Physical Frailty and Cognitive Impairment in Older Adults in United States Nursing Homes

2021 ◽  
pp. 1-8
Author(s):  
Yiyang Yuan ◽  
Kate L. Lapane ◽  
Jennifer Tjia ◽  
Jonggyu Baek ◽  
Shao-Hsien Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
National Database ◽  
Physical Frailty ◽  
Cognitive Performance Scale ◽  
Data Set ◽  
Severe Impairment ◽  
Generalized Estimation Equation ◽  
Mild Impairment ◽  
Over Time

<b><i>Introduction:</i></b> In older US nursing home (NH) residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults’ first 6 months of NH stay. <b><i>Methods:</i></b> Minimum Data Set (MDS) 3.0 is the national database on residents in US Medicare-/Medicaid-certified NHs. MDS 3.0 was used to identify older adults aged ≥65 years, newly admitted to NHs during January 1, 2014, and June 30, 2016, with life expectancy ≥6 months at admission and NH length of stay ≥6 months (<i>N</i> = 571,139). MDS 3.0 assessments at admission, 3 months, and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust, prefrail, and frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild, moderate, and severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. A nonproportional odds model was fitted with a generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. <b><i>Results:</i></b> Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were prefrail at admission, 23% improved to robust by 3 months. At admission, 3 months, and 6 months, over 37% of older residents had severe cognitive impairment and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.33–1.37) and those with severe impairment were 74% more likely (aOR: 1.74, 95% CI: 1.72–1.77) to be frail than prefrail/robust, compared to those with none/mild impairment. The association between the 2 conditions remained positive and consistently increased over time. <b><i>Discussion/Conclusion:</i></b> Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target, and interventions may include efforts to address cognitive impairment.

scholarly journals Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment

2021 ◽  
Vol 12 ◽  
Author(s):  
Björn Andersson ◽  
Hao Luo ◽  
Gloria H. Y. Wong ◽  
Terry Y. S. Lum
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Cognitive Assessment ◽  
Assessment Tools ◽  
Montreal Cognitive Assessment ◽  
Cognitive Performance Scale ◽  
Mild Impairment ◽  
Performance Scale

Background: Bridging scores generated from different cognitive assessment tools is necessary to efficiently track changes in cognition across the continuum of care. This study linked scores from the Montreal Cognitive Assessment-5 min (MoCA 5-min) to the interRAI cognitive Performance Scale (CPS), commonly adopted tools in clinical and long-term care settings, respectively.Methods: We included individual-level data from persons who participated in a home- and community-based care program for older people with mild impairment in Hong Kong. The program used the interRAI-Check Up instrument for needs assessment and service matching between 2017 and 2020. Each participant's cognitive performance was assessed using CPS, CPS Version 2 (CPS2), and MoCA 5-min. We performed equipercentile linking with bivariate log-linear smoothing to establish equivalent scores between the two scales.Results: 3,543 participants had valid data on both scales; 66% were female and their average age was 78.9 years (SD = 8.2). The mean scores for MoCA 5-min, CPS, and CPS2 were 18.5 (SD = 5.9), 0.7 (SD = 0.7), and 1.3 (SD = 1.1), respectively. A CPS or CPS2 score of 0 (intact cognition) corresponds to MoCA 5-min scores of 24 and 25, respectively. At the higher end, a CPS score of 3 (moderately impaired) and a CPS2 score of 5 (moderately impaired Level-2) corresponded to MoCA 5-min scores of 0 and 1, respectively. The linking functions revealed the floor and ceiling effects that exist for the different scales, with CPS and CPS2 measuring more-severe cognitive impairment while the MoCA 5-min was better suited to measure mild impairment.Conclusions: We provided score conversions between MoCA 5-min and CPS/CPS2 within a large cohort of Hong Kong older adults with mild physical or cognitive impairment. This enabled continuity in repeated assessment with different tools and improved comparability of cognitive scores generated from different tools from diverse populations and research cohorts.

scholarly journals Physical Frailty and Cognitive Impairment in Older Nursing Home Residents: A Latent Class Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 823-824
Author(s):  
Yiyang Yuan ◽  
Kate Lapane ◽  
Jennifer Tjia ◽  
Jonggyu Baek ◽  
Shao-Hsien Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Nursing Home Residents ◽  
Class Analysis ◽  
Physical Frailty ◽  
Data Set ◽  
Clinical Presentations ◽  
New Evidence

Abstract Physical frailty (PF) has various clinical presentations and often co-occurs with cognitive impairment in older adults. In older adults in nursing homes (NHs), no research has examined the heterogeneous profile of PF and its association with cognitive impairment. Minimum Data Set 3.0 was used to identify older, long-stay, newly-admitted NH residents (2014-16; n=871,801). Latent class analysis was used to identify PF subgroups with FRAIL-NH items as indicators. Logistic regression was used to estimate the association between PF subgroups and cognitive impairment. The final model indicated three PF subgroups (prevalence): “mild PF” (7.6%), “moderate PF” (44.5%), and “severe PF” (47.9%). In all subgroups, residents had high probability of needing help with dressing. Older adults likely to belong to the “moderate PF” or the “severe PF” subgroups had high probabilities of requiring physical assistance to transfer between locations and inability to walk in a room. Additionally, residents likely to be in the “severe PF” subgroup had greater probability of bowel incontinence. Greater cognitive impairment was associated with increasingly higher odds to be in the “moderate PF” and “severe PF” subgroups: older residents with severe cognitive impairment were 20% more likely [adjusted odds ratio (aOR): 1.20, 95% confidence interval (CI): 1.17-1.23] and almost 7 times as likely (aOR: 6.86, 95%CI: 6.66-7.06) to belong to the “moderate PF” and “severe PF” subgroups, respectively. Findings provide new evidence for the interrelationship between PF and cognitive impairment in older NH residents and have implications for the development of interventions tailored to older residents’ specific PF experience.

Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

2021 ◽  
Author(s):  
Mei-Ling Ge ◽  
Eleanor M Simonsick ◽  
Bi-Rong Dong ◽  
Judith D Kasper ◽  
Qian-Li Xue
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Strong Predictor ◽  
Word Recall ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Clock Drawing Test ◽  
Recurrent Falls ◽  
Health Aging ◽  
Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

scholarly journals PSYCHOLOGICAL WELL-BEING AND THE ONSET OF COGNITIVE IMPAIRMENT AMONG CHINESE OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S114-S115
Author(s):  
Jiaan Zhang
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Multinomial Logistic Regression ◽  
Well Being ◽  
Functional Health ◽  
Survey Study ◽  
Psychological Well Being ◽  
Chinese Older Adults ◽  
Study Results ◽  
Over Time

Abstract Previous research has shown the beneficial effects of positive psychological assets on health, but more research is needed to confirm the prospective effects on cognitive function. The purpose of this study is to examine the relationship between psychological well-being and the earliest onset of cognitive impairment among Chinese older adults. Data came from 2000 to 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Study sample consisted of 6,225 older adults who were free from cognitive impairment in 2000. Psychological well-being was measured based on seven items that assessed optimism, conscientiousness, self-determination, happiness, self-esteem, pessimism, and loneliness, with responses ranging from “always (1)” to never (5)”. Negative feelings items were reverse coded. Higher score indicated more positive psychological well-being. Cognitive impairment was measured by a Chinese version of the Mini-Mental State Examination. Respondents scored at or above 24 were regarded as having no cognitive impairment. A multi-category time-varying variable was used to capture four potential outcomes: (1) persistently free of cognitive impairment between waves, (2) onset of cognitive impairment, (3) death between waves, and (4) attrition. Socio-demographics, chronical diseases conditions, functional health status were served as controls. Multilevel multinomial logistic regression models that account for clustering of observations within a subject over time were employed for the study. Results show that more positive psychological well-being is significantly associated with reduced risk of cognitive impairment onset and death over time. Results suggest that developing more psychological resilience-based intervention programs among older adults may help them delay the onset of cognitive impairment.

scholarly journals COGNITIVE AND HEARING IMPAIRMENTS IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Jessica S West ◽  
Scott Lynch
Keyword(s):  
Older Adults ◽  
Sex Differences ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Hearing Impairment ◽  
Cognitive Impairments ◽  
Hearing Impairments ◽  
The Relationship ◽  
Retirement Study ◽  
Over Time

Abstract As the number of older adults increases, increased prevalence of cognitive and sensory impairments pose growing public health challenges. Research on the relationship between hearing impairment and cognition, however, is minimal and has yielded mixed results, with some studies finding that hearing impairment is associated with cognitive decline, and others reporting that the association is weak or non-existent. Most of this research has been conducted outside of the U.S., and the few U.S.-based longitudinal studies have relied mostly on small, non-representative samples involving short follow-up periods. Further, despite known gendered patterns in cognitive and hearing impairments, no studies to date have examined whether the relationship between the two varies by gender. Our study addresses these weaknesses in the literature by utilizing nine waves of the Health and Retirement Study (1998-2014; n=14,169), a large, nationally representative, longitudinal study that facilitates examination of long-term interrelationships between hearing and cognitive impairments. In this study, we use autoregressive latent trajectory (ALT) methods to model: 1) the relationship between hearing impairment and cognitive decline, and 2) sex differences in the relationship. ALT models enable us to determine whether hearing impairment and cognitive impairment are associated, net of their common tendency simply to co-trend with age. Results indicate that hearing and cognitive impairments are strongly interrelated processes that trend together over time. Moreover, hearing impairment has an increasing impact on cognitive impairment across age while the effect of cognitive impairment on hearing impairment levels out over time. Sex differences in these patterns are discussed.

scholarly journals Deviations in Hippocampal Subregion in Older Adults With Cognitive Frailty

2021 ◽  
Vol 12 ◽  
Author(s):  
Mingyue Wan ◽  
Yu Ye ◽  
Huiying Lin ◽  
Ying Xu ◽  
Shengxiang Liang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Molecular Layer ◽  
Chinese Version ◽  
Healthy Controls ◽  
Physical Frailty ◽  
Cognitive Frailty ◽  
Significant Volume ◽  
The Right ◽  
Volume Decrease

BackgroundCognitive frailty is a particular state of cognitive vulnerability toward dementia with neuropathological hallmarks. The hippocampus is a complex, heterogeneous structure closely relates to the cognitive impairment in elderly which is composed of 12 subregions. Atrophy of these subregions has been implicated in a variety of neurodegenerative diseases. The aim of this study was to explore the changes in hippocampal subregions in older adults with cognitive frailty and the relationship between subregions and cognitive impairment as well as physical frailty.MethodsTwenty-six older adults with cognitive frailty and 26 matched healthy controls were included in this study. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA) scale (Fuzhou version) and Wechsler Memory Scale-Revised Chinese version (WMS-RC), while physical frailty was tested with the Chinese version of the Edmonton Frailty Scale (EFS) and grip strength. The volume of the hippocampal subregions was measured with structural brain magnetic resonance imaging. Partial correlation analysis was carried out between the volumes of hippocampal subregions and MoCA scores, Wechsler’s Memory Quotient and physical frailty indexes.ResultsA significant volume decrease was found in six hippocampal subregions, including the bilateral presubiculum, the left parasubiculum, molecular layer of the hippocampus proper (molecular layer of the HP), and hippocampal amygdala transition area (HATA), and the right cornu ammonis subfield 1 (CA1) area, in older adults with cognitive frailty, while the proportion of brain parenchyma and total number of white matter fibers were lower than those in the healthy controls. Positive correlations were found between Wechsler’s Memory Quotient and the size of the left molecular layer of the HP and HATA and the right presubiculum. The sizes of the left presubiculum, molecular of the layer HP, and HATA and right CA1 and presubiculum were found to be positively correlated with MoCA score. The sizes of the left parasubiculum, molecular layer of the HP and HATA were found to be negatively correlated with the physical frailty index.ConclusionSignificant volume decrease occurs in hippocampal subregions of older adults with cognitive frailty, and these changes are correlated with cognitive impairment and physical frailty. Therefore, the atrophy of hippocampal subregions could participate in the pathological progression of cognitive frailty.

scholarly journals Cognitive Frailty and Its Long-Term Effect on Depression in an Older Population in Korea

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 442-442
Author(s):  
Yoonjung Ji ◽  
TaeWha Lee ◽  
Eunkyung Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Group Analysis ◽  
Secondary Analysis ◽  
Epidemiological Studies ◽  
Physical Frailty ◽  
Older Population ◽  
Cognitive Frailty ◽  
The Relationship

Abstract Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist without dementia. It occurs in 1.8%-8.9% of the general older population, and older people with depression have a higher risk of frailty. However, the relationship between cognitive frailty and depression is still unclear. This study aimed to determine the relationship between cognitive frailty and depression of older adults by time using comparative group analysis. A secondary analysis was conducted using the Korean Longitudinal Study of Aging (KLoSA) dataset from 2010 to 2018. A sample was 981 older adults who were 65 years old and without dementia over residing in the community. Cognitive frailty was defined as having a mini-mental state examination score of 18-23 and 3 or more of the Fried frailty indexes. Generalized Estimating Equation model and chi-square test were employed. Of the 981 subjects, the cognitive frailty(CF) was 28.5%, followed by robust (37.7%), physical frailty (PF, 29.4%), mild cognitive impairment (MCI, 4.4%) at baseline. The group differences on depression measured by the Center for Epidemiological Studies Depression (CESD) were statistically significant in the PF (F=4.70, p&lt;.001) and the CF (F=4.95, p&lt;.001) group compared to the robust group. The time difference effect (F=.09, p=.05) and a group-by-time interaction effect were observed (p&lt;.001). This study confirmed that cognitive frailty is strongly associated with depression. Effective approaches to managing psychological wellbeing, including dementia, are essential for older adults with cognitive frailty.

scholarly journals Using Digital Speech Assessments to Detect Early Signs of Cognitive Impairment

2021 ◽  
Vol 3 ◽  
Author(s):  
Jessica Robin ◽  
Mengdan Xu ◽  
Liam D. Kaufman ◽  
William Simpson
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Screening Tools ◽  
Rapid Decline ◽  
Assessment Task ◽  
Early Signs ◽  
Over Time

Detecting early signs of cognitive decline is crucial for early detection and treatment of Alzheimer's Disease. Most of the current screening tools for Alzheimer's Disease represent a significant burden, requiring invasive procedures, or intensive and costly clinical testing. Recent findings have highlighted changes to speech and language patterns that occur in Alzheimer's Disease, and may be detectable prior to diagnosis. Automated tools to assess speech have been developed that can be used on a smartphone or tablet, from one's home, in under 10 min. In this study, we present the results of a study of older adults who completed a digital speech assessment task over a 6-month period. Participants were grouped according to those who scored above (N = 18) or below (N = 18) the recommended threshold for detecting cognitive impairment on the Montreal Cognitive Assessment (MoCA) and those with diagnoses of mild cognitive impairment (MCI) or early Alzheimer's Disease (AD) (N = 14). Older adults who scored above the MoCA threshold had better performance on speech composites reflecting language coherence, information richness, syntactic complexity, and word finding abilities. Those with MCI and AD showed more rapid decline in the coherence of language from baseline to 6-month follow-up, suggesting that this score may be useful both for detecting cognitive decline and monitoring change over time. This study demonstrates that automated speech assessments have potential as sensitive tools to detect early signs of cognitive impairment and monitor progression over time.

scholarly journals Determinants of Sleep Medication Use among Participants in the National Alzheimer’s Coordinating Center Uniform Data Set

2019 ◽  
Vol 39 (12) ◽  
pp. 1340-1349
Author(s):  
Mairead Moloney ◽  
GYeon Oh ◽  
Daniela C. Moga
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Clinical Intervention ◽  
Medication Usage ◽  
Data Set ◽  
Factors Associated ◽  
Sleep Medication ◽  
Younger Age ◽  
Sedative Hypnotics ◽  
Usage Rates

Sufficient sleep is critical for health in older adults, but prescription sleep aids are associated with numerous health risks (e.g., cognitive impairment and falls). We examine usage prevalence of two medication categories—sedative hypnotics (SH) and medications commonly used for insomnia (MCUFI)—among adults aged 45+ in the National Alzheimer’s Coordinating Center data set. Analyzing the visits conducted between September 2005 and June 2018, we determine the factors associated with SH and MCUFI use, including sociodemographic, health, independence, and cognitive statuses. Usage rates were 9% for MCUFI ( N = 3,279) and 4% for SH ( N = 1,382). Multivariable logistic regression identified White race, higher education, younger age, depression, and sedative polypharmacy as factors associated with prescription sleep aid use. We conclude that sleep medication usage rates among older adults, higher likelihood of sedative medication polypharmacy, and higher likelihood of MCUFI use among adults with cognitive impairment are findings of concern and may warrant clinical intervention.

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