scholarly journals Met and Unmet Needs of Cognitively Impaired Older Adults and Burden and Benefits of Their Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 278-279
Author(s):  
Pildoo Sung ◽  
Johan Suen ◽  
Nawal Hashim ◽  
Rahul Malhotra ◽  
Angelique Chan
Keyword(s):  
Older Adults ◽  
Latent Class ◽  
Unmet Needs ◽  
Multinomial Logistic Regression ◽  
Community Dwelling ◽  
Cognitively Impaired ◽  
Care Recipients ◽  
Caregiver Needs ◽  
Met Needs ◽  
With Memory

Abstract Previous studies typically assess caregiver needs when trying to interpret caregiver burden. We propose that both met and unmet needs of care recipients translate into different caregiving experiences with varying levels of benefits and burden combined. We use data on 263 caregivers of community-dwelling Singaporean older adults with cognitive impairment who participated in a community-based dementia care study conducted in 2018-2020. Our analysis produces three major findings. First, latent class analysis identifies three distinct types of caregiving experience based on caregiver-reported burden and benefits of caregiving: intensive (high burden and high benefits, 11% of caregivers), satisfied (low burden and high benefits; 54%), and dissatisfied (low burden and low benefits; 35%). Second, multinomial logistic regression shows that both met and unmet needs of care recipients are positively associated with the intensive caregiving experience, while only met needs are positively associated with the satisfied caregiving experience, in comparison to dissatisfied caregiving experience. Third, met needs in the areas of daytime activities, memory assistance, and mobility are positively related to the satisfied caregiving experience, compared to the dissatisfied caregiving experience. In other words, caregivers are more likely to be satisfied in their caregiving experiences (i.e., low burden and high benefits) if their care recipients’ problems with memory, mobility, and finding suitable and adequate daytime activities are properly managed. Our findings thus call for interventions to fulfill care recipients’ needs in a more tailored manner in order to increase satisfaction among caregivers.

scholarly journals Impact of Pain and Discomfort on the Lives of Cognitively Impaired Older Adults and Their Informal Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 786-787
Author(s):  
Hyunjin Noh
Keyword(s):  
Older Adults ◽  
Cognitively Impaired ◽  
Community Settings ◽  
Adult Age ◽  
Face To Face ◽  
Disease Trajectory ◽  
Care Recipients ◽  
Home Based ◽  
The Impact ◽  
Future Program

Abstract This qualitative study explored the impact of pain and discomfort on the lives of cognitively impaired older adults and their caregivers from the caregiver perspective. Forty-three individuals of age 19+, who identified themselves as primary caregiver to a chronically or seriously ill older adult (age 50+) with cognitive impairment, such as Alzheimer’s Disease and Related Dementia, were recruited at various community settings. Individual, face-to-face interviews were conducted to ask participants how they thought their care-recipient’s pain and discomfort affected the care-recipient’s and the caregiver’s life respectively. Inductive, thematic analysis of interview transcripts revealed several key themes: compromised mobility, limited social interaction or activities, and depressive symptoms in both care-recipients and caregivers; aggravated cognitive decline in care-recipients; and poorer physical health in caregivers. Participants wanted more information on the disease trajectory and available services, particularly home-based therapies and social activities for care-recipients, which provides future program/practice implications.

Multiple Physical Symptoms of Community-Dwelling Older People in Western China: Prevalence and Its Association with Frailty

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shuli Jia ◽  
Wanyu Zhao ◽  
Yan Zhang ◽  
Lisha Hou ◽  
Xin Xia ◽  
...  
Keyword(s):  
Older Adults ◽  
Multinomial Logistic Regression ◽  
Physical Symptoms ◽  
Community Dwelling ◽  
Western China ◽  
Musculoskeletal Symptoms ◽  
Frailty Phenotype ◽  
The Past ◽  
Organ Systems ◽  
Multiple Symptoms

<b><i>Introduction:</i></b> Physical symptoms and frailty are common in older adults. A previous study has reported that multiple somatic symptoms are associated with frailty. In this study, we aimed to describe the picture of physical symptoms in older adults in western China and examine the relationship of multiple physical symptoms and frailty, as well as the sex difference of this relationship. <b><i>Methods:</i></b> Cross-sectional analyses were based on the West China Health and Aging Trend (WCHAT) study comprising 4,106 community-dwelling older adults (60–95 years). Frailty was assessed using the physical frailty phenotype (PFP). Participants’ experience of 28 different physical symptoms in the past 4 weeks was assessed. Physical symptoms were divided into several categories according to organ systems. Multinomial logistic regression analyses were performed to examine the association between frailty and multiple physical symptoms. <b><i>Results:</i></b> Nearly half of the subjects reported experiencing at least 1 physical symptom during the past 4 weeks. Musculoskeletal symptoms were the most prevalent symptoms. More than 5 physical symptoms were more likely to be frailty, even when all covariates were controlled. A significant association between multiple musculoskeletal symptoms and frailty also was found after adjusted for all covariates and multiple symptoms of other organ systems. Similar results were obtained for multiple cardiopulmonary symptoms. Furthermore, there were sex differences in these relationships. <b><i>Conclusion:</i></b> Multiple physical symptoms appear to have a detrimental impact on frailty in older adults. Compared with counting total symptoms, multiple symptoms of the same organ system may have a greater impact on frailty. Effective interventions and management of multiple physical symptoms are warranted to prevent frailty.

scholarly journals Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlotte Bimou ◽  
Michel Harel ◽  
Cécile Laubarie-Mouret ◽  
Noëlle Cardinaud ◽  
Marion Charenton-Blavignac ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Factors ◽  
Multinomial Logistic Regression ◽  
Cognitive Disorder ◽  
Community Dwelling ◽  
Functional Autonomy ◽  
Process Loss ◽  
Associated Risk Factors ◽  
Study Participants ◽  
Community Dwelling Older Adults

Abstract Background Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies. Methods Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. Results Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD. Conclusions Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

scholarly journals Ageism, Healthy Life Expectancy and Population Ageing: How Are They Related?

2020 ◽  
Vol 17 (9) ◽  
pp. 3159 ◽  
Author(s):  
Alana Officer ◽  
Jotheeswaran Amuthavalli Thiyagarajan ◽  
Mira Leonie Schneiders ◽  
Paul Nash ◽  
Vânia de la Fuente-Núñez
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Sex Education ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Personal Characteristics ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Individual Level ◽  
Explanatory Factors

Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries that took part in Wave 6 of the World Values Survey. Multilevel Latent Class Analysis was performed to identify distinct classes of individuals and countries. Individuals were classified as having high, moderate or low ageist attitudes; and countries as being highly, moderately or minimally ageist, by aggregating individual responses. Individual-level (age, sex, education and wealth) and contextual-level factors (healthy life expectancy, population health status and proportion of the population aged over 60 years) were examined as potential explanatory factors in multinomial logistic regression. From the 83,034 participants included, 44%, 32% and 24% were classified as having low, moderate and high ageist attitudes, respectively. From the 57 countries, 34 were classified as moderately or highly ageist. The likelihood of an individual or a country being ageist was significantly reduced by increases in healthy life expectancy and the proportion of older people within a country. Certain personal characteristics—younger age, being male and having lower education—were significantly associated with an increased probability of an individual having high ageist attitudes. At least one in every two people included in this study had moderate or high ageist attitudes. Despite the issue’s magnitude and negative health impacts, ageism remains a neglected global health issue.

scholarly journals Is there an association between ageist attitudes and frailty?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Douglas Salguero ◽  
Juliana Ferri-Guerra ◽  
Nadeem Y. Mohammed ◽  
Dhanya Baskaran ◽  
Raquel Aparicio-Ugarriza ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Multinomial Logistic Regression ◽  
Frailty Index ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Frailty Status

Abstract Background Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is “a process of systematic stereotyping and discrimination against people because they are old.” Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans. Methods This is a cross-sectional study of Veterans 50 years and older who completed the Kogan’s Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates. Results Patients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95–1.01), p = .221, and OR:=.97 (95% CI = .37–2.53), p = .950 respectively. Conclusions This study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.

scholarly journals Pre-frailty, frailty and associated factors in older caregivers of older adults

2020 ◽  
Vol 54 ◽  
pp. 17
Author(s):  
Roberta De Oliveira Máximo ◽  
Ingrid Cristina Lopes ◽  
Allan Gustavo Brigola ◽  
Bruna Moretti Luchesi ◽  
Aline Cristina Martins Gratão ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Low Income ◽  
Associated Factors ◽  
Multinomial Logistic Regression ◽  
Community Dwelling ◽  
Clinical Aspects ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Older Caregivers

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

scholarly journals Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033661 ◽  
Author(s):  
Ana Rita Sousa-Santos ◽  
Cláudia Afonso ◽  
Nuno Borges ◽  
Alejandro Santos ◽  
Patrícia Padrão ◽  
...  
Keyword(s):  
Older Adults ◽  
Nutritional Assessment ◽  
Multinomial Logistic Regression ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Physical Frailty ◽  
Cross Sectional ◽  
European Working

ObjectivesTo investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population.DesignCross-sectional.SettingPortugal.Participants1454 older adults with 65 years or older, from Nutrition UP 65 study.Primary and secondary outcome measuresSarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index.Results57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated.ConclusionsAlmost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.

scholarly journals The Sequence of Physical and Cognitive Impairment and the Association with Mortality Among Unimpaired Older Mexican Adults

2019 ◽  
Vol 75 (7) ◽  
pp. 1386-1392
Author(s):  
Brian Downer ◽  
Sadaf Milani ◽  
Rebeca Wong
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Multinomial Logistic Regression ◽  
Cognitive Status ◽  
Cognitively Impaired ◽  
Proportional Hazard ◽  
Physical Impairments ◽  
Aging Study ◽  
Mexican Adults

Abstract Background Many older adults become physically and cognitively impaired. However, it is unclear whether unimpaired older adults are more likely to become physically or cognitively impaired first and if this sequence impacts mortality risk. Methods Data came from the Mexican Health and Aging Study. The sample included 1,283 participants aged ≥60 years who were physically and cognitively unimpaired in 2001. Multinomial logistic regression was used to estimate probabilities of being unimpaired, cognitively impaired only, physically impaired only, or cognitively-physically impaired in 2003. Proportional hazard models were used to estimate mortality risk through 2015 according to physical and cognitive status in 2003. Results The probabilities for being unimpaired, physically impaired only, cognitively impaired only, and cognitively-physically impaired in 2003 were 0.45, 0.22, 0.19, and 0.13, respectively. Older age, female sex, and arthritis were associated with significantly greater probability of becoming physically impaired only than cognitively impaired only in 2003. Cognitive impairment only (hazard ratio [HR] = 1.42, 95% confidence interval [CI] = 1.09–1.85) in 2003 but not physical impairment only (HR = 1.22, 95% CI = 0.94–1.58) was associated with greater mortality than being unimpaired in 2003. Cognitively-physically impaired participants had higher mortality risk than participants who were physically (HR = 1.58, 95% CI = 1.18–2.12) or cognitively (HR = 1.36, 95% CI = 1.01–1.84) impaired only. Discussion The likelihood of becoming only physically or cognitively impaired over 2 years varies by demographic and health characteristics. The mortality risk for unimpaired older adults who become cognitively impaired only is similar to those who become physically impaired only. Research should determine if the sequence of cognitive and physical impairments is associated with other outcomes.

scholarly journals Cognitive Impairment, Sexual Activity and Physical Tenderness in Community-Dwelling Older Adults: A Cross-Sectional Exploration

Gerontology ◽  
2018 ◽  
Vol 64 (6) ◽  
pp. 589-602 ◽  
Author(s):  
Rosanne Freak-Poli ◽  
Silvan Licher ◽  
Joanne Ryan ◽  
M. Arfan Ikram ◽  
Henning Tiemeier
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Sexual Activity ◽  
Community Dwelling ◽  
Cognitively Impaired ◽  
Cross Sectional ◽  
Partner Status ◽  
Weak Evidence ◽  
Community Dwelling Older Adults

Background: The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied. Objective: To examine the association between cognitive functioning with sexual activity and physical tenderness among community-dwelling older adults. Methods: From the Rotterdam Study, cognitive impairment and sexual activity were assessed in 4,201 community-dwelling, 60+ year olds between 2008 and 2014 in the Netherlands. Mild cognitive impairment (MCI) was based upon subjective complaints related to age and education-adjusted test scores. Mini-Mental State Examination (MMSE) impairment was defined by a score of < 26. Sexual activity and physical tenderness (e.g., fondling or kissing) in the last 6 months were assessed at an interview. Analyses were stratified by gender and partner status, with prevalence rates for the “no impairment” categories weighted based on age from the cognitive impairment categories. Inter-rater reliability was examined utilising 74 cohabiting couples of opposite gender. Results: It was found that 14% were categorised as having cognitive impairment, and < 1% as dementia (excluded from subsequent analyses). There was strong evidence that the odds of engaging in physical tenderness (observed through MMSE < 26, OR 2.14, 95% CI 1.32–3.48, p = 0.002) and sexual activity (MCI, OR 2.36, 95% CI 1.35–4.12, p = 0.003) among partnered females with no impairment was twice that observed among cognitively impaired partnered females. There was weak evidence that the odds of engaging in physical tenderness (MMSE < 26, OR 1.59, 95% CI 1.04–2.42, p = 0.03) and sexual activity (MMSE < 26, OR 1.51, 95% CI 1.02–2.24, p = 0.04) among partnered males with no impairment was 50% greater than observed among cognitively impaired partnered males. The associations between cognitive functioning and physical tenderness continued to remain after adjustment for physical function, diabetes, cardiovascular disease and cancer. There was no clear evidence of a difference between amnestic and non-amnestic MCI for sexual behaviour. There was moderate to substantial agreement among the coupled adults who had 1 partner categorised with MCI. Conclusion: Having no cognitive impairment was associated with more engagement in sexual activity and physical tenderness among community-dwelling older adults. Sexuality is an important aspect of active aging and our findings illustrate a potential barrier to maintaining or instigating intimate relationships as we age. Longitudinal analyses are required to explore the direction of effect.

scholarly journals Unmet needs in patients with first-episode schizophrenia: a longitudinal perspective

2011 ◽  
Vol 42 (7) ◽  
pp. 1461-1473 ◽  
Author(s):  
K. Landolt ◽  
W. Rössler ◽  
T. Burns ◽  
V. Ajdacic-Gross ◽  
S. Galderisi ◽  
...  
Keyword(s):  
Latent Class ◽  
Unmet Needs ◽  
Multinomial Logistic Regression ◽  
Psychosocial Treatment ◽  
First Episode ◽  
Patient Groups ◽  
First Episode Schizophrenia ◽  
Latent Class Growth

BackgroundThis study aimed to identify the course of unmet needs by patients with a first episode of schizophrenia and to determine associated variables.MethodWe investigated baseline assessments in the European First Episode Schizophrenia Trial (EUFEST) and also follow-up interviews at 6 and 12 months. Latent class growth analysis was used to identify patient groups based on individual differences in the development of unmet needs. Multinomial logistic regression determined the predictors of group membership.ResultsFour classes were identified. Three differed in their baseline levels of unmet needs whereas the fourth had a marked decrease in such needs. Main predictors of class membership were prognosis and depression at baseline, and the quality of life and psychosocial intervention at follow-up. Depression at follow-up did not vary among classes.ConclusionsWe identified subtypes of patients with different courses of unmet needs. Prognosis of clinical improvement was a better predictor for the decline in unmet needs than was psychopathology. Needs concerning social relationships were particularly persistent in patients who remained high in their unmet needs and who lacked additional psychosocial treatment.

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