Biopsychosocial Patterning of Multimorbidity and Its Consequences

Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Charles Emlet ◽  
Karen Fredriksen Goldsen

Abstract This past year, the lives of vulnerable older adults, including those within the older LGBTQ+ community have been disrupted dramatically, as has the research agendas designed to improve their lives. Older people, including LGBTQ+ older adults with dementia, have been placed at increased risk for social isolation and mental health issues during COVID, making viable interventions even more crucial. Additionally, how research is conducted within these communities needed to be adjusted in order to preserve viability. This symposium draws upon data from the National Health Aging and Sexuality/Gender study, the first longitudinal study of LGBTQ+ older adults in the United States, as well as data from Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action), the first randomized controlled trial (RCT) designed to improve quality of life of LGBTQ+ adults living with dementia and their care partners. (1) Kim and Fredriksen Goldsen examine modifiable behavioral and social factors that can improve quality of life among LGBTQ+ older adults with cognitive impairment. (2) Fredriksen Goldsen, Teri, Emlet and colleagues present initial efficacy findings from the IDEA study and how the intervention needed to be altered to be viable in a COVID world. (3) The importance of Motivational Interviewing (MI) as part of a LGBTQ+ sensitive intervention designed for LGBTQ+ older adults with dementia and their care partners is discussed by Petros, Fredriksen Goldsen and Teri. As COVID continues to impact vulnerable populations as well as research and service delivery, identifying new and innovative strategies will become increasingly important.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 302-303
Author(s):  
Stephanie Yamin ◽  
Roxana Manoiu ◽  
Gary Naglie ◽  
Sarah Sanford ◽  
Elaine Stasiulis ◽  
...  

Abstract Driving often provides a sense of independence, quality of life and emotional wellbeing. For older adults living with dementia, driving cessation eventually becomes inevitable. Driving cessation has been shown to negatively impact older adults’ mobility and, consequently, quality of life. Caregivers of persons with dementia (PWD) who have ceased driving are also impacted as they often become responsible for meeting the mobility needs of PWD and they provide emotional support in respect to this significant life transition. To date, there is little information on the role of gender in the transition to driving cessation in PWD. The purpose of this study was to examine the role that gender plays among drivers and ex-drivers with dementia from the perspectives of PWD, their caregivers, and healthcare practitioners. Secondary thematic analyses were conducted from a pre-existing sample of persons with dementia (N=10), family caregivers (N=13), and healthcare practitioners (N=6) who participated in interviews and focus groups about their experiences around driving cessation in the context of dementia. Data analyses involved an inductive thematic technique that allowed for generating themes. The main themes identified gender differences as a significant factor in: (1) difficulty accepting driving cessation (2) driving as it is tied to identity, (3) emotional responses to driving cessation, (4) driving as part of the caregiving role. The findings suggest that there is a need for tailored interventions for men and women who lose their ability to drive, in addressing their unique emotional responses and in supporting them through this important life transition.


2020 ◽  
Vol 32 (S1) ◽  
pp. 15-16
Author(s):  
William E. Reichman ◽  
L. Bradford Perkins ◽  
Hilde Verbeek

This symposium will review the latest data on the influence of environmental design and its attributes on the cognitive and psychological wellbeing of older adults living with dementia. The presenters will cover the myriad ways in which the physical environment of care can adapt to the changing demands of older adults with sensory, motor and cognitive deficits and foster optimal functioning and quality of life. The role of emerging technologies will also be reviewed as they complement the contribution of the design of the physical environment to the wellbeing of older adults with cognitive impairment. Information will be offered through a review of the existing research literature as well as case studies that illustrate the impact of environmental modification on fostering wellbeing and minimizing the emergence of the behavioral and psychological symptoms of dementia. The presenters will represent and integrate sensibilities that have emerged from the fields of architecture, cognitive neuroscience and psychology.How the Principles of the Culture Change Movement Inform Environmental Design and the Application of Technology in the Care of Older Adults Living with DementiaWilliam E. ReichmanThe culture change movement informs a number of principles that have been applied to more contemporary design concepts for the congregate care of older adults living with dementia. This talk will review the core tenets of the Culture Change Movement as exemplified by the Greenhouse, Dementia Village and other innovative models of congregate long-term care. Specific reference will be made to how these tenets have been operationalized around the world into the design of programming and the creation of residential care environments that foster a better quality of life for older adults and an enhanced work environment for care providers. This talk will also include the emerging role of technologies that complement innovative design of the environment and which foster optimized social and recreational functioning of older adults living with dementia.A Better Life Through a Better Nursing Home DesignL. Bradford PerkinsOver the last 20 years there has been extensive experimentation related to the role of the environment in the housing, care and treatment of persons with Alzheimer’s and other age related dementias. Prior to that time the typical housing and care environment was a locked unit in a skilled nursing or other restrictive senior living facility. In 1991 the Presbyterian Association on Aging in Western Pennsylvania opened Woodside Place on its Oakmont campus. This small 36 bed facility was designed to incorporate the latest research and care experience with persons suffering from these issues. This one small project, as well as the long post occupancy research led by Carnegie Mellon University, clearly demonstrated that individuals with Alzheimer’s and related forms of dementia could lead a healthier, happier, higher quality of life in a more residential, less restrictive environment. Not everything in this pioneering project worked, and five generations of living and care models have followed that have refined the ideas first demonstrated by Woodside Place. Bradford Perkins, whose firm designed Woodside Place and over 100 other related projects, will discuss what was learned from Woodside Place as well as the five generations of projects (and post occupancy research) that followed.Innovative dementia care environments as alternatives for traditional nursing homes: evidence and experiences from the NetherlandsHilde VerbeekKey goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable one’s own lifestyle for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed that have radically changed the physical, social and organizational aspects of long-term care in the Netherlands. This presentation discusses various Dutch models that have implemented small-scale and homelike care environments, including green care farms, dementia village and citizen initiatives. The models reflect a common care concept, focusing on residents’ remaining strengths, providing opportunity for choice and aiming to sustain a sense of self and control. A small number of residents (usually 6 to 8) live together in a homelike environment and nursing staff are part of the household. Residents are encouraged to participate in daily household activities, emphasizing normalization of daily life with person-centred care. The physical environment resembles an archetypal home. This talk presents the scientific evidence on the impact and effects of these small-scale, homelike models on residents, their family caregivers and staff. Furthermore, the presentation will highlight working approaches and how these initiatives have positively influenced routine care across the long-term care spectrum.


2020 ◽  
Author(s):  
Á Szabó ◽  
Eva Neely ◽  
C Stephens

© The Author(s) 2019. Community grandparenting may promote the well-being of older adults. We examined the impact of non-kin and grandparental childcare on quality of life and loneliness using longitudinal data from 2653 older New Zealanders collected over 2 years. Providing both non-kin and grandparental childcare predicted greater self-realisation for women only and was associated with reduced levels of control and autonomy for men. Non-kin childcare was also associated with reduced social loneliness over time independent of gender. Findings suggest that non-kin grandparenting has psychosocial benefits for older adults. Surrogate grandparenting offers promising avenues for those without grandchildren to experience the benefits of grandparenting.


2021 ◽  
Vol 67 (1) ◽  
pp. 83-87
Author(s):  
Levi Bezerra Sena ◽  
Larissa Paixão Batista ◽  
Flávia Fonseca Fernandes ◽  
Alfredo Nicodemos Cruz Santana

Author(s):  
Murtaja Ali Saare ◽  
Azham Hussain ◽  
Wong Seng Yue

This article examines the link between the older adult’s cognitive decline, and Assistive Mobile Health Applications in terms of quality of life as researcher has found scarcity in explaining the mediating role of assistive mobile health applications towards the quality of life of older adults with cognitive decline. Researchers have identified the importance of using assistive mobile health applications in connection of the older adult’s cognitive decline. However, it remained unaddressed in the explaining the mediating role of assistive mobile health application. Therefore, this paper aims to provide an insight that the adoption of assistive m-health applications will provide this population with potential solution to their challenging aging life, hence, enhancing their quality of life. In addition, this paper is only a conceptual explanation, as it aims to identify the possible reasons that influence their Smartphone adoption. Factors were identified using a systematic literature review on relevant peer reviewed papers. The study summarized the empirical evidences which were used to support the conceptual explanation. It is expected that this work will lead towards the empirical findings on the explanation of the mediating role of the assistive mobile health applications to address the relationship of older adult’s cognitive decline and quality of life. This paper providesdirections for future studies in improving the quality of life of older adults.


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