Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil

Factors associated with older adults' cognitive decline 6 months after gamma-variant SARS-CoV-2 infection

Background

Cognitive deficits are commonly reported after COVID-19 recovery, but little is known in the older population. This study aims to investigate possible cognitive damage in older adults 6 months after contracting COVID-19, as well as individual risk factors.

Methods

This cross-sectional study involved 70 participants aged 60-78 with COVID-19 6 months prior and 153 healthy controls. Montreal Cognitive Assessment-Basic (MoCA-B) screened for cognitive impairment; Geriatric Depression Scale and Geriatric Anxiety Inventory screened for depression and anxiety. Data were collected on demographics and self-reports of comorbid conditions.

Results

The mean age of participants was 66.97 ± 4.64 years. A higher proportion of individuals in the COVID group complained about cognitive deficits (χ2 = 3.574; p = 0.029) and presented with deficient MoCA-B scores (χ2 = 6.098, p = 0.014) compared to controls. After controlling for multiple variables, all the following factors resulted in greater odds of a deficient MoCA-B: COVID-19 6-months prior (OR, 2.44; p = 0.018), age (OR, 1.15; p < 0.001), lower income (OR, 0.36; p = 0.070), and overweight (OR, 2.83; p = 0.013). Further analysis pointed to individual characteristics in COVID-19-affected patients that could explain the severity of the cognitive decline: age (p = 0.015), lower income (p < 0.001), anxiety (p = 0.049), ageusia (p = 0.054), overweight (p < 0.001), and absence of cognitively stimulating activities (p = 0.062).

Conclusion

Our study highlights a profile of cognitive risk aggravation over aging after COVID-19 infection, which is likely mitigated by wealth but worsened in the presence of overweight. Ageusia at the time of acute COVID-19, anxiety, being overweight, and absence of routine intellectual activities are risk factors for more prominent cognitive decline among those infected by COVID-19.

Multiple socioeconomic risks and cognitive impairment among older men and women in India

Introduction

Socioeconomic status (SES) is negatively associated with innumerable health outcomes, including cognitive functioning. Yet much remains undiscovered about SES patterns in later-life cognition in low-and middle-income countries (LMICs). The purpose of this study was to examine the association between separate and combined socioconomic risks and cognitive impairment among older adults in India. Further, given gender disparities in later life cognitive functioning and SES, the study examines the associations between socioeconomic risks and cognitive impairment separately, for older men and women.

Methods

Data come from the 2017-18, first wave of the Longitudinal Aging Study in India (LASI), with 31,464 older adults aged 60 years and above. Cognitive impairment was assessed using multiple broad measures of memory, orientation, arithmetic function, and visuo-spatial construction skills. We present descriptive statistics along with cross-tabulation of the outcome variable. Additionally, binary logistic regression analysis was used to test the association between outcome and explanatory variables. SES is measured using education, paid work status, and household wealth measured using monthly per-capita consumption expenditure (MPCE).

Results

A proportion of 7.14% of the older men and 20.03% of older women reported cognitive impairment. The odds of cognitive impairment were higher among uneducated older men and women, and older men and women in lowest wealth quintile. Surprisingly, older women without current or prior work history report lower odds of cognitive impairment compared to their peers in labor force. While odds of cognitive impairment are higher among non-working older men, this association is not statistically significant. In older men, the odds of cognitive impairment were 5.34, 7.14, and 13.05 times higher with one, two, and three risk factors, respectively, compared with those with no risk exposure. A similar trend was observed for women but with comparatively lower odds.

Conclusions

Our findings underscore the need to distinguish between varying elements of SES to construct "upstream" health policies and programs that redistribute resources. In particular, the findings support the use of multiple SES indicators in identifying older adults most susceptible to cognitive deficits, and planning gender-based interventions to improve cognitive health in late life.

The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers

Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.

Mental Fatigue Is Associated with Subjective Cognitive Decline among Older Adults

Both Subjective Cognitive Decline (SCD) and mental fatigue are becoming increasingly prevalent as global demographics shifts indicate our aging populations. SCD is a reversible precursor for Alzheimer's disease, and early identification is important for effective intervention strategies. We aim to investigate the association between mental fatigue-as well as other factors-and SCD. A total of 707 old adults (aged from 60 to 99) from Shanghai, China, participated in this study and completed self-reported instruments covering their cognitive and mental status as well as demographic information. Mental fatigue status was assessed by using four items derived from the functional impairment syndrome of the Old Adult Self Report (OASR). SCD was assessed by using the Memory/Cognition syndrome of OASR. A total of 681 old adults were included in the current study. The means of SCD significantly differed between each group of factors (age, gender, and mental fatigue). The general linear regression models showed that SCD increased with age, females scored higher than males, and SCD was positively associated with mental fatigue factors including difficulty getting things done, poor task performance, sleeping more, and a lack of energy among old adults. The study also found that SCD is negatively associated with the high-income group among young-old (aged from 60 to 75) males and associated with good marital/living status with the companion of spouses/partners among young-old females. These results suggest that gender, income level, marital/living status, and mental fatigue are crucial factors in preventing SCD among old adults and are pivotal in developing early intervention strategies to preserve the mental health of an increasingly aging population.

Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review

Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.

Vulnerability, family violence and institutionalization: narratives for elderly and professionals in social welcome center

OBJECTIVE

To know the institutionalization process and the functional clinical condition of elderly people who suffered family violence, from the perspective of the elderly and professionals.

METHODS

Qualitative, which used oral history as a data collection technique. Held in a long-term institution for the elderly, using a semi-structured interview script. The participants were three nursing technicians, two nursing assistants, five caregivers for the elderly and eight elderly. Thematic analysis was performed with the aid of the MAXQDA® software.

RESULTS

Three categories were identified: The condition of vulnerability and the care needs of the elderly, indicating welcoming as an intervention; Suffering and denial of conditions of vulnerability; and Situations of family violence and the positive aspects of reception.

CONCLUSIONS

Long-term institutions are considered important spaces for comprehensive and humanized care, as well as essential for the protection of elderly victims of family violence.

Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review

BACKGROUND

Social environments are a contributing determinant of health and disparities. This scoping review details how social environments have been operationalized in observational studies of cognitive aging and dementia.

METHODS

A systematic search in PubMed and Web of Science identified studies of social environment exposures and late-life cognition/dementia outcomes. Data were extracted on (1) study design; (2) population; (3) social environment(s); (4) cognitive outcome(s); (5) analytic approach; and (6) theorized causal pathways. Studies were organized using a 3-tiered social ecological model at interpersonal, community, or policy levels.

RESULTS

Of 7802 non-duplicated articles, 123 studies met inclusion criteria. Eighty-four studies were longitudinal (range 1-28 years) and 16 examined time-varying social environments. When sorted into social ecological levels, 91 studies examined the interpersonal level; 37 examined the community/neighborhood level; 3 examined policy level social environments; and 7 studies examined more than one level.

CONCLUSIONS

Most studies of social environments and cognitive aging and dementia examined interpersonal factors measured at a single point in time. Few assessed time-varying social environmental factors or considered multiple social ecological levels. Future studies can help clarify opportunities for intervention by delineating if, when, and how social environments shape late-life cognitive aging and dementia outcomes.

Instrumentos de avaliação cognitiva utilizados nos últimos cinco anos em idosos brasileiros

Resumo A detecção e o monitoramento do déficit cognitivo em idosos são necessários já que podem causar impacto em sua funcionalidade. O objetivo dessa revisão integrativa é analisar a produção científica sobre uso de instrumentos de avaliação cognitiva em idosos brasileiros por meio de artigos publicados nos últimos cinco anos, indexados nas bases de dados Web of Science, PubMed, Scopus e Bireme. Os critérios de inclusão foram: artigos originais publicados em inglês e português, de 2012 a 2016, com critério de idade definido para ser considerado idoso, e escore maior que 6 no CASP adaptado. O critério de exclusão foi: ser resumo de congresso. A amostra final foi composta por 100 artigos. Foram apresentados os 61 instrumentos de avaliação cognitiva utilizados nos estudos, com destaque para o Mini Exame do Estado Mental. Essa revisão apresenta o uso de instrumentos cognitivos na pesquisa brasileira, suas diferentes versões e quais domínios são avaliados. O número de instrumentos presentes na literatura foi amplo. Os mais utilizados foram o MEEM (versão de Brucki e colaboradores), o Teste de Fluência Verbal (categoria animais) e o Teste Span de dígitos (ordem direta e inversa). Os achados apresentados nessa revisão são relevantes não apenas para área da pesquisa observacional e experimental, mas também para a prática clínica.

Association between built environment and the incidence of disability in basic and instrumental activities of daily living in the older adults: Results of a cohort study in southern Brazil

The aim of this study was to evaluate the association between subjective and objective characteristics of the built environment and the incidence of disability in the activities of daily living in the older adults. A cohort study was conducted with 1196 older adults from Florianopolis, Santa Catarina, Brazil. Incidences were evaluated after four years by the difficulty or inability to perform six basic and nine instrumental activities. The subjective built environment was evaluated by the adapted Neighborhood Environment Walkability Scale and the objective for variables related to the characteristics of streets, sidewalks and land uses in the census tracts. Multilevel Logistic Regression analyzes were performed, where significant positive associations were observed between the presence of hills, and negative associations between safety for walking at night, a high proportion of commercial area, intermediate mixed land use and the incidence of disability in basic activities. The built environment characteristics associated with disability point to the need for improvements in urban infrastructure to promote functional independence in the older adults.

The perception of the elderly about suffering related to frailty

Abstract Objective: To understand how elderly persons perceive subjective aspects linked to current and other life experiences related to the process of becoming frail. Method: A qualitative study, anchored in interpretative anthropology, was performed. The elderly were selected from the FIBRA Network database from those classified as robust or pre-frail, according to the frailty phenotype of Fried et al., in Belo Horizonte, Minas Gerais, Brazil in 2009. We interviewed 15 elderly people of different genders, ages, income, religion and functional status, in 2016. In data collection and analysis, the "signs, meanings and actions" analysis model was used, which allows the understanding of the elements that are significant for a population to read a given situation and to position themselves in relation to it. Results: From the analysis the following categories emerged: a) suffering throughout life and b) suffering and the resources to deal with them. Conclusion: The interviewees described sufferings of different aspects that constitute their life, from birth to aging, according to experiences related to pain, loss and learning. The perception of current frailty refers to their life history, marked by physical or mental suffering, whether insidious or temporary - as well as illnesses, how they manifest themselves today, and a lack of financial resources and urban security. The narratives bring us closer to the perception of frailty as being constitutive of human beings, who can easily break.