Transforming Aging: Increased Access to Care Minimizes Rural and Urban Differences in Cognitive Change

Abstract Rural-urban disparities in cognitive health outcomes, such as greater prevalence of cognitive decline among rural-dwelling older adults, have been linked to inequity in access to care. However, few studies have demonstrated whether longitudinal increased access to care may mitigate such disparities. This paper presents data from ongoing systematically collected behavioral health data on new and returning patients at an interdisciplinary geriatrics clinic at the University of Alabama Medical Center. The aim of this study was to determine baseline predictors of cognitive change across three annual visits (n = 42, mean age of 75.63 years (SD = 9.15)). Adjusting for baseline cognitive status, baseline subjective health literacy, and baseline depression and anxiety, results from a univariate ANCOVA showed that age at first visit (B = -.024, 95% CI [-.041, -.008], t(35) = -2.990, p = .005) and rural-urban status (B = .555, 95% CI [.123, .988], t(35) = 2.608, p = .013) predicted cognitive change at timepoint three (T3). Specifically, individuals from rural areas were less likely to experience cognitive decline and scored .555 points better than individuals from urban areas on cognitive screeners at T3 compared with baseline cognitive status. These results suggest that increased access to and utilization of care may ameliorate traditional disparate rates of cognitive decline between rural- and urban-dwelling older adults. Moreover, behavioral health screenings in primary geriatrics clinic care may help identify patient cognitive needs and facilitate integrated care through combined medical, pharmacological, and behavioral interventions to promote positive cognitive health outcomes.

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Neighborhood Environments and Cognitive Decline Among Middle-Aged and Older People in China

The Journals of Gerontology Series B ◽

10.1093/geronb/gbz016 ◽

2019 ◽

Vol 74 (7) ◽

pp. e60-e71 ◽

Cited By ~ 7

Author(s):

Ye Luo ◽

Lingling Zhang ◽

Xi Pan

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Older People ◽

Cognitive Decline ◽

Urban Areas ◽

Developed Countries ◽

Cognitive Change ◽

Middle Aged ◽

Rural And Urban ◽

Neighborhood Environments

Abstract Objectives Despite the growing interest in the effects of neighborhood environments on cognitive function, most studies on older people are based on cross-sectional survey data from developed countries. This study examines the relationship between neighborhood environments and decline in cognitive function over time among middle-aged and older people in China and whether this relationship varies between rural and urban residents. Methods The three waves of China Health and Retirement Longitudinal Study (CHARLS 2011–2015) were used. The sample included 12,131 respondents living in 298 rural villages and 4,059 respondents living in 150 urban communities. Three-level linear growth curve models were estimated to track trajectories of cognitive change over a 4-year period. Results Chinese older people who lived in neighborhoods with more handicap access, more bus lines, employment service, and higher socioeconomic status (SES) had slower cognitive decline. Neighborhood basic infrastructures, number of days that roads were unpassable, outdoor exercise facilities, and average social activity participation were associated with baseline cognitive function in both rural and urban areas, but neighborhood environments had more impact on cognitive decline among rural older adults than urban older adults. Discussions Findings from this study call for increased infrastructure development and community building programs in rural China.

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Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes

Physical Therapy ◽

10.1093/ptj/pzz186 ◽

2020 ◽

Vol 100 (4) ◽

pp. 718-727

Author(s):

Miguel Á De la Cámara ◽

Sara Higueras-Fresnillo ◽

Kabir P Sadarangani ◽

Irene Esteban-Cornejo ◽

David Martinez-Gomez ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Predictive Validity ◽

Gait Speed ◽

Well Being ◽

Cognitive Status ◽

Community Dwelling ◽

Walk Test ◽

Physical And Mental Health ◽

Cognitive Health

Abstract Background Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes. Objective The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults. Design A cross-sectional design was used. Methods The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status). Results The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures. Limitations The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study. Conclusion The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal designs.

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Associations Among Personality Traits, Stress Experiences, and Physical and Cognitive Outcomes in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.034 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 9-9

Author(s):

Eileen Graham ◽

David Almeida

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Personality Traits ◽

Perceived Stress ◽

Cognitive Change ◽

Cognitive Outcomes ◽

Key Factors ◽

Cognitive Health ◽

Novel Approach ◽

New Findings

Abstract Understanding between and within person variability in personality traits, and the processes of general and perceived stress are essential to understanding how to optimize cognitive health in older adults. It is well known that there is large variation in cognitive change: the pace and direction of change differs greatly across individuals. Personality traits and stress experiences are key factors that may account for some of these individual differences. The goal of our symposium is to present novel research in this area and discuss the implications for understanding personality, stress, and cognitive decline. First, Ferguson and colleagues will present a novel approach to assessing daily variability in personality. Their results demonstrate that daily personality assessments are able to capture within-person variability in personality, which could potentially help predict health trajectories in later adulthood. This is an important step in the study of change processes. Second, Luo and colleagues will present the factor structure of general and perceived stress, and show the predictive utility of these factors on physical and cognitive health outcomes. Third, Lawson and colleagues will discuss the extent to which personality is associated with cognitive function in a large sample of Mexican-origin adults. Fourth, Graham and colleagues will present results from a coordinated analysis that addressed associations among personality traits and cognitive decline both pre- and post- dementia diagnosis. Discussant David Almeida will contextualize these new findings and propose next steps.

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Behavioural health outcomes in veterans compared to nonveterans by rural and urban areas in Alabama, 2015–2018

Health & Social Care in the Community ◽

10.1111/hsc.13392 ◽

2021 ◽

Author(s):

David L. Albright ◽

Kari L. Fletcher ◽

Kate H. Thomas ◽

Justin T. McDaniel ◽

Kirsten Laha‐Walsh ◽

...

Keyword(s):

Health Outcomes ◽

Urban Areas ◽

Rural And Urban Areas ◽

Behavioural Health ◽

Rural And Urban

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Association between plasma CCL11 (eotaxin-1) and cognitive status in older adults: Differences between rural and urban dwellers

Experimental Gerontology ◽

10.1016/j.exger.2018.10.004 ◽

2018 ◽

Vol 113 ◽

pp. 173-179 ◽

Cited By ~ 3

Author(s):

Lee Butcher ◽

Karine Pérès ◽

Perrine André ◽

Roger H. Morris ◽

Stefan Walter ◽

...

Keyword(s):

Older Adults ◽

Cognitive Status ◽

Rural And Urban

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Aging, Cognitive Decline and Hearing Loss: Effects of Auditory Rehabilitation and Training with Hearing Aids and Cochlear Implants on Cognitive Function and Depression among Older Adults

Audiology and Neurotology ◽

10.1159/000448350 ◽

2016 ◽

Vol 21 (Suppl. 1) ◽

pp. 21-28 ◽

Cited By ~ 59

Author(s):

Alessandro Castiglione ◽

Alice Benatti ◽

Carmelita Velardita ◽

Diego Favaro ◽

Elisa Padoan ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Cognitive Decline ◽

Cochlear Implants ◽

Hearing Aids ◽

Digit Span ◽

Depression Scale ◽

Cognitive Status ◽

Long Term Memory ◽

Auditory Rehabilitation

A growing interest in cognitive effects associated with speech and hearing processes is spreading throughout the scientific community essentially guided by evidence that central and peripheral hearing loss is associated with cognitive decline. For the present research, 125 participants older than 65 years of age (105 with hearing impairment and 20 with normal hearing) were enrolled, divided into 6 groups according to their degree of hearing loss and assessed to determine the effects of the treatment applied. Patients in our research program routinely undergo an extensive audiological and cognitive evaluation protocol providing results from the Digit Span test, Stroop color-word test, Montreal Cognitive Assessment and Geriatric Depression Scale, before and after rehabilitation. Data analysis was performed for a cross-sectional and longitudinal study of the outcomes for the different treatment groups. Each group demonstrated improvement after auditory rehabilitation or training on short- and long-term memory tasks, level of depression and cognitive status scores. Auditory rehabilitation by cochlear implants or hearing aids is effective also among older adults (median age of 74 years) with different degrees of hearing loss, and enables positive improvements in terms of social isolation, depression and cognitive performance.

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IN-HOSPITAL NURSE CARE CONTINUITY: DOES IT MATTER?

Innovation in Aging ◽

10.1093/geroni/igz038.2711 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S740-S740

Author(s):

Orly Tonkikh ◽

Anna Zisberg ◽

Efrat Shadmi

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Interpersonal Relationship ◽

Severity Of Illness ◽

Cognitive Status ◽

Cognitive Outcomes ◽

Full Time ◽

Hospital Nursing ◽

Hospitalized Older Adults ◽

Time Standard

Abstract In-hospital cognitive decline affects up to 40% of hospitalized older adults and is associated with post-hospitalization worsening of medical and functional status. Studies pointed to the substantial role of the interpersonal relationship between older adults with cognitive impairment and the nurses who care for them. We investigated the association between nursing interpersonal continuity and cognitive outcomes in a cohort of 646 older adults aged 70 or older admitted to internal units for non-disabling conditions. Cognitive decline was defined as at least one point decline in the Short Portable Mental Status Questionnaire from at admission to discharge assessments. Nursing interpersonal continuity was measured using continuity of care index (CoC). CoC assesses the extent of different nurses assigned to take care of each patient during the hospital stay (2 shifts per day) and ranges from 0 (none of the nurses is the same) to 0.4 (highest feasible score according to full time standard shift plan and length of stay (LOS)). Multivariate logistic regression showed that achieving 25% of the highest feasible in-hospital nursing CoC was associated with lower odds of cognitive decline (OR=0.67, 95% CI=0.47-0.97), controlling for age, sex, premorbid activities of daily living status, at admission cognitive status, comorbidities, severity of illness and LOS. This study shows that in-hospital nursing continuity is negatively associated with older adults’ cognitive decline, even in low-continuity levels. Future studies should investigate in-hospital continuity patterns and interventions maintaining continuity in larger and more heterogenic samples.

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Health Trajectories in Swedish Centenarians

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa152 ◽

2020 ◽

Vol 76 (1) ◽

pp. 157-163

Author(s):

Davide L Vetrano ◽

Giulia Grande ◽

Alessandra Marengoni ◽

Amaia Calderón-Larrañaga ◽

Debora Rizzuto

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Chronic Diseases ◽

Care Delivery ◽

Cognitive Status ◽

National Study ◽

Health Trajectories ◽

Kungsholmen Project ◽

Cognitively Intact

Abstract Background Longitudinal studies describing centenarians’ health trajectories are currently lacking. We compared health trajectories of older adults becoming centenarians and their shorter-living counterparts in terms of chronic diseases, disability, and cognitive decline. Methods We identified 3,573 individuals participating in the Kungsholmen Project and the Swedish National Study on Aging and Care in Kungsholmen who lived <100 years and 222 who survived to their 100th birthday. Trajectories of chronic diseases, disability (impaired activities of daily living), and cognitive status were obtained via linear mixed models over 13 years. Results Centenarians had fewer chronic diseases than noncentenarians. Before age 85, centenarians showed slower health changes. In centenarians, multimorbidity, disability, and cognitive impairment occurred 4 to 9 years later than in noncentenarians. After age 85, the speed of accumulation of chronic diseases, disabilities, and cognitive decline accelerated in centenarians. At age 100, 39% of the centenarians were cognitively intact and 55% had escaped disability. Only 5% were free of multimorbidity at age 100. When compared with their shorter lived counterparts, in terms of years spent in poor health, centenarians experienced more years with multimorbidity (9.4 vs 6.8 years; p < .001), disability (4.3 vs 3.1 years; p = .005), and cognitive impairment (6.3 vs 4.3 years; p < .001). Conclusions Older people who become centenarians present a delay in the onset of morbidity, but spend more years in this condition compared to their shorter lived peers. The observation of older adults’ health trajectories might help to forecast healthier aging, and plan future medical and social care delivery.

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