scholarly journals Unmet Caregiving Needs Are Associated With Cognitive Functioning Among Older Sepsis Survivors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 255-255
Author(s):  
Jo-Ana Chase ◽  
Lizyeka Jordan ◽  
Christina Whitehouse ◽  
Kathryn Bowles
Keyword(s):  
Cognitive Functioning ◽  
Unmet Need ◽  
Caregiver Training ◽  
Cognitively Impaired ◽  
Medicare Beneficiaries ◽  
Care Needs ◽  
Information Set ◽  
Sepsis Survivors ◽  
The Relationship ◽  
Care Outcome

Abstract Sepsis survivorship is associated with cognitive decline and complex post-acute care needs. Family caregivers may be unprepared to manage these needs, resulting in decline or no improvement in patient outcomes. Using a national dataset of Medicare beneficiaries who were discharged from the hospital for sepsis and received post-acute HHC between 2013 and 2014 (n=165,228), we examined the relationship between unmet caregiving needs and improvement or decline in cognitive functioning. Multivariate logistic regression was used to determine associations between unmet caregiving needs at the start of HHC and changes in cognitive functioning. Unmet caregiving needs included seven items from the start of care Outcome and Assessment Information Set (OASIS). Changes in cognitive functioning were measured using the start of care and discharge OASIS assessments. Twenty-four percent of patients either declined or did not improve in cognitive functioning from HHC admission to discharge, with variation seen by unmet need type. Sepsis survivors with unmet caregiving needs for activities of daily living assistance (OR 1.05, 95% CI 1.01, 1.09), medication assistance (OR 1.06, 95% CI 1.02,1.10), and supervision and safety assistance (OR 1.110, 95% CI 1.06,1.16) were more likely to decline or not improve in cognitive functioning, even after accounting for clinical and demographic characteristics. Older sepsis survivors with both cognitive impairment and unmet caregiving needs in the post-acute HHC setting are at high-risk for worsening cognition. Alerting the care team of cognitively impaired sepsis survivors with unmet caregiving needs may trigger evidence-based strategies to enhance caregiver training and reduce unmet caregiving needs.

scholarly journals Content of Home-Based Dementia Care: Adverse Consequences of Unmet Toileting Needs

2020 ◽  
pp. 073346482095299
Author(s):  
Jennifer M. Reckrey ◽  
Evan Bollens-Lund ◽  
Katherine A. Ornstein
Keyword(s):  
High Intensity ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Multivariable Model ◽  
Care Needs ◽  
Content Of Care ◽  
Home Based ◽  
Key Variables ◽  
The Relationship ◽  
Reduced Risk

Despite high-intensity caregiving support, those with dementia may experience adverse consequences because the care they receive does not match their care needs. This study evaluates the relationship between content of care (i.e., specific assistance with toileting) and adverse consequences (i.e., toileting accidents because no one was there to help) in a population of community-dwelling Medicare beneficiaries with dementia and impairment in toileting enrolled in the National Health and Aging Trends Study (NHATS). Only two thirds of individuals received specific assistance with toileting, which was associated with a reduced risk of adverse consequences related to toileting in a multivariable model adjusted for key variables including high-intensity caregiving (odds ratio [OR] = 0.36, 95% confidence interval [CI] = [0.23, 0.58]). To ensure care meets the needs of those with dementia living in the community, it is important to consider not only the quantity but also the content of care received.

scholarly journals Patient Cognitive Impairment Associated With Greater Care Intensity During Medicare Home Health Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 188-188
Author(s):  
Julia Burgdorf ◽  
Kathy Bowles
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Home Health Care ◽  
Home Health ◽  
Cognitively Impaired ◽  
Medicare Beneficiaries ◽  
Assessment Data ◽  
Care Needs ◽  
Nationally Representative ◽  
Health Payment

Abstract Medicare beneficiaries with cognitive impairment are more likely to access home health care than those without such impairment, and an estimated 1 in 3 Medicare home health patients has diagnosed dementia. However, recent changes to the Medicare home health payment system do not adjust for patients’ cognitive impairment. To the extent that cognitive impairment prompts higher intensity care, this could create a financial disincentive for providers serving this patient population. We draw on a nationally representative sample of 1,214 (weighted n=5,856,333) community-living Medicare beneficiaries who received home health care between 2011-2016. We measure care intensity by the number and type of visits received during an index home health care episode. We model care intensity as a function of patient cognitive impairment during the episode, measured via clinician reports in standardized patient assessment data. In propensity score adjusted, multivariable models holding all covariates at their means, home health patients with identified cognitive impairment received a significantly greater number of visits. During the index home health episode, cognitively impaired patients received an additional 2.82 total visits (95% CI: 1.32-4.31; p<0.001), 1.39 nursing visits (95% CI: 0.49-2.29; p=0.003), 0.72 physical therapy visits (95% CI: 0.06-1.39; p=0.03), and 0.60 occupational therapy visits (95% CI: 0.15-1.05; p=0.01). Findings suggest that recent changes to Medicare home health care reimbursement do not reflect the more intensive care needs of patients with cognitive impairment, and may threaten access to care for these individuals.

Cognitive Factors Mediate the Relation Between Age and Flight Path Maintenance in General Aviation

2016 ◽  
Vol 6 (2) ◽  
pp. 81-90 ◽  
Author(s):  
Kathleen Van Benthem ◽  
Chris M. Herdman
Keyword(s):  
Cognitive Functioning ◽  
Flight Path ◽  
General Aviation ◽  
Cognitive Factors ◽  
Pilot Performance ◽  
Pilot Error ◽  
Age Related ◽  
And Performance ◽  
Relationship Of ◽  
The Relationship

Abstract. Identifying pilot attributes associated with risk is important, especially in general aviation where pilot error is implicated in most accidents. This research examined the relationship of pilot age, expertise, and cognitive functioning to deviations from an ideal circuit trajectory. In all, 54 pilots, of varying age, flew a Cessna 172 simulator. Cognitive measures were obtained using the CogScreen-AE ( Kay, 1995 ). Older age and lower levels of expertise and cognitive functioning were associated with significantly greater flight path deviations. The relationship between age and performance was fully mediated by a cluster of cognitive factors: speed and working memory, visual attention, and cognitive flexibility. These findings add to the literature showing that age-related changes in cognition may impact pilot performance.

The Relationship between Cognitive Functioning and Adjudicative Competence

2012 ◽  
Author(s):  
Beth Caillouet ◽  
Jesse Brand ◽  
Bernice Marcopulos ◽  
Julie-Ann Kent
Keyword(s):  
Cognitive Functioning ◽  
Adjudicative Competence ◽  
The Relationship

Prehospital Emergency Provider’s Knowledge of and Comfort With Pediatric and Special Needs Cases: A Cross-Sectional Study in Los Angeles County

2021 ◽  
pp. 016327872110039
Author(s):  
Christopher J. Rogers ◽  
Marianne Gausche-Hill ◽  
Laurie Lee Brown ◽  
Rita V. Burke
Keyword(s):  
Health Care ◽  
Los Angeles ◽  
Continuing Education ◽  
Los Angeles County ◽  
Special Health Care Needs ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
The Relationship ◽  
Special Health

The current study assesses the relationship between continuing education (CE) with a focus on pediatrics and children with special heath care needs and how CE influences the knowledge and comfort levels of prehospital providers who treat these cases. Data are survey responses provided by paramedic and emergency medical technician (EMT) level providers (N = 575) in Los Angeles County. Regression models assessed the relationship between pediatric-focused continuing education and EMTs’ knowledge of and comfort with pediatric cases, adjusting for relevant covariates. EMTs’ participation in continuing education focusing on pediatrics and special health care needs was significantly associated with an increase in perceived comfort and knowledge. Among EMTs who did not receive continuing education focused on either pediatrics or special health care needs, the most frequently reported barrier to education was a perceived lack of availability. The impact of continuing education on perceived comfort and knowledge was more pronounced than the effect of prior experience, especially considering the limited prevalence of provider exposure to pediatric and childhood special health care needs cases compared to adult cases. Expanding educational opportunities is a promising approach to increasing the comfort and knowledge of EMTs who transport and care for pediatric cases.

scholarly journals Socioeconomic Status and Long-Term Care Provision to Parents in Japan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 725-725
Author(s):  
Yoko Ibuka ◽  
Yui Ohtsu
Keyword(s):  
Socioeconomic Status ◽  
Long Term Care ◽  
Living Condition ◽  
Care Provision ◽  
Burden Of Care ◽  
Care Needs ◽  
Term Care ◽  
Japanese Adults ◽  
The Relationship

Abstract Socioeconomic status (SES) is generating considerable interest in terms of health of individuals, but how it is associated with long-term care has not been established yet. We study the relationship between SES and long-term care provision to parents among the Japanese adults using JSTAR. We use the following six measures of SES for the analysis: income, asset, expenditure, living condition, housing condition and education. We find a greater probability of care provision to parents among those in higher SES categories for some SES measures, compared to the lowest category. However, after considering the survival probability of parents, the relationship is reversed and the probability of care provision is found to be greater among lower SES individuals. The association is more pronounced among males. The association is likely to be partly mediated by care needs of parents. These results suggest a higher burden of care disproportionately falls in low SES individuals.

scholarly journals The Relationship Between Daily Rapid-Eye Movement Sleep and Cognitive Functioning in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 159-159
Author(s):  
Tiana Broen ◽  
Tomiko Yoneda ◽  
Jonathan Rush ◽  
Jamie Knight ◽  
Nathan Lewis ◽  
...  
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Cognitive Functioning ◽  
Eye Movement ◽  
Rem Sleep ◽  
Cognitive Tests ◽  
Rapid Eye Movement ◽  
Targeted Interventions ◽  
The Impact ◽  
The Relationship

Abstract Previous cross-sectional research suggests that age-related decreases in Rapid-Eye Movement (REM) sleep may contribute to poorer cognitive functioning (CF); however, few studies have examined the relationship at the intraindividual level by measuring habitual sleep over multiple days. Applying a 14-day daily diary design, the current study examines the dynamic relationship between REM sleep and CF in 69 healthy older adults (M age=70.8 years, SD=3.37; 73.9% female; 66.6% completed at least an undergraduate degree). A Fitbit device provided actigraphy indices of REM sleep (minutes and percentage of total sleep time), while CF was measured four times daily on a smartphone via ambulatory cognitive tests that captured processing speed and working memory. This research addressed the following questions: At the within-person level, are fluctuations in quantity of REM sleep associated with fluctuations in next day cognitive measures across days? Do individuals who spend more time in REM sleep on average, perform better on cognitive tests than adults who spend less time in REM sleep? A series of multilevel models were fit to examine the extent to which each index of sleep accounted for daily fluctuations in performance on next day cognitive tests. Results indicated that during nights when individuals had more REM sleep minutes than was typical, they performed better on the working memory task the next morning (estimate = -.003, SE = .002, p = .02). These results highlight the impact of REM sleep on CF, and further research may allow for targeted interventions for earlier treatment of sleep-related cognitive impairment.

scholarly journals The Effect of State Gratitude on Cognitive Flexibility: A Within-Subject Experimental Approach

2020 ◽  
Vol 10 (7) ◽  
pp. 413
Author(s):  
Andree Hartanto ◽  
Nadia C. H. Ong ◽  
Wee Qin Ng ◽  
Nadyanna M. Majeed
Keyword(s):  
Pilot Study ◽  
Cognitive Functioning ◽  
Cognitive Flexibility ◽  
Positive Emotion ◽  
Positive Emotions ◽  
Experimental Approach ◽  
Main Study ◽  
Considerable Research ◽  
Potential Benefits ◽  
The Relationship

Considerable research has examined the relationship between positive emotion and cognitive flexibility. Less is known, however, about the causal relationship between discrete positive emotions, specifically gratitude, and cognitive flexibility. Given that different positive emotions may dissimilarly affect cognitive functioning, we sought to examine the effect of state gratitude on cognitive flexibility. A pilot study with ninety-five participants was employed to ensure the effectiveness of our gratitude manipulation. One hundred and thirteen participants were recruited for the main study, which utilized a within-subject experimental approach. After the manipulation, participants completed a well-established task-switching paradigm, which was used to measure cognitive flexibility. Contrary to our hypotheses, we did not find any evidence that state gratitude may enhance cognitive flexibility. The current study identified some boundary conditions around the potential benefits of the experience of gratitude.

Patients' Supportive Care Needs Beyond the End of Cancer Treatment: A Prospective, Longitudinal Survey

2009 ◽  
Vol 27 (36) ◽  
pp. 6172-6179 ◽  
Author(s):  
Jo Armes ◽  
Maggie Crowe ◽  
Lynne Colbourne ◽  
Helen Morgan ◽  
Trevor Murrells ◽  
...  
Keyword(s):  
Negative Affect ◽  
Supportive Care ◽  
Unmet Needs ◽  
Unmet Need ◽  
Hormone Treatment ◽  
Longitudinal Survey ◽  
Supportive Care Needs ◽  
Fear Of Recurrence ◽  
Care Needs ◽  
Prospective Longitudinal

Purpose To estimate prevalence and severity of patients' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need. Patients and Methods A multicenter, prospective, longitudinal survey was conducted. Sixty-six centers recruited patients for 12 weeks. Patients receiving treatment for the following cancers were recruited: breast, prostate, colorectal, and gynecologic cancer and non-Hodgkin's lymphoma. Measures of supportive care needs, anxiety and depression, fear of recurrence, and positive and negative affect were completed at the end of treatment (T0) and 6 months later (T1). Results Of 1,850 patients given questionnaire packs, 1,425 (79%) returned questionnaires at T0, and 1,152 (62%) returned questionnaires at T1. Mean age was 61 years; and most respondents were female (69%) and had breast cancer (57%). Most patients had no or few moderate or severe unmet supportive care needs. However, 30% reported more than five unmet needs at baseline, and for 60% of these patients, the situation did not improve. At both assessments, the most frequently endorsed unmet needs were psychological needs and fear of recurrence. Logistic regression revealed several statistically significant predictors of unmet need, including receipt of hormone treatment, negative affect, and experiencing an unrelated significant event between assessments. Conclusion Most patients do not express unmet needs for supportive care after treatment. Thirty percent reported more than five moderate or severe unmet needs at both assessments. Unmet needs were predicted by hormone treatment, negative mood, and experiencing a significant event. Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial resources.

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