321 DOI: 10.1186/s12877-020-01877-1] [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: 12/17/2019] [Accepted: 11/09/2020] [Indexed: 02/02/2023] Open
Abstract
Background Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function. Methods A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated. Results There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function. Conclusion The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.
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Affiliation(s)
- Reidun Haarr Johansen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Karoline Olsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,General Practice Research unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Berkers E, Cloïn M, Pop I. Informal help in a local setting: The Dutch Social Support Act in practice. Health Policy 2020; 125:47-53. [PMID: 33012538 DOI: 10.1016/j.healthpol.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022]
Abstract
The Dutch Social Support Act provides municipal social support for people that experience limitations in daily life and cannot rely on informal help from their social network to compensate these limitations. In this paper, we study whether the probability and intensity (number of services) of receiving municipal social support for daily limitations is affected by informal help by the social network (i.e. family, friends and neighbors). This study took place in Breda, a middle large city in the South of the Netherlands. We combined data from the Municipal Personal Records Database, the registration containing information on demographics and municipal social support receipt of all inhabitants, with data from the Municipality Policy Monitor, a survey containing information on daily limitations and informal help (n = 5256). We find that people experiencing daily limitations are more likely to receive municipal social support and also receive a higher number of support services (intensity). However, the perceived help from family and friends does not decrease either the probability or intensity of receiving municipal social support. Informal help from neighbors decreased the likelihood of receiving of municipal social support, but not the intensity. This implies that the overall relation between daily limitations and municipal social support is not different for people who indicate that they can or cannot rely on their informal network for help.
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Affiliation(s)
- Eline Berkers
- Department of Sociology, Tilburg University, the Netherlands; Tranzo, Tilburg University, the Netherlands.
| | | | - Ioana Pop
- Department of Sociology, Tilburg University, the Netherlands.
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High prevalence of dementia among community dwelling older adults in receipt of state funded home care packages: implications for health care planning. Ir J Psychol Med 2019; 36:139-144. [PMID: 31187722 DOI: 10.1017/ipm.2017.80] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The majority of people living with dementia in Ireland reside in their own homes, some supported by formal or informal home care. This audit aimed to estimate the prevalence of dementia and suspected cognitive impairment (CI) among older adults, 65+ years, in receipt of formal home care (domiciliary care) in a defined health service area in North Dublin. A secondary objective of the audit was to explore factors associated with dementia or CI in this cohort. METHODS A cross-sectional audit was conducted on all clients aged 65+ years actively receiving publicly funded home care packages (HCPs) during May 2016 in Healthcare Service Executive CHO9 Dublin North Central. A total of 935 urban community dwelling older adults were included in the study [mean age 83.7 (s.d. 7.4) years and 65% female]. Basic socio-demographic and health data were extracted from common summary assessment reports. Service users were categorised as having (a) dementia if a diagnosis of dementia or cognitive decline which impacts on independent living, was documented by a health professional or (b) suspected CI where a validated cognitive screening tool was applied and the score was indicative of mild CI. RESULTS Overall, the estimated prevalence of dementia and suspected CI was 37.1% and 8.7%, respectively. Factors significantly associated with dementia and suspected CI were higher dependency and home care hours, communication difficulty and being non-self-caring (p<0.001). Notably, half (51.6%) of those with either dementia or suspected CI group lived alone. CONCLUSIONS Our findings suggest a high prevalence dementia among HCP users, highlighting a need and opportunity for dementia-specific approaches to support older people in their homes.
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Mahlknecht A, Krisch L, Nestler N, Bauer U, Letz N, Zenz D, Schuler J, Fährmann L, Hempel G, Flamm M, Osterbrink J. Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT. BMC Geriatr 2019; 19:257. [PMID: 31533630 PMCID: PMC6749664 DOI: 10.1186/s12877-019-1263-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncoordinated interprofessional communication in nursing homes increases the risk of polypharmacy and inappropriate medication use. This may lead to augmented frequency of adverse drug events, hospitalizations and mortality. The aims of this study were (1) to improve interprofessional communication and medication safety using a combined intervention and thus, (2) to improve medication appropriateness and health-related outcomes of the included residents. METHODS The single-arm interventional study (2014-2017) was conducted in Muenster, Germany and involved healthcare professionals and residents of nursing homes. The intervention consisted of systematic education of participating healthcare professionals and of a structured interprofessional medication review which was performed via an online communication platform. The primary endpoint was assessed using the Medication Appropriateness Index MAI. Secondary endpoints were: cognitive performance, delirium, agitation, mobility, number of drugs, number of severe drug-drug interactions and appropriateness of analgesics. Outcomes were measured before, during and after the intervention. Data were analyzed using descriptive and inference-statistical methods. RESULTS Fourteen general practitioners, 11 pharmacists, 9 nursing homes and 120 residents (n = 83 at all testing times) participated. Overall MAI sum-score decreased significantly over time (mean reduction: -7.1, CI95% -11.4 - - 2.8; median = - 3.0; dCohen = 0.39), especially in cases with baseline sum-score ≥ 24 points (mean reduction: -17.4, CI95% -27.6 - - 7.2; median = - 15.0; dCohen = 0.86). MAI sum-score of analgesics also decreased (dCohen = 0.45). Mean number of severe drug-drug interactions rose slightly over time (dCohen = 0.17). The proportion of residents showing agitated behavior diminished from 83.9 to 67.8%. Remaining secondary outcomes were without substantial change. CONCLUSION Medication appropriateness increased particularly in residents with high baseline MAI sum-scores. Cognitive decline of participating residents was seemingly decelerated when compared with epidemiologic studies. A controlled trial is required to confirm these effects. Interprofessional interaction was structured and performance of medication reviews was facilitated as the online communication platform provided unlimited and consistent access to all relevant and updated information. TRIAL REGISTRATION DRKS Data Management, ID: DRKS00007900 , date of registration: 2015-09-02 (retrospectively registered i.e. 6 weeks after commencement of the first data collection).
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Laura Krisch
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Nadja Nestler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Ulrike Bauer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Nina Letz
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Daniel Zenz
- smart-Q Softwaresysteme GmbH, BioMedizinZentrum Bochum, Universitätsstraße 136, 44799 Bochum, Germany
| | - Jochen Schuler
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Laura Fährmann
- Department of Pharmaceutical and Medical Chemistry - Clinical Pharmacy, Westfaelische Wilhelms-University, Corrensstraße 48, 48149 Muenster, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry - Clinical Pharmacy, Westfaelische Wilhelms-University, Corrensstraße 48, 48149 Muenster, Germany
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
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12
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Nerius M, Johnell K, Garcia-Ptacek S, Eriksdotter M, Haenisch B, Doblhammer G. The Impact of Antipsychotic Drugs on Long-term Care, Nursing Home Admission, and Death in Dementia Patients. J Gerontol A Biol Sci Med Sci 2019; 73:1396-1402. [PMID: 29228107 PMCID: PMC6132113 DOI: 10.1093/gerona/glx239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Behavioral and psychological symptoms of dementia are commonly treated with antipsychotic drugs (APDs), which have been associated with adverse health effects. We examine the effect of APDs on long-term care (LTC), nursing home (NH) admission, and death of dementia patients. Methods We used health claims data of the largest German health insurer from 2004 to 2010 and followed newly-diagnosed dementia patients aged 60 years and older into LTC, NH, and until death. Cox proportional hazards models were estimated to explore whether the risk of these outcomes differed between patients receiving haloperidol, melperone, risperidone, or quetiapine. Results In a cohort of 6,930 dementia patients who were initially free of LTC dependency, APD users generally faced a twofold increased risk of LTC relative to nonusers. Quetiapine was the exception, showing a comparatively lower risk (HR = 1.64; CI = 1.35–1.98). Among 9,950 dementia patients initially living in private homes, the risk of moving into a NH was generally increased by about 50% among APD users relative to nonusers. Risk of death (N = 10,921) was significantly higher for haloperidol-, melperone-, and risperidone- but not for quetiapine users (HR = 0.91; CI = 0.78–1.08). The excess mortality associated with haloperidol and melperone was greater among patients living in private households. Conclusions In our study, APDs appeared to accelerate adverse health outcomes in German dementia patients. Differentiating between the effect of antipsychotic drug use among dementia patients residing in private households and in NHs, we found that excess mortality for haloperidol and melperone users was higher in private settings.
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Affiliation(s)
- Michael Nerius
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute for Sociology and Demography, University of Rostock, Germany.,Rostock Center for the Study of Demographic Change, Germany
| | - Kristina Johnell
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gabriele Doblhammer
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute for Sociology and Demography, University of Rostock, Germany.,Rostock Center for the Study of Demographic Change, Germany.,Max Planck Institute for Demographic Research, Rostock, Germany
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13
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Helvik AS, Barca ML, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Borza T. The course of depressive symptoms with decline in cognitive function - a longitudinal study of older adults receiving in-home care at baseline. BMC Geriatr 2019; 19:231. [PMID: 31443638 PMCID: PMC6708209 DOI: 10.1186/s12877-019-1226-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė-Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tom Borza
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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14
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Aspell N, O'Sullivan M, O'Shea E, Irving K, Duffy C, Gorman R, Warters A. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry 2019; 34:999-1007. [PMID: 30901483 PMCID: PMC6619240 DOI: 10.1002/gps.5101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 03/17/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify factors that predict admission to long-term care (LTC) and mortality among community-based, dependent older people in Ireland, who were in receipt of formal home support. METHODS An audit was conducted of all community-dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. RESULTS The audit comprised 1597 community-dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12-month period. Factors significantly associated with admission to LTC were "cognitive dysfunction" [OR 2.10 (1.41-3.14), P < .001] and the intensity of home support [OR 1.05 (1.01-1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). CONCLUSION "Cognitive dysfunction" and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive-specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.
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Affiliation(s)
- Niamh Aspell
- North Dublin Homecare Ltd.DublinIreland,Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
| | - Maria O'Sullivan
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Eamon O'Shea
- Centre for Economic and Social Research on DementiaNational University of IrelandGalwayIreland
| | - Kate Irving
- School of Nursing and Human SciencesDublin City UniversityDublinIreland
| | - Chloe Duffy
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Rebecca Gorman
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Austin Warters
- Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
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15
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Gulla C, Flo E, Kjome RLS, Husebo BS. Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS). BMC Geriatr 2019; 19:130. [PMID: 31064365 PMCID: PMC6505068 DOI: 10.1186/s12877-019-1139-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 04/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimorbid patients in nursing homes are prescribed long lists of medication, often without sufficient clinical evaluations beforehand. This results in poor clinical effects of the prescribed medication and significant side-effects, especially in patients with impaired cognition. The aim of this paper is to describe the process, content and implementation of a clinical medication review encompassing clinical testing and collegial support to prescribers. Methods The implementation process of a novel approach to medication review in nursing homes was logged thoroughly by structured staff feedback. Staff experienced promotors and barriers to implementation also were collected. The study was part of a cluster randomized controlled trial, in which 36 long-term care units received the COSMOS intervention. Nurses and physicians randomized to the intervention group participated in educational programs, training in clinical evaluation of the patients, and interprofessional medication review with collegial mentoring. Results The intervention group contained 297 patients from 36 nursing home units. There were 105 staff attendees for the education program. The units were served by 21 different physicians. Clinical medication reviews were performed in all units and all patients were assessed prior to the medication reviews. Of the 240 patients with a logged intervention process, 220 (92%) underwent a medication review. The intervention generated enthusiasm and improved communication among nursing staff and between nursing staff and physicians. The interprofessional discussions helped to facilitate difficult decisions pertaining to treatment levels. Reported barriers were lack of time, low engagement of all nursing staff and physicians, and ethical dilemmas. Conclusions Clinical medication reviews were implemented for almost all patients, and every patient was systematically assessed prior to the medication review. The physicians perceived collegial mentoring as an asset, learning from each other facilitated decision making in terms of difficult aspects of prescribing. Knowledge about barriers and promotors can improve implementation of similar interventions in other nursing homes. Trial registration Clinicaltrials.gov (NCT02238652). Registered July 7th 2014.
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Affiliation(s)
- Christine Gulla
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Reidun L S Kjome
- Department of Global Public Health and Primary Care/Centre for pharmacy, University of Bergen, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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16
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Nakashima T, Young Y, Hsu WH. Do Nursing Home Residents With Dementia Receive Pain Interventions? Am J Alzheimers Dis Other Demen 2019; 34:193-198. [PMID: 30971106 PMCID: PMC10852503 DOI: 10.1177/1533317519840506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study compares pain interventions received by nursing home residents with and without dementia. Secondary data analyses of cross-sectional data from 50,673 nursing home residents in New York State were collected by the Minimum Data Set 3.0. Frequency distributions and bivariate analyses with χ2 tests were used to organize and summarize the data. Logistic regression analyses were performed to quantify the relationship between dementia and pain interventions. Our results show that residents with dementia had significantly fewer pain assessments and less reported pain presence than their counterparts. After adjusting for covariates, the results indicate that residents with dementia were significantly less likely to receive pro re nata and nonmedication pain intervention. However, there were no significant differences in scheduled pain medication between the 2 groups. To address the gap, we need more research to design a pain assessment tool that can differentiate severity of pain so that appropriate interventions can be applied.
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Affiliation(s)
- Taeko Nakashima
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Albany, NY, USA
- Department of Economics, Rutgers University, Camden, NJ, USA
| | - Yuchi Young
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Wan-Hsiang Hsu
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, NY, USA
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17
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Liu X, Yin X, Tan A, He M, Jiang D, Hou Y, Lu Y, Mao Z. Correlates of Mild Cognitive Impairment of Community-Dwelling Older Adults in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2705. [PMID: 30513638 PMCID: PMC6313802 DOI: 10.3390/ijerph15122705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 01/22/2023]
Abstract
Mild cognitive impairment (MCI) is an early stage of Alzheimer's disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess potential differences in the risk of MCI among different elderly groups in Wuhan, China, and to further identify the most vulnerable populations using logistic regression models. A total of 622 older adults participated in this study, and the prevalence of MCI was 34.1%. We found that individuals aged 80⁻84 (odds ratio, OR = 1.908, 95% confidence interval, 95% CI 1.026 to 3.549) or above (OR = 2.529, 95% CI 1.249 to 5.122), and those with two chronic diseases (OR = 1.982, 95% CI 1.153 to 3.407) or more (OR = 2.466, 95% CI 1.419 to 4.286) were more likely to be diagnosed with MCI. Those with high school degrees (OR = 0.451, 95% CI 0.230 to 0.883) or above (OR = 0.318, 95% CI 0.129 to 0.783) and those with a family per-capita monthly income of 3001⁻4500 yuan (OR = 0.320, 95% CI 0.137 to 0.750) or above (OR = 0.335, 95% CI 0.135 to 0.830) were less likely to experience MCI. The results also showed that those aged 80 or above were more likely to present with cognitive decline and/or reduced activities of daily living (ADL) function, with the odds ratios being 1.874 and 3.782, respectively. Individuals with two, or three or more chronic diseases were more likely to experience cognitive decline and/or reduced ADL function, with odds ratios of 2.423 and 2.631, respectively. Increased risk of suffering from either MCI and/or decline in ADL functioning is strongly positively associated with older age, lower educational levels, poorer family economic status, and multiple chronic diseases. Our findings highlight that the local, regional, and even national specific MCI-related health promotion measures and interventions must target these vulnerable populations.
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Affiliation(s)
- Xiaojun Liu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
| | - Xiao Yin
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- College of Public Administration, Huazhong University of Science and Technology, 1037# Luoyu Road, Wuhan 430074, China.
| | - Anran Tan
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Meikun He
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Dongdong Jiang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Yitan Hou
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Yuanan Lu
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
- Department of Public Health Sciences, University of Hawaii at Mānoa, 1960 East-West Road, Honolulu, HI 96822, USA.
| | - Zongfu Mao
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 8# South Donghu Road, Wuhan 430072, China.
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18
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Goyal AR, Bergh S, Engedal K, Kirkevold M, Kirkevold Ø. Trajectories of quality of life and their association with anxiety in people with dementia in nursing homes: A 12-month follow-up study. PLoS One 2018; 13:e0203773. [PMID: 30204812 PMCID: PMC6133386 DOI: 10.1371/journal.pone.0203773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify possible groups of people with dementia (PWD) in nursing homes with different trajectories of proxy-rated quality of life (QoL), and to explore how anxiety (along with other characteristics) was associated with these trajectories of QoL of PWD in nursing homes at a 12-month follow-up. METHODS We included 298 PWD aged 65 years and older from 17 Norwegian nursing homes. The Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) was used to assess anxiety, defined as RAID-N score ≥12; proxy-rated QoL was assessed by Quality of Life in Late-Stage Dementia (QUALID). The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). A growth mixture model identified two distinct trajectories of QUALID scores. Association between the QUALID score trajectories and demographic and clinical characteristics were analyzed with logistic regression models. RESULTS Trajectory group 1 (206 participants) had a lower proportion of participants with anxiety, and a more stable and better QoL, compared to trajectory group 2 (92 participants) at a 12-month follow-up. In a multivariate logistic regression analysis, more severe impairment in activities of daily living, along with presence of anxiety, depression, agitation, and use of antipsychotics at baseline, were associated with belonging to the trajectory group with proxy-rated poor QoL. SIGNIFICANCES This study reveals that anxiety is associated with proxy-rated poor QoL of PWD at a 12-month follow-up. Efforts should be made to identify anxiety among nursing home residents with dementia to initiate treatment.
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Affiliation(s)
- Alka R. Goyal
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Sverre Bergh
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian University of Science and Technology (NTNU) in Gjøvik, Faculty of Health, Care and Nursing, Gjøvik, Norway
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Borza T, Benth JŠ, Helvik AS. Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging Ment Health 2018; 22:379-388. [PMID: 28051894 DOI: 10.1080/13607863.2016.1262817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. METHOD In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). RESULTS At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. CONCLUSION LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental Health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway.,e National School of Public Health, Fundação Oswaldo Cruz , Rio , Brazil
| | - Deborah Bezerra Maia
- f Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU)
| | - Tom Borza
- d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway
| | - Jūratė Šaltytė Benth
- g St Olav's University Hospital , Trondheim , Norway.,h Institute of Clinical Medicine, Campus Ahus, University of Oslo , Norway
| | - Anne-Sofie Helvik
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,i HØKH, Research Centre , Akershus University Hospital , Norway
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20
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Effectiveness of cognition-focused interventions in activities of daily living performance in people with dementia: A systematic review. Br J Occup Ther 2017. [DOI: 10.1177/0308022617698166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Dementia affects cognitive functions and has a direct impact on the ability to perform activities of daily living. Studies have focused on the impact of cognition-focused interventions on cognitive functions, but less on the daily functionality of people with dementia. The aim of this study was to review systematically evidence of the effectiveness of cognition-focused interventions on the ability of people with dementia to perform activities of daily living. Method A search of randomised controlled trials was performed in 10 databases to find all available evidence on the subject. Two reviewers independently selected articles based on predetermined inclusion criteria. The articles had to describe randomised controlled trials involving cognition-focused interventions in people with some form of dementia, aged 65 years or over, and specify their score on the Mini-Mental State Examination or the Clinical Dementia Rating. Eleven articles met the inclusion criteria for the review. Results Cognitive rehabilitation through functional tasks led to maintenance or improvement in everyday tasks in some cases. In cognitive stimulation studies the subjects maintained their performance in activities of daily living with respect to the control condition, but this was not the case in reminiscence stimulation groups. Subjects who underwent cognitive training of cognitive functions did not show significant improvements in activities of daily living. Conclusion The evidence on the effectiveness of cognition-focused interventions suggests that multi-component programmes that include cognitive rehabilitation or cognitive stimulation could maintain or improve functionality in people with dementia.
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Su P, Ding H, Zhang W, Duan G, Yang Y, Long J, Du L, Xie C, Jin C, Hu C, Sun Z, Duan Z, Gong L, Tian W. Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China. J Nutr Health Aging 2017; 21:362-369. [PMID: 28346562 DOI: 10.1007/s12603-016-0777-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability. METHODS Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody. RESULTS A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21). CONCLUSIONS Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.
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Affiliation(s)
- P Su
- Wenhua Tian, PhD, Department of Health Services Management, the Second Military Medical University, No.800 Xiangyin Rd, Shanghai, 200433, China; Tel: +86-21-8187-1428; Fax: +86-21-8187-1428; Email address:
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Greater Independence in Activities of Daily Living is Associated with Higher Health-Related Quality of Life Scores in Nursing Home Residents with Dementia. Healthcare (Basel) 2015; 3:503-18. [PMID: 27417776 PMCID: PMC4939554 DOI: 10.3390/healthcare3030503] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQL) for nursing home residents is important, however, the concept of quality of life is broad, encompasses many domains and is difficult to assess in people with dementia. Basic activities of daily living (ADL) are measured routinely in nursing homes using the Resident Assessment Instrument-Minimum Data Set Version 2.0 (RAI-MDS) and Functional Independence Measure (FIM) instrument. We examined the relationship between HRQL and ADL to assess the future possibility of ADL dependency level serving as a surrogate measure of HRQL in residents with dementia. To assess ADL, measures derived from the RAI-MDS and FIM data were gathered for 111 residents at the beginning of our study and at 6-month follow-up. Higher scores for independence in ADL were correlated with higher scores for a disease-specific HRQL measure, the Quality of Life-Alzheimer's Disease Scale. Preliminary evidence suggests that FIM-assessed ADL is associated with HRQL for these residents. The associations of the dressing and toileting items with HRQL were particularly strong. This finding suggests the importance of ADL function in HRQL. The RAI-MDS ADL scales should be used with caution to evaluate HRQL.
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