Incidence of nursing home placement in a defined community

Social engagement and cognitive impairment among nursing home residents: The role of sensory impairment

BACKGROUND AND OBJECTIVES

Using US national nursing home data, this cross-sectional study sought to evaluate 1) the association between lack of social engagement and level of cognitive impairment; and 2) the extent to which this association differs by hearing and visual impairment.

RESEARCH DESIGN AND METHODS

Our sample included 793,846 nursing home residents aged ≥ 50 years. The Index of Social Engagement was categorized as none/lower (0, 1, 2) or higher levels (3 through 6). Cognitive Performance Scale was grouped as intact/mild (0, 1, 2), moderate (3, 4), or severe (5, 6). Multinomial models provided adjusted odds ratio (aOR) and 95 % confidence intervals (CI) between none/lower social engagement and cognitive impairment. We estimated relative excess risk due to interaction (RERI) to quantify the joint effects of social engagement and sensory impairment types.

RESULTS

Overall, 12.6 % had lower social engagement, 30.3 % had hearing impairment, and 40.3 % had visual impairment. Compared to residents with high social engagement, those with lower social engagement were more likely to have moderate/severe cognitive impairment (aORmoderate = 2.21, 95 % CI 2.17-2.26; aORsevere = 6.49, 95 % CI 6.24-6.74). The impact of low social engagement on cognitive impairment was more profound among residents with hearing impairment and/or visual impairment (RERIhearing = 3.89, 95 % CI 3.62-4.17; RERIvisual = 25.2, 95 % CI 23.9-26.6)).

DISCUSSION AND IMPLICATIONS

Residents with lower social engagement had higher levels of cognitive impairment. Residents with sensory impairments are potentially more susceptible to the negative impact of lower levels of social engagement on level of cognitive impairment.

Factors associated with health-related quality of life among people with visual impairments living in nursing homes in Armenia: a cross-sectional study

PURPOSE

The study aimed to examine the effect of visual impairment (VI), eye diseases, and other risk factors on health-related quality of life (HRQoL) in nursing home residents in Armenia.

METHODS

This cross-sectional study administered an interviewer-administered structured questionnaire to collect information about socio-demographics, chronic diseases, HRQoL, smoking, receiving and giving instrumental/emotional social support, and sleeping disorders among 313 nursing home residents. An ophthalmic examination of the participants was conducted.

RESULTS

The mean age was 72.5 years, ranging from 45.5 to 91.4. Women constituted 50% of the sample. The prevalence of normal vision by presenting visual acuity with available correction was 55.3%, while VI and blindness were present in 40.8% and 3.9%, respectively. Uncorrected refractive error (URE) was found in 20% of participants. The mean HRQoL score was 51.3, ranging from 7.9 to 95.0. In the adjusted analysis, having at least one chronic non-communicable disease, sleeping disorders, eye diseases, URE, VI, blindness, and giving instrumental social support were associated with HRQoL.

CONCLUSIONS

Regular eye care services could improve the eye health and HRQoL of nursing home residents. Interventions addressing vision loss and chronic non-communicable diseases could enhance the functioning and overall well-being of the target population.

Patient-Reported Measures of the Effects of Vision Impairments and Low Vision Rehabilitation on Functioning in Daily Life

The quantification of vision impairments dates to the mid-nineteenth century with standardization of visual acuity and visual field measures in the eye clinic. Attempts to quantify the impact of vision impairments on patients' lives did not receive clinical attention until the close of the twentieth century. Although formal psychometric theories and measurement instruments were well developed and commonplace in educational testing, as well as in various areas in psychology and rehabilitation medicine, the late start applying them to clinical vision research created a vacuum that invited poorly developed and poorly functioning instruments and analytic methods. Although this research is still burdened with legacy instruments, mandates by regulatory agencies to include the patients' perspectives and preferences in the evaluation of clinical outcomes have stimulated the development and validation of self-report instruments grounded in modern psychometric theory and methods. Here I review the progress and accomplishments of applying modern psychometrics to clinical vision research. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Low rates of eye care utilization among visually impaired subsidized senior housing residents

OBJECTIVE

To examine the rate of self-reported vision impairment, eye disease, and eye care utilization among residents of subsidized senior housing (SSH) communities.

METHODS

In this cross-sectional, observational study, residents of 14 SSH communities in Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of vision screening events held in their community.

RESULTS

Two hundred and thirty-seven residents self-reported their vision status, presence of eye disease, and eye care utilization. A third of participants (33.3%) reported difficulty with distance vision while 38% reported difficulty with near vision. Rates of eye disease among this sample were as follows: 40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of participants (52.8%) had not been to see an eye care provider within the last year. Persons with vision impairment were less likely to report having seen an eye care provider within the last year than those without impairment (p = .03).

CONCLUSION

This study illuminates the low utilization of eye care among socioeconomically disadvantaged older adults residing in SSH, especially among those with vision impairment and eye disease. Vision-related health care is important in maintaining both physical and mental health in older adults.

Recommended long term care settings following aged care assessments in Australia

The purpose of this study was to examine the prevalence and correlates of recommended long term care settings following aged care assessments in Australia. Using unique administrative data on 500,000 aged care assessments, we utilized multinomial logistic regression models to estimate the association between characteristics of the individual (their assistance needs, health conditions and demographic characteristics) and the recommended long-term care setting. The vast majority (94%) of recommended long-term care settings were for private residences (54%) or residential care (40%). Persons assessed in a setting other than a private residence were unlikely to have a recommended setting for a private residence. Consistent with the assessors toolkit, assistance needs were strongly associated with long term care recommendations. Results provide strong support for the evidence-based approach of aged care assessments in Australia. Nonetheless, with improvements in administrative data linkages and ongoing policy reforms, further analysis is required to reinforce extant policy guidelines.

Informal care relationships and residential aged care recommendations: evidence from administrative data

Background

The Australian government recognises the importance of informal care to enable ageing in place. Yet, few multivariable studies have examined aspects of informal care that alter the probability of entry to residential care in Australia. Existing Australian and international studies show differing effects of informal care on entry to residential care.

Methods

We utilise unique administrative data on aged care assessments collected from 2010 to 2013, consisting of 280,000 persons aged 65 and over. Logistic regression models were fitted to measure the propensity to be recommended care in a residential care setting, disaggregated by characteristics of informal care provision.

Results

Providing some explanation for the divergent findings in the literature, we show that close familial carer relationships (partner or child) and coresidence are associated with recommendations to live in the community. Weaker non-coresidential friend or neighbour carer relationships are associated with recommendations to live in residential care for women, as are non-coresidential other relatives (not a child, partner or in-law) for both males and females. Non-coresident carers who are in-laws (for females) or parents have no impact on assessor recommendations. Despite these significant differences, health conditions and assistance needs play a strong role in assessor recommendations about entry to residential care.

Conclusion

Co-resident care clearly plays an important protective role in residential care admission. Government policy should consider the need for differential supports for co-resident carers as part of future aged care reform.

Older Adults’ and Case Managers’ Perceptions of Smoking and Smoking Cessation

Objectives: This study explores older smokers’ and case managers’ perceptions of smoking and smoking cessation. Methods: Data were collected from 48 case managers via focus group sessions and questionnaires and from 20 smoking clients via structured interviews. Results: Case managers identified barriers to addressing clients’ smoking at the client, staff, and organizational levels. Clients and case managers lacked information on the benefits of smoking cessation in older adults. The majority of clients interviewed had no plans to quit smoking. Discussion: Results suggest that smoking cessation programs for this population need to be geared to clients who are not ready to quit. Education about the benefits of quitting smoking in older adults is needed for both case managers and smokers.

Poor self-rated health did not increase risk of permanent nursing placement or mortality in people with mild Alzheimer's disease

BACKGROUND

Self-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality. However, the predictive value of SRH to NH placement and mortality among elderly people is not consistent. This may be due to cognitive impairment. Since the SRH item is widely used, it is important to know whether SRH has different predictive value among people with cognitive impairments. We aimed to examine SRH and the risk of permanent NH placement and mortality among people with mild Alzheimer's disease (AD).

METHODS

Data are from The Danish Alzheimer Intervention StudY (DAISY), a large randomized controlled trial of psychosocial intervention for patients with mild dementia and their caregivers with 3-years' follow-up. Five out of 14 Danish counties participated and 321 home-living elderly (mean age: 76.2 years) with mild AD (46.4 % male) were included during 2004 and 2005. Self-rated SRH, cognitive function (MMSE), quality of life (proxy-rated QOL-AD), activities of daily living (ADCS-ADL), insight, and socio-demographics were assessed at baseline. Comorbidities and information about NH placement and mortality was obtained over 3-years' follow-up from registries. With Cox proportional hazard regression we analysed the association between SRH (dichotomised into good vs. poor) and NH placement and mortality adjusted for potential confounders.

RESULTS

At baseline 66 % reported excellent or good, and 34 % fair, poor or very poor SRH. Mean MMSE was 24.0 (range: 20-30). NH placement and mortality totalled 28.1 % and 16.5 % at 3-years' follow-up, respectively. Poor SRH at baseline was not related to increased risk of NH placement or to increased mortality neither in the univariable nor in multivariable analysis: In the fully adjusted models HR was 0.63 (95 % CI 0.38-1.05) and 1.28 (95 % CI 0.67-2.45), respectively.

CONCLUSIONS

When poor SRH was present we found no increased risk for NH placement or death among elderly people with mild AD. SRH is a widely used parameter in clinical and epidemiological research but may not be a valid indicator of health in patients with AD due to loss of insight.

Past Cigarette Smoking Is More Common among Those with Cholinergic Than Noncholinergic Dementias

Background. Patients with progressive dementing disorders associated with cortical cholinergic dysfunction gradually develop cholinergic deficits many years before symptom onset and may begin to smoke cigarettes during midlife as a form of self-medication. The aim of this study was to compare self-reported past smoking rates between those with and without cholinergic dementias, to determine if those who developed cholinergic dementias were more likely to smoke during midlife than those who did not. Methods. Retrospective cross-sectional study of past smoking status among patients treated at an outpatient clinic during a three-year period. Results. A total of 440 patients were evaluated during the study period, including 224 with cholinergic dementias and 216 with noncholinergic dementias and controls. Past smoking rates were greater among those with cholinergic dementias compared to those without cholinergic dementias (43.92% versus 26.96%, P = 0.012). Additionally, smokers with cholinergic dementias reported significantly greater mean pack-years of smoking (P = 0.038). Conclusions. Greater midlife smoking rates and greater pack-years of smoking were associated with cholinergic dementias. These results suggest midlife smoking may be an early indicator for those developing brain cholinergic deficits related to progressive dementing disorders and support initiating treatment prior to symptom onset in cholinergic dementias.

The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up

BACKGROUND

self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear.

METHODS

seven-hundred fifty-seven non-nursing home residents ≥65 years from general practices in Central Copenhagen were followed for 4 years (2002-2006). Patients gave information on SRH, cognition (SMC and MMSE), quality of life (EQ-5D) and socio-demographics. Information on comorbidities and permanent NH placement came from registries. The association between SRH (dichotomised into good versus poor) and SMC, and permanent NH placement was assessed using Cox proportional hazard regression adjusted for potential confounders.

RESULTS

NH placement totaled 6.5% at 4-year follow-up. Poor SRH increased NH placement [hazard ratio (HR) = 2.07, 95% CI: 1.11-3.87] adjusted for age, SMC, MMSE, sex and comorbidities. SRH was not associated with NH placement if accounting for additional health information; however, SMC was (HR = 2.47, 95% CI: 1.26-4.86). Increased placement was seen for patients with good SRH and SMC (HR = 6.64, 95% CI: 2.31-19.12), but not among patients with poor SRH and SMC (HR = 1.37, 95% CI: 0.59-3.20) when compared with the reference group (good SRH and without SMC).

CONCLUSIONS

both poor SRH and SMC were associated with permanent NH placement risk among elderly primary care patients. However, when SMC was present a reverse association was found for SRH: good SRH increased NH placement. Since SRH is integrated in widely used psychometric instruments, further research is needed to establish the mechanism and implications of this finding.

Housing tenure and older people

Housing tenure takes a variety of forms, the most common of which are rental and owner-occupation. Currently, in the United Kingdom (UK), approximately 70% of older people live in owner-occupier properties, with the majority of the remainder renting from a public or private landlord. Research has consistently shown higher levels of morbidity and mortality among renters compared with owner-occupiers. However, it is unclear whether this is due to tenure acting as a proxy for other indicators of socio-economic status, such as income, which directly influences health, or whether other characteristics associated with tenure, including housing quality and location, explain the association. Untangling these competing influences of tenure on health is important, as it may provide clues on tackling health inequalities at older ages. Tenure too, appears to be related to the risk of long-stay care admission, with owner-occupiers significantly less likely to leave their home than renters; more work is required to identify why this is the case, as it may provide some insights on facilitating ageing in place.

Utility weights for the vision-related Assessment of Quality of Life (AQoL)-7D instrument

PURPOSE

To obtain utility weights consistent with the needs of economic evaluation for the Assessment of Quality of Life (AQoL)-7D, a generic instrument created to increase the sensitivity of the measurement of quality of life amongst people with impaired vision.

METHODS

Two extant instruments were combined, the Vision-related Quality of Life Index (VisQoL) and the AQoL-6D. Utilities were obtained from patients with visual impairment and from the general population using time trade-off (TTO) methodology. Dimensions were combined and an econometric adjustment used to eliminate the effects of instrument redundancy. Bias was tested by comparison of holistic TTO values with utility scores predicted from the AQoL-7D scoring formula.

RESULTS

The AQoL-7D instrument consists of 26 items and 7 dimensions each with good psychometric properties. Their combination into a single instrument resulted in significant redundancy which was successfully eliminated. Utility formulae for both the public and patients produced bias-free estimates of the utility of holistic health states describing visual impairment. Results imply differing valuations of health states by the public and by people with impaired vision.

CONCLUSIONS

The AQoL-7D can detect changes in health states affecting people with impaired vision which are likely to be overlooked by other generic instruments due to content insensitivity. The utilities it produces are generated using a "mainstream" methodology, the TTO. Quality-adjusted life year values based on the AQoL-7D may therefore be used for economic evaluation of programs.

An economic evaluation of community and residential aged care falls prevention strategies in NSW

AIM

To evaluate the cost-effectiveness of strategies designed to prevent falls amongst people aged 65 years and over living in the community and in residential aged-care facilities.

METHODS

A systematic review and meta-analysis of the literature was conducted. The pooled fall rate ratio was used in a decision analytic model that combined a Markov model and decision tree to estimate the costs and outcomes of potential interventions and/or strategies. The resulting cost per quality-adjusted life year was estimated.

RESULTS

The most cost-effective falls prevention strategy in community-dwelling older people was Tai Chi. Expedited cataract surgery and psychotropic medication withdrawal were also found to be cost-effective; however, the effectiveness of these interventions is less certain due to small numbers of trials and participants. The most cost-effective falls prevention strategies in residential aged-care facilities were medication review and vitamin D supplementation.

Prediction of institutionalization in the elderly. A systematic review

OBJECTIVE

in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries.

DESIGN

relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined.

RESULTS

thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use.

CONCLUSIONS

findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.

Variation in care home admission across areas of Northern Ireland

BACKGROUND

much has been written about the demographic and health characteristics which act as risk factors for care home admission in the UK. However, few studies have examined variation in care home admission rates across areas, whilst controlling for the demographic and health characteristics of the individuals living within these areas. This is surprising given that decisions which affect admission are often taken at the local level. The aim of the study was to determine if there were variations in care home admission rates across trusts in Northern Ireland, once adjustment had been made for the demographic and health characteristics of the individuals residing within these areas.

METHODS

a retrospective cohort study was undertaken, using data from the Data Retrieval in General Practice (DRGP) project in Northern Ireland, to identify a cohort of individuals aged 65 and over and living in the community at the outset of the study. A total of 28,064 individuals were followed up for 5 years to identify those who subsequently entered a nursing or residential care home. Controlling for the demographic, household composition and health characteristics of individuals, Poisson regression was used to estimate the incidence rate ratios of care home admission for 10 trusts.

RESULTS

a total of 24,691 of the initial cohort had complete information for all variables and were included in the final analysis; 1,313 (5.3%) had entered a care home at the end of the 5 years of follow-up. Admission increased significantly with age, and diagnoses of dementia and stroke. Controlling for the age, sex and health composition of individuals, some variations in admission rates were found across trusts.

CONCLUSIONS

the study has highlighted the importance of age and clinical conditions as risk factors for care home admission. In addition, it appears that the area of residence might be important in determining a person's risk of care home admission. Such differences may be attributable to particular characteristics of the trust, such as the level of deprivation or degree of rurality, or to differing policies in relation to services for older people. More work is required to identify the causes of the differences to allow policies to be implemented to ensure equitable access to care homes across Northern Ireland.

Use of emergency departments by older people from residential care: a population based study

OBJECTIVE

to investigate the differences between emergency department (ED) presentations of older people who do and do not live in residential care facilities (RCFs).

DESIGN

a population-based retrospective cohort study. ED records linked to ambulance and hospital morbidity records.

SETTING

public EDs in Perth, Western Australia.

SUBJECTS

all patients 65 years and older who presented to EDs between 1 January 2003 and 31 December 2006 (n = 97,161).

MEASUREMENTS

patient demographic and clinical characteristics. Logistic regression was used to model the effect of living in RCFs on the likelihood of a particular ED diagnosis, hospital admission and in-hospital death.

RESULTS

the age-sex standardised rate of ED presentation for those living in RCFs was 1.69 times that of community dwellers. Compared to community dwellers, people from RCFs were older (mean age 84.7 years vs. 76.0 years, P < 0.001) and a lower proportion were male (28.7% vs. 46.7%, P < 0.001). Adjusting for age and sex revealed that people from RCFs were more likely to be diagnosed with pneumonia/influenza [odds ratio (OR) 1.94, 95% confidence interval (CI) = 1.72-2.19], urinary tract infections (OR 1.72, 95% CI 1.49-1.98) or hip fractures (OR 1.16, 95% CI 1.03-1.32); less likely to be diagnosed with circulatory system diseases (OR 0.69, 95% CI 0.64-0.75) or neoplasms (OR 0.47, 95% CI 0.31-0.72); more likely to be admitted (OR 1.13, 95% CI 1.06-1.20) and to die in hospital (OR 1.57, 95% CI 1.40-1.75).

CONCLUSION

there are different patterns of ED presentations and hospital admissions of older people who do and do not live in RCFs. The appropriateness of these differences is uncertain.

Health-related quality of life and visual and cognitive impairment among nursing-home residents

AIM

To examine whether the relationship between vision impairment and health-related quality of life (HRQoL) in nursing-home residents is impacted by coexisting cognitive impairment.

METHODS

This cross-sectional study involved a total of 382 English-speaking older adults (>55 years of age) with > or =13 on the Mini Mental State Exam (MMSE) from seventeen nursing homes in Birmingham, Alabama. Assessments were taken of visual acuity (Lighthouse Near Visual Acuity Test), cognition (MMSE) and health-related quality of life (Nursing Home Vision-Targeted Health-Related Quality of Life Questionnaire, VF-14, and the SF-36).

RESULTS

A greater portion of participants had both vision and cognitive impairments (38.5%) as compared with those with neither impairment (21.5%), vision impairment alone (13.4%), and cognitive impairment alone (26.7%). Cognitive impairment did not modify the impact of vision impairment on HRQoL. The reduction in HRQoL associated with vision impairment was similar for those with and without cognitive impairment.

CONCLUSION

The deleterious impact of vision impairment on HRQoL in nursing-home residents was not exacerbated by the co-occurrence of cognitive impairment. Ageing-related visual impairment in nursing-home residents is often reversible through treatment leading to improved HRQoL, and thus it is clinically important to know that cognitive impairment is unlikely to interfere with this benefit.

Vision and quality of life: development of methods for the VisQoL vision-related utility instrument

Purpose

To describe the methods and innovations used in constructing the VisQoL, a vision-related utility instrument for the health economic evaluation of eye care and rehabilitation programs.

Methods

The VisQoL disaggregates vision into six items. Utilities were estimated for item worst responses (the worst level for each item, with all other items at their best level) and VisQoL all-worst responses (all items at their worst level) using the time trade-off procedure. Time trade-off questions require people to imagine living a fixed number of years with a particular health condition and then indicate how many of those years of life they would be willing to trade to have perfect health. Where respondents indicated a health state was “worse than death” negative utilities were estimated. Time trade-off questions minimized the “focusing effect,” which occurs if respondents discount the fact that all other aspects of health are at their best when answering questions, by using pictorial and verbal aids.

Results

Item utilities were combined using a multiplicative model, and VisQoL model utilities placed on a scale where 0.00 and 1.00 represent full health and death, respectively. The VisQoL allows utilities to be calculated for a wide range of vision-related conditions.

Conclusion

The 6-item VisQoL has excellent psychometric properties and is specifically designed to be sensitive to vision-related quality of life. It is the first instrument to permit the rapid estimation of utility values for use in economic evaluations of vision-related programs.

Early identification of relocation risk in older adults with critical illness

One aspect of an evidence-based practice (EBP) guideline on managing relocation in cognitively intact older adults is elaborated upon in this article. The older population is at particular risk for needing to relocate to a new permanent home following hospitalization for a critical illness, but planning for these moves is often done in crisis mode. The purpose of this article is to sensitize nurses to risks for relocation in critically ill older persons and to encourage application of the EBP guideline in practice. Recommendations for risk assessment are made including using existing and supplementary assessment methods and data. Implementing EBP guidelines such as this is one key element in providing quality care to critically ill older adults.

Delaying dementia and nursing home placement: the Dubbo study of elderly Australians over a 14-year follow-up

In order to capture the "longevity dividend," modifiable risk factors for a diagnosis of dementia and nursing home placement were examined in a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. One thousand two-hundred thirty-three men and 1572 women 60 years and older living in the community were examined in 1988 and followed to 2002 for diagnosis of dementia and nursing home placement. There were 244 (8.7%) nursing home placements and 44% of these placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. The Cox proportional hazards model for nursing home placement, showed placement increased significantly with age, urinary incontinence, impaired peak expiratory flow, physical disability, and depression. The hazard of placement was significantly reduced by alcohol intake and female gender. Socioeconomic factors were not significant. Similar risk factors for dementia and nursing home placement indicate that the continuation of moderate alcohol intake, the maintenance of physical activity, especially daily gardening, and improvement of respiratory function, and the treatment of depression are recommended targets for interventions to delay or prevent major negative late-life experiences.

Do social networks affect the use of residential aged care among older Australians?

Background

Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants) and total social networks upon use of low-level residential care and nursing homes.

Methods

Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks.

Results

Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75). Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90). Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use.

Discussion

Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.

Changes in visual acuity in a population over a 15-year period: the Beaver Dam Eye Study

PURPOSE

To describe the change in visual acuity in a 15-year period.

DESIGN

Population-based study.

METHODS

setting: Beaver Dam, Wisconsin. participants: 4068 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, and with follow-up examinations every five years thereafter. observation procedures: Best-corrected visual acuity after refraction, assessed by a modification of the ETDRS protocol. main outcome measure: Doubling of the visual angle; incidence of visual impairment.

RESULTS

Eight percent of the population developed impaired vision (20/40 or worse), 0.8% developed severe visual impairment (20/200 or worse), 7% had doubling of the visual angle, and 2% had improved vision. People 75 years of age or older at baseline were more likely to develop impaired vision (odds ratio [OR] 12.8, 95% confidence interval [CI] 9.6 to 17.1, P < .001), doubling of the visual angle (OR 7.8, 95% CI 5.6 to 10.7, P < .001), and severe visual impairment (OR 20.6, 95% CI 9.5 to 44.8, P<0.001) compared with people younger than 75 years of age.

CONCLUSIONS

These data provide population-based estimates of the cumulative 15-year incidence of loss of vision over a wide spectrum of ages. In people 75 years of age or older the cumulative incidence of visual impairment accounting for the competing risk of death is 25%, of which 4% is severe, indicating a public health problem of considerable proportions as the US population in this age is expected to increase by 55% from 18 million in the year 2005 to 28 million by the year 2025.

Driving status and risk of entry into long-term care in older adults

OBJECTIVES

Given the importance of driving in American society, older non-drivers may be unable to meet basic needs while living independently. We assessed whether not driving is an independent risk factor for entering long-term care (LTC) institutions.

METHODS

Data were used from 1593 older adults who participated in the Salisbury Eye Evaluation cohort study and completed an additional telephone survey. Questions on driving status and LTC entry were obtained by self/proxy report. Cox time-dependent regression procedures were used to adjust for demographic and health factors.

RESULTS

Former and never drivers had higher hazards of LTC entry after adjustment for demographic and health variables (hazard ratio [HR]=4.85; 95% confidence interval [CI]=3.26, 7.21; and HR=3.53; 95% CI=1.89, 6.58, respectively). Also, having no other drivers in the house was an independent risk factor for LTC entry (HR=1.72; 95% CI=1.15, 2.57).Discussion. Older adults are expected to make good decisions about when to stop driving, but the hardships imposed on older adults by not driving are not widely recognized. Innovative strategies to improve transportation options for older adults should be considered.

End-of-life in a Swedish population: demographics, social conditions and characteristics of places of death

The objectives of this study were to identify and describe the demographics and social conditions as well as characteristics of the places of death in a randomly selected sample that died in a county in Sweden during 2001. The present study reports part of the findings from a larger study undertaken during 2003 using a survey design of retrospective reviews of death certificates, medical records, and nursing records. Among several noteworthy findings are: first, an examination of these individuals' living arrangements reveal not only a large and vulnerable group that lives alone at the end-of-life but also a group living separated from their partners near end-of-life; second, individuals differ with respect to residence prior to death, that is private homes versus residential care facilities, imparting highly different contexts of care at the end-of-life; and third, a high prevalence of institutionalized deaths demonstrates that places of death other than hospitals and residential care facilities are uncommon, if not rare. It is concluded that increased attention to the social circumstances of the time period surrounding individuals' at the end-of-life is essential. There is need to develop more integrated models of care for dying people. Contemporary services available are not designed to meet a wide range of peoples' needs at the end-of-life. Home-based care, residential care and hospital care must be adapted to the changing patterns of dying. The services available should be organized to the benefit of the users rather than around the providers. This is the first study of its kind of a Swedish sample and while the data are limited to one county in Sweden its findings may contribute to a deeper understanding of demographic and social patterns at the end-of-life in general.

The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations

The aim of this study was to determine the effect of frailty on the risk of residential/nursing home admission independently of chronic diseases and functional limitations. Frailty consists of multisystem decline and is considered to be a consequence of changes in neuromuscular, endocrine and immune system functioning that occur as people age. Frailty is a combination of multiple impairments in functioning that might lead to functional limitations and disability but it is not clear whether frailty has an independent effect on residential/nursing home admission. Data were used from the Longitudinal Aging Study Amsterdam. The respondents participated at both T₁ (1992/1993) and T₂ (1995/1996), lived independently at T₂, and were aged 65 and over (n=1,503). Nine frailty markers were assessed at two cycles (T₁ and T₂). The frailty markers were defined in two ways: low functioning at T₂ (static frailty); and change in functioning between T₁ and T₂ (dynamic frailty). The outcome variable was residential/nursing home admission between T₂ and T₄ (2001/2002). Cox proportional hazard analyses were used adjusting for chronic diseases, functional limitations, care received, partner status, income, age and sex. Static (RR 1.93, 95%CI 1.36-2.74) and dynamic frailty (RR 1.69, 95%CI 1.19-2.39) were associated with institutionalization in both men and women independently of the effect of chronic diseases and functional limitations. Additional analyses of the total number of both sets of frailty markers present revealed an increased risk of institutionalization when the number increased. In conclusion, frailty is associated with institutionalization, independently of the effect of chronic diseases and functional limitations.

Incidence of open-angle glaucoma in a general elderly population: the Rotterdam Study

PURPOSE

To determine the incidence of open-angle glaucoma (OAG) in a general elderly white population.

DESIGN

Population-based cohort study.

PARTICIPANTS

Participants 55 years and older from the Rotterdam Study, The Netherlands.

METHODS

Participants at risk for incident OAG underwent at baseline (1990-1993) and follow-up (1997-1999) the same ophthalmic examination, including measurement of intraocular pressure, visual field testing, and stereo optic disc photography. The diagnosis of probable or definite OAG was made with an algorithm based on optic disc parameters and on visual field testing, independent of the intraocular pressure.

MAIN OUTCOME MEASURES

Five-year risk and incidence rates of OAG.

RESULTS

In total, 3842 participants were examined (participation rate at follow-up, 78%). After a mean follow-up time of 6.5 years, probable (n = 58) or definite OAG (n = 29) developed in 87 persons. The 5-year risk of probable OAG was 1.2% and that of definite OAG 0.6%, and the rate rose for both together from 1% at age 60 years to approximately 3% at age 80 years. Bilateral OAG occurred 5 times more often after than before age 75 years. In participants with prevalent OAG in 1 eye, the 5-year risk of OAG in the fellow eye was 5 times higher than in fellow eyes of non-OAG eyes. Only 37% of the incident cases received treatment for OAG at the time of the reexamination.

CONCLUSIONS

The incidence of OAG rose significantly with age. Most of the patients with incident OAG were unaware of having OAG.