Multiple chronic conditions and risk of cognitive impairment and dementia among older Americans: findings from the Aging, Demographics, and Memory Study (ADAMS)

2020 ◽  
pp. 1-15
Author(s):  
Yura Lee ◽  
Youngjoo Cho ◽  
Hyunkyoung Oh
Keyword(s):  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Older Americans

scholarly journals Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

2021 ◽  
Vol 10 (10) ◽  
pp. 2112
Author(s):  
Tullika Garg ◽  
Courtney A. Polenick ◽  
Nancy Schoenborn ◽  
Jane Jih ◽  
Alexandra Hajduk ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Clinical Care ◽  
Intervention Development ◽  
Healthcare Services ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Older Americans ◽  
Innovative Strategies ◽  
Department Of Health ◽  
Innovative Methods

Multiple chronic conditions (MCC) are one of today’s most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

scholarly journals Association between patterns of multiple chronic conditions and cognitive impairment in community‐dwelling older adults in Taiwan

2021 ◽  
Vol 17 (S10) ◽  
Author(s):  
Pei‐Iun Hsieh ◽  
Yen‐Ching Chen ◽  
Jeng‐Min Chiou ◽  
Ta‐Fu Chen ◽  
Su‐Ling Yeh ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Community Dwelling Older Adults

Future hypertension guidelines for older americans with multiple chronic conditions

2016 ◽  
Vol 10 (4) ◽  
pp. e44 ◽  
Author(s):  
Brent M. Egan ◽  
Susan E. Sutherland ◽  
C. Shaun Wagner ◽  
Douglas O. Fleming ◽  
Robert A. Davis ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Older Americans ◽  
Hypertension Guidelines

scholarly journals Birth Cohort Differences in Multimorbidity Burden Among Aging U.S. Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 257-257
Author(s):  
Nicholas Bishop ◽  
Steven Haas ◽  
Ana Quiñones
Keyword(s):  
Cognitive Impairment ◽  
Birth Cohort ◽  
Repeated Measures ◽  
Chronic Conditions ◽  
Linear Models ◽  
Birth Cohorts ◽  
Older Americans ◽  
Cohort Differences ◽  
Increased Risk ◽  
The Us

Abstract Multimorbidity is the co-occurrence of two or more chronic health conditions and affects more than half of the US population aged 65 and older. Recent trends suggest increased risk of poor self-reported health, physical disability, cognitive impairment, and mortality among later born birth cohorts, yet we are unaware of work examining cohort trends in multimorbidity among aging US adults. Observations were drawn from the Health and Retirement Study (2000–2018) and included adults aged 51 and older across 7 birth cohorts (1923 and earlier, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, and 1960–1965). Multimorbidity was measured as a count of 9 chronic conditions including heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer (excluding skin cancer), depression, and cognitive impairment. General linear models adjusting for repeated measures and covariates including age, sex, race/ethnicity, and education were used to identify whether trends in multimorbidity varied across birth cohort. 31,923 adults contributed 153,940 total observations, grand mean age was 68.0 (SD=10.09), and mean multimorbidity was 2.19 (SD=1.49). In analyses adjusted for age and other covariates, adults born 1948–1953 reported .34 more chronic conditions (SE=.03, p<.001), adults born 1954–1959 reported .42 more chronic conditions (SE=.03, p<.001), and adults born 1960–1965 reported .55 more chronic conditions (SE=.03, p<.001), than those born 1931–1941, respectively. Our preliminary results confirm increasing multimorbidity among later birth cohorts of older Americans and should help guide policy to manage impending health declines among older Americans.

scholarly journals MULTIPLE CHRONIC CONDITIONS AND RISK OF DEMENTIA AND COGNITIVE IMPAIRMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S316-S316 ◽  
Author(s):  
Yura Lee ◽  
Youngjoo Cho ◽  
Hyunkyoung Oh
Keyword(s):  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Longitudinal Design ◽  
Multinomial Logistic Regression ◽  
Cognitive Activity ◽  
Multiple Chronic Conditions ◽  
Multiple Chronic Condition ◽  
Increased Risk ◽  
The Relationship

Abstract This study explores the relationship between the presence of multiple chronic condition and risk of dementia and cognitive impairment with no dementia (CIND) among older Americans. The study sample included 617 participants aged 70 years and older from the Aging, Demographics, and Memory Study (ADAMS). An expert consensus panel of the ADAMS data provided each participant a cognitive diagnosis into 1) no cognitive impairment, 2) CIND, or 3) dementia. The presence of multiple chronic condition was defined as having three or more chronic conditions in this study (e.g., heart attack, stroke, respiratory problems, cancer, hypertension, diabetes). Functional limitation, depression, cognitive activity engagement, apolipoprotein E (ApoE), and sociodemographic characteristics were included as covariates. A multinomial logistic regression analysis showed that individuals who have multiple chronic conditions have increased odds of being diagnosed with CIND versus no cognitive impairment controlling for other covariates. However, multiple chronic condition was not associated with increased risk of being diagnosed with dementia versus no cognitive impairment. Conclusion: The finding suggests that the presence of multiple chronic conditions may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the relationship between cognition and multiple chronic conditions.

scholarly journals The Combined Burden of Hearing Loss and Cognitive Impairment in a Group Care Setting for Older Adults

2021 ◽  
Vol 64 (2) ◽  
pp. 328-336 ◽  
Author(s):  
Sara K. Mamo ◽  
Kara A. Wheeler
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Care Setting ◽  
Group Care ◽  
Multiple Chronic Conditions ◽  
Convenience Sample ◽  
Dual Burden ◽  
The Impact

Purpose The purpose of the current study is to better characterize the medical and social health characteristics of older adults in a long-term group care setting and consider the impact of the dual burden of hearing loss and cognitive impairment. Method This descriptive analysis of a convenience sample of 160 adults ( M age = 74 years, age range: 59.8–99.7) participating in Program for All-inclusive Care for the Elderly programs in Massachusetts and Rhode Island included data from hearing testing, questionnaires, and medical chart review. Using descriptive statistics, groups are compared across a range of demographic and health variables on the categorical bases of hearing loss and cognitive status. Results Results suggest that hearing loss and cognitive impairment are highly prevalent among this sample of older adults. Forty-three percent of this sample has at least a mild hearing loss in the better hearing ear in addition to cognitive impairment. Descriptive analyses across demographic and health variables suggest there are few differences between those with and without cognitive impairment when compared within degree of hearing loss categories in this convenience sample. Across all participants, there was a high prevalence of other chronic conditions, most notably diabetes (59%), hypertension (90%), cardiovascular disease (80%), and depression (67%). Conclusions In this sample, there were not significant differences on demographic and health variables between the cognitive impairment groups when considered within their degree of hearing loss; however, the prevalence of the dual burden of hearing loss and cognitive impairment in this sample is high. Clinicians serving older adults, especially those accessing group care services, should be cognizant of the high burden of multiple chronic conditions and plan care that can be integrated into a comprehensive approach.

scholarly journals Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 754-755
Author(s):  
Rachel O'Conor ◽  
Julia Yoshino Benavente ◽  
Mogan Eifler ◽  
Lauren Opsasnick ◽  
Laura Curtis ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Health Literacy ◽  
Cognitive Aging ◽  
Chronic Conditions ◽  
Clinical Care ◽  
Medication Management ◽  
Patient Activation ◽  
Community Dwelling ◽  
Multiple Chronic Conditions

Abstract Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.

scholarly journals Intervention Design With Cognitively Impaired Populations: The Optimize Deprescribing Intervention

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 403-403
Author(s):  
Orla Sheehan ◽  
Elizabeth Bayliss ◽  
Ariel Green ◽  
Melanie Drace ◽  
Jonathan Norton ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Multiple Chronic Conditions ◽  
Cognitively Impaired ◽  
Potentially Inappropriate Medications ◽  
Intervention Delivery ◽  
Time Required ◽  
Inappropriate Medications

Abstract Older adults with cognitive impairment and multiple other chronic conditions often have polypharmacy which increases their risks of medication related cognitive effects, adverse drug events, hospitalization and death and leads to higher health care costs. Deprescribing, the process of reducing or stopping potentially inappropriate medications may improve outcomes for those older adults with cognitive impairment and multiple chronic conditions. The OPTIMIZE trial examined whether a primary care-based, patient- and family-centered intervention educating and activating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and potentially inappropriate medications for older adults with dementia or mild cognitive impairment and multiple chronic conditions. We explored the mechanisms of intervention effectiveness through post hoc qualitative stakeholder interviews and surveys with 15 patients, 7 family caregivers, and 28 clinicians. All stakeholder groups endorsed the acceptability of the intervention. Success of the intervention was affected by contextual factors including prior knowledge and openness to deprescribing, cognition and prognosis. Positive outcomes included patients and care partners scheduling specific appointments to discuss deprescribing and providers remembering to consider deprescribing in cognitively impaired older adults. Recollection of intervention materials was inconsistent over time but highest shortly after intervention delivery. The time required to mail intervention materials to patients prior to a scheduled appointment limited the reach of the intervention by excluding persons with rapidly scheduled appointments. Our work identifies key learnings in intervention roll out which can guide future translation of our intervention to other settings and other pragmatic intervention studies in this vulnerable population.

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