scholarly journals Prevalence and Impact of Comorbid Cancer and Dementia on Health Outcomes in Older Adults: A Longitudinal Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 184-184
Author(s):  
Jyotsana Parajuli ◽  
Diane Berish ◽  
Ying-Ling Jao ◽  
Yo-Jen Liao ◽  
Lee Ann Johnson
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Hospital Stay ◽  
Daily Living ◽  
Medical Expenditure ◽  
Future Research ◽  
Longitudinal Impact ◽  
Nursing Home Stay

Abstract Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.

Preparation for Death and Preparation for Care in Older Community-Dwelling Adults

2002 ◽  
Vol 45 (1) ◽  
pp. 69-88 ◽  
Author(s):  
Martin Pinquart ◽  
Silvia SÖrensen
Keyword(s):  
United States ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Psychosocial Interventions ◽  
Community Dwelling ◽  
Future Research ◽  
Care Needs ◽  
The Future ◽  
Future Care

Preparation for one's death (e.g., having signed a will, having made preparations for one's funeral) and preparation for future care needs (e.g., having selected a source of support) were investigated in 593 United States and 582 German independently living seniors. The older adults reported higher levels of preparation for death than preparation for care. The lower level of preparation for care is interpreted as reflecting the uncertainty whether care needs will emerge in the future. Seniors who reported some preparation for death were more likely to report preparation for future care needs as well. Older, more educated, and more religious individuals were more likely to prepare for death. In addition, U.S. seniors were more likely to report some death preparation than German seniors. Limitations in activities of daily living did not predict levels of preparation for death. Implications for future research and for psychosocial interventions are discussed.

scholarly journals Intrinsic capacity predicts negative health outcomes in older adults

2021 ◽  
Author(s):  
Erwin Stolz ◽  
Hannes Mayerl ◽  
Wolfgang Freidl ◽  
Regina Roller-Wirnsberger ◽  
Thomas M Gill
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Health Outcomes ◽  
Warning System ◽  
Repeated Measurements ◽  
Intrinsic Capacity ◽  
Adl Disability ◽  
Nursing Home Stay ◽  
Negative Health Outcomes

Abstract BACKGROUND Monitoring trajectories of intrinsic capacity (IC) in older adults has been suggested by the WHO as a means to inform prevention to avoid or delay negative health outcomes. Due to a lack of longitudinal studies, it is currently unclear how IC changes over time and whether repeatedly measured IC predicts negative health outcomes. METHODS Based on 4,751 repeated observations of IC (range=0-100) during 21 years of follow-up among 754 older adults 70+ years, we assessed longitudinal trajectories of IC, and whether time-varying IC predicted the risk of chronic ADL disability, long-term nursing home stay, and mortality using joint models. RESULTS Average IC declined progressively from 77 to 11 points during follow-up, with substantial heterogeneity between older adults. Adjusted for socio-demographics and chronic diseases, a one-point lower IC value was associated with a 7% increase in the risk of ADL disability, a 6% increase in the risk of a nursing home stay, and a 5% increase in mortality. Accuracy for 5- and 10-year predictions based on up to three repeated measurements of IC ranged between moderate and good (AUC = 0.76-0.82). DISCUSSION Our study indicates that IC declines progressively and that it predicts negative health outcomes among older adults. Therefore, regular monitoring of IC could work as an early warning system informing preventive efforts.

scholarly journals Social isolation and health outcomes among older people in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yun Zhang ◽  
Wen Hu ◽  
Zhixin Feng
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Social Isolation ◽  
Daily Living ◽  
Functional Health ◽  
Social Contacts ◽  
Living Children

Abstract Background Social isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China. Methods We assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes. Results Older people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively). Conclusions Kinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.

scholarly journals Intrinsic capacity predicts negative health outcomes in older adults

2021 ◽  
Author(s):  
Erwin Stolz ◽  
Hannes Mayerl ◽  
Wolfgang Freidl ◽  
Regina Roller-Wirnsberger ◽  
Thomas M Gill
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Health Outcomes ◽  
Warning System ◽  
Repeated Measurements ◽  
Intrinsic Capacity ◽  
Adl Disability ◽  
Nursing Home Stay ◽  
Negative Health Outcomes

BACKGROUND: Monitoring trajectories of intrinsic capacity (IC) in older adults has been suggested by the WHO as a means to inform prevention to avoid or delay negative health outcomes. Due to a lack of longitudinal studies, it is currently unclear how IC changes over time and whether repeatedly measured IC predicts negative health outcomes. METHODS: Based on 4,751 repeated observations of IC (range=0-100) during 21 years of follow-up among 754 older adults 70+ years, we assessed longitudinal trajectories of IC, and whether time-varying IC predicted the risk of chronic ADL disability, long-term nursing home stay, and mortality using joint models for longitudinal and time-to-event data. RESULTS: Average IC declined progressively from 77 to 11 points during follow-up, with substantial heterogeneity between older adults. Adjusted for socio-demographics and chronic diseases, a one-point lower IC value was associated with a 7% increase in the risk of ADL disability, a 6% increase in the risk of a nursing home stay, and a 5% increase in mortality. Accuracy for 5- and 10-year predictions based on up to three repeated measurements of IC ranged between moderate and good (AUC = 0.76-0.82). DISCUSSION: Our study indicates that IC declines progressively and that it predicts negative health outcomes among older adults. Therefore, regular monitoring of IC could work as an early warning system informing preventive efforts.

scholarly journals Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults

2019 ◽  
Vol 75 (6) ◽  
pp. 1176-1183 ◽  
Author(s):  
Aron S Buchman ◽  
Robert J Dawe ◽  
Sue E Leurgans ◽  
Thomas A Curran ◽  
Timothy Truty ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adverse Health Outcomes ◽  
Backward Elimination ◽  
Cox Proportional Hazards Models

Abstract Background Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes. Methods A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome. Results During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes. Conclusions When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.

scholarly journals Short-Term and Long-Term Effects of Social Isolation on Health Outcomes among Older People in China

2021 ◽  
Author(s):  
Yun Zhang ◽  
Zhixin Feng
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Health Effects ◽  
Social Isolation ◽  
Daily Living ◽  
Long Term Effects ◽  
Short Term

Abstract Background Social isolation and loneliness are serious public health risks affecting a significant number of older adults globally. However, it is uncertain whether their health effects are short-term or long-term, which impedes the developing of more effective and precising interventions. We therefore assessed the varied health effects of short-term and long-term exposure of social isolation and loneliness among a nationwide sample of older adults from China. Methods We assessed social isolation and loneliness in 6,066 men and women aged 65 and older who took part in both 2011 and 2014 waves of Chinese Longitudinal Healthy Longevity Survey. Social isolation was assessed in terms of absence of key family members, including spouse, children or siblings, and a deficiency in participating in social activities. Loneliness was administered by using a questionnaire. Four health outcomes were investigated: self-rated health, activities of daily living (ADLs), Instrumental activities of daily living (IADLs), and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the short-term (< 3 years) and long-term (>= 3 years) effects of social isolation and loneliness on health outcomes.Results After controlling for covariates of demographic, socioeconomic, lifestyle, and baseline health factors, in the short-term effects, there are significant associations found between absence of children and poor SRH and cognitive impairment (ORs=1.53 and 9.87); absence of siblings and poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.29, 1.35, 1.26 and 1.22 respectively); loneliness and poor SRH and difficulties with IADLs (ORs=1.92 and 1.55). While, in the long-term effects, absence of siblings is marginally significantly associated with cognitive impairment (OR=1.21), but significant associations are found between deficiency in participating in social activities and poor SRH, difficulty with ADLs and IADLs (ORs=1.33, 1.55 and 1.69, respectively); loneliness and poor SRH, difficulty with IADLs and less difficulties in ADLs (ORs=2.96, 2.45 and 0.32, respectively).Conclusions The results of this study show that social isolation at family level mainly have short-term effects, while social isolation at societal level have mainly have long-term, and loneliness has both short-term and long-term effects on older people’s health outcomes.

scholarly journals Type and Severity of Cognitive Decline in Older Adults after Noncardiac Surgery

2008 ◽  
Vol 108 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Catherine C. Price ◽  
Cynthia W. Garvan ◽  
Terri G. Monk
Keyword(s):  
Older Adults ◽  
Executive Function ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Daily Living ◽  
Noncardiac Surgery ◽  
Future Research ◽  
Equal Distribution ◽  
Memory Decline ◽  
Instrumental Activities

Background The authors investigated type and severity of cognitive decline in older adults immediately and 3 months after noncardiac surgery. Changes in instrumental activities of daily living were examined relative to type of cognitive decline. Methods Of the initial 417 older adults enrolled in the study, 337 surgery patients and 60 controls completed baseline, discharge, and/or 3-month postoperative cognitive and instrumental activities of daily living measures. Reliable change methods were used to examine three types of cognitive decline: memory, executive function, and combined executive function/memory. SD cutoffs were used to grade severity of change as mild, moderate or severe. Results At discharge, 186 (56%) patients experienced cognitive decline, with an equal distribution in type and severity. At 3 months after surgery, 231 patients (75.1%) experienced no cognitive decline, 42 (13.6%) showed only memory decline, 26 (8.4%) showed only executive function decline, and 9 (2.9%) showed decline in both executive and memory domains. Of those with cognitive decline, 36 (46.8%) had mild, 25 (32.5%) had moderate, and 16 (20.8%) had severe decline. The combined group had more severe impairment. Executive function or combined (memory and executive) deficits involved greater levels of functional (i.e., instrumental activities of daily living) impairment. The combined group was less educated than the unimpaired and memory groups. Conclusion Postsurgical cognitive presentation varies with time of testing. At 3 months after surgery, more older adults experienced memory decline, but only those with executive or combined cognitive decline had functional limitations. The findings have relevance for patients and caregivers. Future research should examine how perioperative factors influence neuronal systems.

The Association of Hearing Impairment and Its Severity with Physical and Mental Health among Chinese Middle-aged and Older Adults

2020 ◽  
Author(s):  
Xin Ye ◽  
Dawei Zhu ◽  
Siyuan Chen ◽  
Ping He
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Hearing Impairment ◽  
Daily Living ◽  
Hearing Impaired ◽  
Physical And Mental Health ◽  
Middle Aged

Abstract Background: Hearing loss is a common chronic condition which can be closely related with people’s health. However, current studies on this topic are quite limited in developing countries, and few with standardized audiometric measurement and multiple health outcomes. Therefore, we aimed to explore the association between hearing impairment and its severity with physical and mental health among Chinese middle-aged and older adults. Methods: We obtained data from two sources: (1) China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015, in which hearing impairment was measured by asking whether participants aged 45 years old had hearing problems; and (2) Hearing Survey 2019, the baseline survey of a randomized controlled trial conducted in Shandong Province of China, including 376 middle-aged and older participants. The severity of hearing impairment was identified by pure tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz. Results: In CHARLS, 1248 (8.36%) participants suffered from hearing impairment at baseline, and hearing-impaired individuals were more likely to have chronic diseases, impaired activities of daily living (ADLs), impaired instrumental activities of daily living (IADLs) and depressive symptoms. For the 376 hearing-impaired participants in Hearing Survey 2019, 30.32%, 38.30% and 31.38% of them had moderate, severe and profound hearing impairment, respectively. As the severity of hearing impairment increased, individuals were likely to have impaired ADLs, impaired IADLs and depressive symptoms. Conclusions: Hearing impairment and its severity were closely related to multiple physical and mental health outcomes among Chinese middle-aged and older adults. Actions should be taken to prevent and treat hearing impairment, so as to improve people’s health and well-being.

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