scholarly journals IN-HOSPITAL NURSE CARE CONTINUITY: DOES IT MATTER?

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.

Relationship Between Changes in Sedative-Hypnotic Medications Burden and Cognitive Outcomes in Hospitalized Older Adults

2020 ◽  
Vol 75 (9) ◽  
pp. 1699-1705
Author(s):  
Juliana Smichenko ◽  
Efrat Gil ◽  
Anna Zisberg
Keyword(s):  
Cognitive Decline ◽  
Older Patients ◽  
Secondary Analysis ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Logistic Analysis ◽  
Number Of Patients ◽  
Hospitalized Older Adults ◽  
Study Participants ◽  
Patients Experience

Abstract Background Sedative-hypnotic medications (SHMs) are frequently used in hospitalized older patients, despite undesirable effects on cognitive status. Although previous studies found a significant number of patients experience changes in SHM use during hospitalization, it is unclear which pattern of change leads to hospital-associated cognitive decline (HACD). This study tested the association between patterns of SHM change and HACD. Methods This secondary analysis study included 550 patients age 70+ who were cognitively intact at admission (Short Portable Mental Status Questionnaire [SPMSQ] ≥8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization (average SB of all hospitalization days) were coded using the Drug Burden Index sorting study participants into four groups: without SB (n = 254), without SB changes (n = 132), increased SB (n = 82), and decreased SB (n = 82). Results Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, SB score at home, pain on admission and depression, the odds of HACD were 2.45 (95% CI: 1.16 to 5.13) among participants with increased SB, 2.10 (95% CI: 1.13 to 3.91) among participants without SB changes, compared with participants with decreased SB. Conclusion Older patients whose SB is increased or does not change are at higher risk for acquired cognitive decline than are those whose SB is reduced. Identifying patients with a potential increase in SB and intervening to reduce it may help to fight HACD.

scholarly journals 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

2016 ◽  
Vol 21 (Suppl. 1) ◽  
pp. 21-28 ◽  
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.

scholarly journals Health Trajectories in Swedish Centenarians

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.

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

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 482-483
Author(s):  
Timothy Ly ◽  
Rebecca Allen ◽  
Barbara Jackson ◽  
Amy Albright ◽  
John Bell ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Cognitive Decline ◽  
Access To Care ◽  
Behavioral Health ◽  
Urban Areas ◽  
Cognitive Change ◽  
Cognitive Status ◽  
Cognitive Health ◽  
Rural And Urban

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.

scholarly journals Effects of Caregiver Interventions for Informal Caregivers of Older Adults With Cognitive Decline

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 647-647
Author(s):  
Machiko Tomita
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Classification Accuracy ◽  
Informal Caregivers ◽  
Cognitive Status ◽  
Process Data ◽  
Physical Strain ◽  
Caregiver Support ◽  
Baseline Factors ◽  
Process Factors

Abstract Objectives To identify baseline factors and process factors, which indicate changes that are associated with caregiving confidence improvement attributed to caregiver support. Methods An intervention study using 35 informal caregivers (ICG) of older adults (≥65 years old) with cognitive decline. Recipients of ICGs belonged to the Programs of All Inclusive Care for the Elderly (PACE). Interventions were occupational therapy (OT) support or education about illness and effective caregiving methods, which took place in ICGs’ homes. OT interventions included training to reduce physical strain, and improve time and task organizations, and providing assistive devices). Caregiver confidence was measured using a Visual Analog Scale. Data were divided into two groups: improved confidence and decreased/no-change confidence. Eleven baseline data of care recipients (CRs) and ICGs as well as five process data were analyzed using logistic regression. Results Baseline factors that differentiated the two groups were ICG’s age, caregiving confidence level, and CR’s cognitive status, of which classification accuracy was 94.3%. Only Zarit Buren Interview (ZBI) score was associated with caregiving confidence change, of which classification accuracy was 74.3%. Younger ICGs, lower cognition, and lower caregiving confidence among baseline factors, and improved ZBI among the process factors were associated with improved confidence. Discussion Although our interventions prevented 65.7% of caregivers form declining their caregiving confidence, improving caregiving confidence was difficult while CRs’ cognition continued to decline. However, this positive change was possible even CRs had moderate dementia, on average. Personal interventions may be necessary to improve caregiving confidence and reduce ICG’s burden.

scholarly journals Hospital-Associated Disability Associated With Delirium Among Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 584-584
Author(s):  
Richard Kennedy ◽  
Hyun Freeman ◽  
Roy Martin ◽  
Caroline Whittington ◽  
John Osborne ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Admission ◽  
Mixed Models ◽  
Cognitive Status ◽  
Common Complication ◽  
Mediation Analyses ◽  
Nursing Delirium Screening Scale ◽  
Hospitalized Older Adults ◽  
Screening Scale

Abstract Hospital-associated disability (HAD), defined as a loss of activities of daily living (ADLs) occurring during hospitalization, is a common complication among older adults. Delirium is also a common complication during hospitalization and is associated with multiple long-term sequelae. We sought to determine the effect of delirium and known covariates on the risk of incident HAD in hospitalized older adults. We examined electronic health record (EHR) data for 35,201 older adults ≥ 65 years of age admitted to the general inpatient (non-ICU) units of UAB Hospital from January 1, 2015 to December 31, 2019. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission, and HAD defined as a decline on the Katz ADL scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations for individuals with multiple admissions. We found that 21.2% of older adults developed HAD during their hospitalization and experienced higher delirium rates as compared to those not developing HAD (25.2% vs. 16.3%). Presence of delirium, medical comorbidity score, baseline cognitive status, and baseline ADL function were associated (all p <0.001) with incident HAD. Mediation analyses also showed that 8% of the effect of comorbidity on incident HAD was due to delirium (p < 0.001). Reducing rates of delirium can be one component of a comprehensive approach to reduce rates of HAD in older adults.

scholarly journals 1137 Sleep Duration, Physical Activity And Cognitive Decline In Chinese Older Adults: Findings From The CHARLS

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A433-A433
Author(s):  
J Li ◽  
A J Alfini ◽  
F Yu ◽  
J A Schrack ◽  
V Cotter ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cognitive Decline ◽  
Sleep Duration ◽  
Community Dwelling ◽  
Cognitive Outcomes ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Long Sleep

Abstract Introduction Lack of physical activity and disturbed sleep have been linked to older adult’s poor cognitive outcomes; however, little is unknown how they interact to affect cognition long-term. The purpose of this study was to examine the association of baseline sleep duration and physical activity (PA) with change in cognition independently and interactively over four years. Methods The sample included 1126 community-dwelling older adults aged 60+ (mean age 67.1±5.9 years, 51% female) from the 2011 baseline and 2015 follow-up data of the China Health and Retirement Longitudinal Study (CHARLS). All variables were assessed through interviews. Sleep duration was measured with hours per 30-minute interval and categorized as very-short (<5h), short (5-6.5h), normal (7-8.5h), and long (≥9h). PA was calculated based on PA intensity, duration, and number of days. Cognition was a composite score of mental capacity, episodic memory, and visuospatial abilities. Data were analyzed using multiple regression (primary outcome: change in cognition; main independent variables: baseline sleep, PA, and sleep PA interaction). Results At baseline, 19% of participants had very-short sleep duration, 34.4% had short sleep, 39.2% had normal sleep, and 7.2% had long sleep. At follow-up, 57.5% of participants experienced cognitive decline (-3.5±2.5). After controlling for age, gender, education, region, body mass index, smoking, drinking, number of chronic conditions, pain, depression, and cognition at baseline, compared to participants reporting 7-8.5h sleep, those with ≥9h sleep had significantly greater decline in cognition [β=-1.4, 95% CI=2.4, -0.4], while those with <5h sleep [β=-0.5, 95% CI=-1.2, 0.2] and 5-6.5h sleep did not [β=-0.1, 95% CI=-0.7, 0.5]. PA was neither associated with cognitive decline, nor moderated the relationship between sleep duration and cognitive decline. Conclusion Long sleep might be a marker of cognitive decline in older adults. Prospective analysis, using objectively measured PA and sleep should be conducted to further examine these associations. Support National Institute of Nursing Research R00NR016484

scholarly journals 4489 Association between surgery with general anesthesia and cognitive decline in older adults: analysis using shared parameter models for informative dropout

2020 ◽  
Vol 4 (s1) ◽  
pp. 45-45
Author(s):  
Phillip Schulte ◽  
Katrina Devick ◽  
Juraj Sprung
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Mixed Effects ◽  
Cognitive Outcomes ◽  
Drop Out ◽  
Mixed Effects Models ◽  
Z Score ◽  
Informative Dropout ◽  
Linear Mixed Effects Models ◽  
Linear Mixed Effects

OBJECTIVES/GOALS: Recent studies have assessed the association between surgery with general anesthesia and cognitive decline in longitudinal cohorts of older adults. Patients diagnosed with dementia more frequently drop out of these longitudinal studies or are unable to complete the test battery. We revisit this aim with focus on methods for informative dropout. METHODS/STUDY POPULATION: We use data from the Mayo Clinic Study of Aging (MCSA), a longitudinal epidemiological study of the prevalence, incidence, and risk factors for mild cognitive impairment (MCI) and dementia. Our primary outcome of interest was global cognitive z-score, assessed at study visits every 15 months. We implement linear mixed effects models to assess the association between post-enrollment exposure to surgery/anesthesia and subsequent cognitive decline trajectories. Demented patients more frequently drop out of MCSA, so, subjects with the worst cognitive outcomes are unobserved and missing data may be informative. Since this missingness may be missing not at random, we use shared parameter models to analyze continuous cognitive outcomes while jointly modeling time to dementia. RESULTS/ANTICIPATED RESULTS: A total 1948 subjects, non-demented at baseline, from the MCSA were included. Median age was 79, 51% of subjects were male, and 16% had MCI at enrollment. Among median follow-up of 4 study visits over median 5.4 years, 172 patients developed dementia and dropped out from further assessments of cognitive function. In adjusted linear mixed effects models, our data suggest post-enrollment exposure to surgery/anesthesia is associated with a decline in cognitive function over time (change in slope = −0.07 standard deviations of cognitive z-score per year, 95%CI = −0.08, −0.05, p<.001). After adjusting for informative dropout using shared parameter models, surgery/anesthesia is associated with greater cognitive decline (change in slope = −0.14 per year, 95%CI = −0.16, −0.12, p<.001). DISCUSSION/SIGNIFICANCE OF IMPACT: We revisited a prior analysis by our group with consideration of informative dropout. Subjects who dropout due to dementia may have different trajectories of cognitive decline compared to non-demented subjects. Shared parameter models estimate the association between surgery/anesthesia and cognitive decline accounting for informative dropout.

scholarly journals Temporal context effects are associated with cognitive status in advanced age

2021 ◽  
Author(s):  
Sarah Maaß ◽  
Thomas Wolbers ◽  
Hedderik van Rijn ◽  
Martin Riemer
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Context Effects ◽  
Clinical Stage ◽  
Cognitive Status ◽  
Mixed Block ◽  
Diagnostic Tools ◽  
Temporal Context ◽  
Memory Functioning ◽  
Temporal Intervals

AbstractThe perception of temporal intervals changes during the life-span, and especially older adults demonstrate specific impairments of timing abilities. Recently, we demonstrated that timing performance and cognitive status are correlated in older adults, suggesting that timing tasks can serve as a behavioral marker for the development of dementia. Easy-to-administer and retest-capable timing tasks therefore have potential as diagnostic tools for tracking cognitive decline. However, before being tested in a clinical cohort study, a further validation and specification of the original findings is warranted. Here we introduce several modifications of the original task and investigated the effects of temporal context on time perception in older adults (> 65 years) with low versus high scores in the Montreal Cognitive Assessment survey (MoCA) and a test of memory functioning. In line with our previous work, we found that temporal context effects were more pronounced with increasing memory deficits, but also that these effects are stronger for realistic compared to abstract visual stimuli. Furthermore, we show that two distinct temporal contexts influence timing behavior in separate experimental blocks, as well as in a mixed block in which both contexts are presented together. These results replicate and extend our previous findings. They demonstrate the stability of the effect for different stimulus material and show that timing tasks can reveal valuable information about the cognitive status of older adults. In the future, these findings could serve as a basis for the development of a diagnostic tool for pathological cognitive decline at an early, pre-clinical stage.

scholarly journals Human anterolateral entorhinal cortex volumes are associated with preclinical cognitive decline

2016 ◽  
Author(s):  
RK Olsen ◽  
L-K Yeung ◽  
A Noly-Gandon ◽  
MC D’Angelo ◽  
A Kacollja ◽  
...  
Keyword(s):  
Older Adults ◽  
White Matter ◽  
Cognitive Decline ◽  
Entorhinal Cortex ◽  
Medial Temporal Lobe ◽  
Cognitive Status ◽  
Community Dwelling ◽  
White Matter Hyperintensity ◽  
Whole Brain ◽  
Community Dwelling Older Adults

AbstractWe investigated whether older adults without subjective memory complaints, but who present with cognitive decline in the laboratory, demonstrate atrophy in medial temporal lobe (MTL) subregions associated with Alzheimer's disease. Forty community-dwelling older adults were categorized based on Montreal Cognitive Assessment (MoCA) performance. Total grey/white matter, cerebrospinal fluid, and white matter hyperintensity load were quantified from whole-brain T1-weighted and FLAIR magnetic resonance imaging scans, while hippocampal subfields and MTL cortical subregion volumes (CA1, dentate gyrus/CA2/3, subiculum, anterolateral and posteromedial entorhinal, perirhinal, and parahippocampal cortices) were quantified using high-resolution T2-weighted scans. Cognitive status was evaluated using standard neuropsychological assessments. No significant differences were found in the whole-brain measures. However, MTL volumetry revealed that anterolateral entorhinal cortex (alERC) volume -- the same region in which Alzheimer's pathology originates -- was strongly associated with MoCA performance. This is the first study to demonstrate that alERC volume is related to cognitive decline in preclinical, community-dwelling older adults.

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