Inhome Service Use by Caregivers and Their Elders: Does Cognitive Status Make a Difference?

2002 ◽  
Vol 21 (2) ◽  
pp. 257-271 ◽  
Author(s):  
Pamela Hawranik
Keyword(s):  
Cognitive Impairment ◽  
Functional Status ◽  
Service Use ◽  
Living Arrangement ◽  
Cognitive Status ◽  
Personal Care ◽  
Care Services ◽  
Significant Factors

ABSTRACTThe intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

scholarly journals Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Constanca Paul ◽  
Susana Sousa ◽  
Pedro Santos ◽  
Rónán O’Caoimh ◽  
William Molloy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Community Sample ◽  
Neurocognitive Disorders ◽  
Cognitive Status ◽  
Health Concerns ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Concerns

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

The Use and Cost of Community Care Services by Elders with Unimpaired Cognitive Function, with Cognitive Impairment/No Dementia and with Dementia

1997 ◽  
Vol 16 (4) ◽  
pp. 665-681 ◽  
Author(s):  
Evelyn Shapiro ◽  
Robert B. Tate
Keyword(s):  
Cognitive Impairment ◽  
Daily Living ◽  
Community Care ◽  
Independent Predictor ◽  
Living Arrangement ◽  
The Elderly ◽  
Mental Functioning ◽  
Care Services ◽  
Diagnosis Of Dementia ◽  
Cognitive Impairment No Dementia

ABSTRACTData from the Manitoba Study of Health and Aging were used to compare the utilization and direct costs of formal community care services among the elderly diagnosed as persons with no cognitive impairment, with cognitive impairment/no dementia and with dementia. The results of the analyses indicate that, in addition to living arrangement and limitation on basic and instrumental activities of daily living, mental function diagnosis is an independent predictor of community care use. A diagnosis of dementia increases the likelihood of community care use over those with unimpaired mental functioning, whereas cognitive impairment without dementia does not. The three diagnostic groups differ in the type of services used. Standardization by age, sex and the other variables which significantly affect the need for community care can help a program improve its ability to project realistic cost estimates.

scholarly journals Telemedicine assessment of long-term cognitive and functional status in anti-leucine-rich, glioma-inactivated 1 encephalitis

2019 ◽  
Vol 7 (2) ◽  
pp. e652 ◽  
Author(s):  
Nuria Sola-Valls ◽  
Helena Ariño ◽  
Domingo Escudero ◽  
Elisabeth Solana ◽  
Albert Lladó ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Functional Status ◽  
Verbal Memory ◽  
Cognitive Reserve ◽  
Disease Onset ◽  
Cognitive Status ◽  
Functional Activities ◽  
Telephone Interviews ◽  
Status Assessment

ObjectiveTo assess the feasibility of a structured telephone interview examining the long-term cognitive and functional status in anti–leucine-rich, glioma-inactivated 1 (LGI1) encephalitis.MethodsTelephone interviews were conducted with 37 patients after a median follow-up of 87 months from disease onset and 23 healthy controls matched for age and sex. Cognitive status was assessed with the telephone Mini-Mental State Examination (t-MMSE) and 3 tests exploring verbal memory, fluency, and executive function. Functional status was evaluated with the Functional Activities Questionnaire and the modified Rankin Scale (mRS). Patients were classified as normal, with mild cognitive impairment (MCI), or with dementia based on cognitive and functional status. Assessment of the cognitive reserve was performed with a structured questionnaire. Logistic regression analysis was applied to identify predictors of cognitive impairment.ResultsTelephone interviews were successful in 36/37 (97%) patients. Cognitive impairment was detected in 27 (75%) including 17 with MCI and 10 with dementia. Eight (29%) patients would have been misclassified using only the t-MMSE. Twenty-six (72%) patients were functionally independent according to the mRS, but only 9 (35%) were cognitively normal. Independent predictors for long-term cognitive impairment were a low cognitive reserve (OR = 1.36, 95% CI: 1.05–1.76; p = 0.02) and bilateral hippocampal hyperintensity at initial MRI (OR = 27.03, 95% CI: 1.87–390; p = 0.02).ConclusionsTelemedicine is a feasible tool to assess the cognitive and functional outcome in patients with anti-LGI1 encephalitis. Cognitive impairment is often missed if only functional scales are used. Premorbid cognitive reserve and MRI with bilateral hippocampal hyperintensity were predictors for long-term cognitive impairment.

scholarly journals Examining Satisfaction With Assisted Living Among Residents With and Without Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 382-383
Author(s):  
Sarah Holmes ◽  
Elizabeth Galik ◽  
Barbara Resnick
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Assisted Living ◽  
Physical Environment ◽  
Health Care Services ◽  
Cognitive Status ◽  
Dissemination And Implementation ◽  
Social Activities ◽  
Care Services ◽  
The Impact

Abstract Understanding residents’ satisfaction with assisted living (AL) is essential for creating supportive environments that are focused on residents’ needs and preferences. Nearly half of AL residents experience some level of cognitive impairment, although limited research has examined residents’ satisfaction with AL particularly among those with cognitive impairment. The purpose of this study was to compare satisfaction with AL between residents with and without dementia. Baseline data from the Dissemination and Implementation of Function Focused Care in AL study was used in this analysis. A total of 481 AL residents were included in the sample. Measures included demographic information, Saint Louis University Mental Status Exam (SLUMS), and the Resident Satisfaction Index. Controlling for age, gender, and comorbidities, multivariate analyses of variance was performed to consider the impact of cognitive status on residents’ satisfaction with health care services, physical environment, relationships with staff, and social activities. The majority of participants were female (71%), White (97%), mean age was 89 years old (SD=7.43), and mean SLUMS score was 15.90 (SD=4.74). On average, residents were highly satisfied with AL reporting a mean score of 19.17 (SD=3.15). There were no significant differences in residents’ satisfaction scores (p>.05) between residents with dementia and without dementia across all subdomains of satisfaction: health care services, physical environment, relationships with staff, and social activities. There may have been some bias in results due to social desirability. Further research should explore additional aspects of residents’ satisfaction with staff such as whether or not person-centered care is provided.

scholarly journals P072: Using the Bergman-Paris Question to detect ED seniors’ cognitive impairment and functional status

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S102-S102
Author(s):  
A. Laguë ◽  
M. Émond ◽  
V. Boucher ◽  
R. Daoust ◽  
M. Pelletier ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Functional Status ◽  
Negative Answer ◽  
Cognitive Status ◽  
Screening Tests ◽  
Negative Group ◽  
Older Americans ◽  
Positive Group ◽  
Memory Clinics ◽  
Geriatric Screening

Introduction: Mild Cognitive Impairment (MCI) remains frequently undiagnosed and Emergency Department (ED) guidelines suggest screening for CI. The Bergman-Paris Question (BPQ) which is currently used in memory clinics, is a one-question screening test administered to the patient’s relative; a negative answer suggests presence of CI. We sought to validate if the BPQ would be associated with MCI and functional status in ED elders. Methods: A planned sub-study of the prospective MIDI-INDEED study on ED-induced delirium, which included patients from 4 Canadian EDs was realized. Inclusion criteria were: patients ≥65 y.o., with and ED stay ≥8 hours, admitted to the hospital, non-delirious at the end of the first 8 hours and independent or semi-independent. Eligible patients were assessed in ED and at 60 days after ED visit using validated screening tests: the Telephone Interview for Cognitive Status-modified (TICS-m) for CI and the Older Americans Resources and Services scale (OARS) for functional status. The BPQ was asked at any time depending on the availability of a relative. Patients with a TICS-m score <31 are considered to have MCI. Data from patients with incident delirium, and those with documented dementia was individually analyzed. Univariate and multivariate analyses were used to ascertain outcomes. Results: 167 patients had a BPQ response, 126 (75.5%) were negative, and 41 positive (24.5%). For MCI, 40 (32.8%) patients of the negative group have a TICS-m below 31 comparatively to 6 (14.3%) for the positive group (p=0.2). The BPQ was significantly associated with functional status. The mean OARS scores were 25.1 (3.9) in the negative group and 27.1 (1.3) in the positive group. This difference was maintained at 60 days. The number of delirium in the negative group was 24 (18%) vs 2 (5%) in the positive group (p=0.04). Conclusion: BPQ could provide detection of MCI but further validation in a larger population is needed. BPQ was interestingly associated with ED-induced delirium and dementia. Detection of functional status and frailty shows good results. More research is needed to evaluate the usefulness of the BPQ “single” question for geriatric screening by ED professionals.

scholarly journals Cognitive Impairment Is Not a Predictor of Failure to Adhere to Anticoagulation of Stroke Patients with Atrial Fibrillation

2015 ◽  
Vol 39 (5-6) ◽  
pp. 325-331 ◽  
Author(s):  
Solveig Horstmann ◽  
Timolaos Rizos ◽  
Michaela Saribas ◽  
Evdokia Efthymiou ◽  
Geraldine Rauch ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Functional Status ◽  
Cognitive Performance ◽  
Functional Disability ◽  
Cognitive Status ◽  
Stroke Severity ◽  
Detailed Medical History

Background: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) is an effective strategy that is used for stroke prevention in patients with atrial fibrillation (AF). However, OAC is underused particularly in elderly patients, who are often physically disabled or cognitively impaired. We aimed at evaluating the effect of cognitive status and disability on OAC adherence 1 year after stroke or TIA. Methods: In this prospective, single-center, observational study patients with ischemic stroke or TIA were consecutively included between 3/2011 and 9/2012. The detailed medical history, basic demographic variables, cardiovascular risk factors, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), medication including OAC were all recorded. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional status was assessed by recording activities and instrumental activities of daily living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit to reassess the cognitive and functional status (MoCA, ADL and IADL) and to document the current use of OAC. Results: In total, 12 months after the ischemic stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not associated with the absence of OAC treatment. However, regression analysis revealed that patients with AF with physical (ADL) and functional disability (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, respectively) 12 months after a stroke. None of these two factors, however, was independently associated with nonadherence to OAC 12 months after stroke. Although cognitive performance was similar in patients receiving VKA and direct anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 0.12). Conclusions: In stroke and TIA patients with AF, the multifactorial medical and functional constellation rather than cognitive impairment specifically can be an obstacle for long-term OAC.

Caregiving Networks in Later Life: Does Cognitive Status Make a Difference?

2003 ◽  
Vol 22 (3) ◽  
pp. 261-273 ◽  
Author(s):  
Laurel A. Strain ◽  
Audrey A. Blandford
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Later Life ◽  
Cognitive Status ◽  
Future Research ◽  
Personal Care ◽  
Cognitively Intact ◽  
To Receive

ABSTRACTThis study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Coresidence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole.

scholarly journals Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention

2021 ◽  
pp. 1-9
Author(s):  
Anoop Sheshadri ◽  
Piyawan Kittiskulnam ◽  
Cynthia Delgado ◽  
Rebecca L. Sudore ◽  
Jennifer C. Lai ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Physical Performance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Cognitive Status ◽  
Dialysis Patients ◽  
Exercise Interventions ◽  
And Performance

<b><i>Introduction:</i></b> A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. <b><i>Methods:</i></b> Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26–32: ambiguous impairment, 21–25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. <b><i>Results:</i></b> One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: −620 [95% CI −174, −1,415], MCI: −1,653 [95% CI −120, −3,187]); less improvement in SPPB (ambiguous: −0.22 points [95% CI −0.08, −0.44], MCI: −0.45 [95% CI −0.13, −0.77]); and less improvement in PF (ambiguous: −4.0 points [95% CI −12.2, 4.1], MCI: −14.0 [95% CI −24.9, −3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: −0.54 [95% CI −1.27, 0.19], MCI: −0.97 [95% CI −0.37, −1.58]) and PF (ambiguous: −3.3 [95% CI −6.5, −0.04], MCI: −10.5 [95% CI −18.7, −2.3]). <b><i>Discussion/Conclusion:</i></b> Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.

scholarly journals Frequency of But Not Capacity for Participation in Everyday Activities Is Associated With Cognitive Impairment in Late Life

2021 ◽  
pp. 073346482098428
Author(s):  
Chao-Yi Wu ◽  
Juleen Rodakowski ◽  
Lauren Terhorst ◽  
Mary Amanda Dew ◽  
Meryl Butters ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Late Life ◽  
Cognitive Status ◽  
Computerized Adaptive Test ◽  
Time Points ◽  
Everyday Activities ◽  
Neuropsychological Status ◽  
Activity Frequency ◽  
Test Version ◽  
Life Function

We examined features of everyday activities (capacity and frequency) between older adults with and without cognitive impairment over 12 months. Participants aged ≥60 years and at risk for depression were included (n = 260); 26% ( n = 69) had an acquired cognitive impairment at baseline. Cognitive impairment was defined as one standard deviation below norms on the Repeatable Battery for the Assessment of Neuropsychological Status. Features of everyday activities were measured by a computerized adaptive test version of Late-Life Function and Disability Instrument (LLFDI) at six time points (baseline, 6 weeks, 3, 6, 9, 12 months). There were significant between-group differences in activity frequency ( p = .04), but not activity capacity ( p = .05). The group difference in activity frequency exceeded minimal detectable changes (MDC90 = 3.7) and reached moderate clinical meaningfulness (∆ at six time points = 3.7–4.7). Generalized linear mixed models revealed no Group × Time interactions on activity capacity and frequency ( p = .65 and p = .98). Practitioners may assess changes in activity frequency to monitor cognitive status of clients even when there is no loss of activity capacity.

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