scholarly journals Expectations and Concerns of Older Adults With Cognitive Impairment About Their Relationship With Medical Providers: A Call for Therapeutic Alliances

2020 ◽  
Vol 30 (10) ◽  
pp. 1584-1595
Author(s):  
Elena Portacolone ◽  
Kenneth E. Covinsky ◽  
Julene K. Johnson ◽  
Jodi Halpern
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Therapeutic Alliance ◽  
Narrative Analysis ◽  
Medical Providers ◽  
Therapeutic Alliances ◽  
First Case ◽  
Dementia Research ◽  
Study Participants ◽  
The Relationship

We sought to understand the expectations and concerns of older adults with cognitive impairment with regard to their relationship with medical providers. In particular, we observed whether study participants were involved in therapeutic alliances. Medical providers and patients create therapeutic alliances when they agree on the goals of the treatment and share a personal bond. Whereas such alliances have been studied in cancer research, little is known about therapeutic alliances in dementia research. Data were gathered in a qualitative study of 27 older adults with cognitive impairment and analyzed with narrative analysis. We introduce four case studies that illustrate the effects of having or missing a therapeutic alliance. Whereas the participant in the first case benefited from a therapeutic alliance, the other cases are marked by different experiences of abandonment. Findings suggest that interventions should concentrate on ways to enhance the relationship between medical providers and patients with cognitive impairment.

scholarly journals Bidirectional Relationship Between Subjective Age and Frailty: Findings From the NHATS

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 271-271
Author(s):  
Yuxiao Li ◽  
Minhui Liu ◽  
Christina Miyawaki ◽  
Xiaocao Sun ◽  
Tianxue Hou ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Syndrome ◽  
Community Dwelling ◽  
Chronological Age ◽  
Subjective Age ◽  
Bidirectional Relationship ◽  
Study Participants ◽  
Community Dwelling Older Adults ◽  
The Relationship ◽  
Hispanic White

Abstract Frailty is a clinical syndrome that becomes increasingly common as people age. Subjective age refers to how young or old individuals experience themselves to be. It is associated with many risk factors of frailty, such as increased depression, worse cognitive function, and poorer psychological wellbeing. In this study, we examined the relationship between subjective age and frailty using the 2011-2015 waves of the National Health and Aging Trends Study. Participants were community-dwelling older adults without frailty in the initial wave (N=1,165). Subjective age was measured by asking participants, “What age do you feel most of the time?” Based on the Fried five phenotypic criteria: exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength, frailty was categorized into robust=0, pre-frail=1 or 2; frail=3 or more criteria met. Participants were, on average, 74.1±6.5 years old, female (52%), and non-Hispanic White (81%). Eighty-five percent of the participants felt younger, and 3% felt older than their chronological age, but 41% of them were pre-frail/frail. Generalized estimating equations revealed that an “older” subjective age predicted a higher likelihood of pre-frailty and frailty (OR, 95%CI= 1.01, 1.01-1.02). In contrast, frailty predicted an “older” subjective age (OR, 95%CI= 2.97, 1.65-5.35) adjusting for demographics and health conditions. These findings suggest a bidirectional relationship between subjective age and frailty. Older people who feel younger than their chronological age are at reduced risk of becoming pre-frail/frail. Intervention programs to delay frailty progression should include strategies that may help older adults perceive a younger subjective age.

Abstract W P156: Arterial Stiffness in Older Adults With and Without Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ada Tang ◽  
Daria Shkredova ◽  
Derek W Stouth ◽  
Maureen J MacDonald ◽  
Jennifer J Heisz
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Arterial Stiffness ◽  
Cardiovascular Events ◽  
Pulse Transit Time ◽  
Group Differences ◽  
Ongoing Work ◽  
Increased Risk ◽  
Stroke Group ◽  
The Relationship

Introduction: Silent cerebrovascular infarcts resulting from vascular disease can manifest as a decline in cognitive function. These silent events are also associated with increased risk of clinically overt stroke. Arterial stiffness is a marker that represents atherosclerotic progression and is a predictor of cardiovascular events and mortality. This study examined the relationship between arterial stiffness and cognitive impairment between adults aged 50-80 years old with and without stroke. Hypothesis: We hypothesized that elevated arterial stiffness would be observed in individuals with stroke, and also be associated with increased cognitive impairment across all participants. Methods: Cognition was assessed using the Montreal Cognitive Assessment (MoCA). Arterial stiffness was quantified using carotid-femoral pulse wave velocity (cfPWV, in m/s), calculated as cfPWV=D/Δt, where D was the distance measured between arterial sites and Δt was the pulse transit time. Higher values represent increased stiffness, and values >10 m/s are associated with increased risk for cardiovascular events. Results: Twenty-five participants were assessed: 11 participants 4.7±2.4 years post-stroke and 14 older adults without stroke. The non-stroke group was older (73.1±3.9 vs. 65.2±9.4 years, P=0.009), while the stroke group had lower MoCA scores (21.2±3.2 vs. 24.4±2.8, P=0.01). There were no between-group differences in cfPWV (stroke 9.4 m/s vs. older adults 9.9 m/s, P=0.49), when controlling for age and MoCA scores. In backward regression analysis, age explained 21% of the variance of cfPWV (P=0.03), while MoCA was not a contributor. Conclusions: In conclusion, these results suggest that age is a significant correlate of arterial stiffness, regardless of the presence of stroke or cognitive impairment. Ongoing work will examine whether stroke history also contributes to arterial stiffness when groups are matched for age.

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 INCIDENCE OF COGNITIVE IMPAIRMENT AMONG U.S. CHINESE OLDER ADULTS: DOES SOCIAL ENGAGEMENT MATTER?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S929-S929
Author(s):  
Dexia Kong ◽  
XinQi Dong
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Aging ◽  
Social Engagement ◽  
Population Based ◽  
Chinese Older Adults ◽  
Cognitive Domains ◽  
Prior Literature ◽  
Cognitive Activities ◽  
The Relationship

Abstract The increasing diversity in U.S. aging population warrants improved understanding of risk factors of cognitive aging in minority populations. This study presents the prevalence of incident cognitive impairment (CI) among U.S. Chinese older adults; and the relationship between social engagement and incident CI. Data were obtained from the Population-based Study of Chinese Elderly in Chicago, a prospective cohort study of Chinese older adults. Baseline (collected between 2011 and 2013) and one subsequent wave of data (collected between 2013 and 2015) were used in analyses (N=2,713). Social engagement was measured by the frequency of participation in social and cognitive activities (range=0-65). Cognitive function was assessed by a battery of 5 validated instruments. Incidence of CI was defined as having a follow-up cognition score lower than 1.5 standard deviations below the mean baseline cognition score. Logistic regression analyses were conducted. Nearly 6% of the sample reported incident CI. Chinese older adults who are more socially-engaged had a lower likelihood of developing CI (odds ratio [OR] 0.94, 0.92-0.96). The relationship was consistent across cognitive domains, including episodic memory (OR 0.95, 0.92-0.97), working memory (OR 0.92, 0.88-0.95), and perceptual speed (OR 0.95, 0.92-0.98). Furthermore, older age (OR 1.12, 1.09-1.15), and lower education (OR 0.91, 0.87-0.96) were associated with incident CI. No significant association was observed between gender, income, marital status, household size, acculturation, medical morbidities, depressive symptoms, and incident CI. The findings highlight the importance of social engagement in cognitive aging. Discrepancies with prior literature and implications of these findings will be discussed.

scholarly journals Visual-Somatosensory Integration and Balance: Evidence for Psychophysical Integrative Differences in Aging

2014 ◽  
Vol 27 (1) ◽  
pp. 17-42 ◽  
Author(s):  
Jeannette R. Mahoney ◽  
Roee Holtzer ◽  
Joe Verghese
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Multisensory Processing ◽  
Reaction Times ◽  
The Elderly ◽  
Static Balance ◽  
Healthy Older Adults ◽  
Stance Time ◽  
Study Participants ◽  
The Relationship

Research detailing multisensory integration (MSI) processes in aging and their association with clinically relevant outcomes is virtually non-existent. To our knowledge, the relationship between MSI and balance has not been well-established in aging. Given known alterations in unisensory processing with increasing age, the aims of the current study were to determine differential behavioral patterns of MSI in aging and investigate whether MSI was significantly associated with balance and fall-risk. Seventy healthy older adults ( years; 58% female) participated in the current study. Participants were instructed to make speeded responses to visual, somatosensory, and visual-somatosensory (VS) stimuli. Based on reaction times (RTs) to all stimuli, participants were classified into one of two groups (MSI or NO MSI), depending on their MSI RT benefit. Static balance was assessed using mean unipedal stance time. Overall, results revealed that RTs to VS stimuli were significantly shorter than those elicited to constituent unisensory conditions. Further, the current experimental design afforded differential patterns of multisensory processing, with 75% of the elderly sample demonstrating multisensory enhancements. Interestingly, 25% of older adults did not demonstrate multisensory RT facilitation; a finding that was attributed to extremely fast RTs overall and specifically in response to somatosensory inputs. Individuals in the NO MSI group maintained significantly better unipedal stance times and reported less falls, compared to elders in the MSI group. This study reveals the existence of differential patterns of multisensory processing in aging, while describing the clinical translational value of MSI enhancements in predicting balance and falls risk.

Alcohol consumption and cognitive impairment among Korean older adults: does gender matter?

2013 ◽  
Vol 26 (2) ◽  
pp. 335-340 ◽  
Author(s):  
Jiyoung Lyu ◽  
Seungah Hannah Lee
Keyword(s):  
Older Adults ◽  
Gender Differences ◽  
Cognitive Impairment ◽  
Alcohol Consumption ◽  
Service Providers ◽  
Cognitively Impaired ◽  
Heavy Drinkers ◽  
Prevention And Treatment ◽  
Using Data ◽  
The Relationship

ABSTRACTBackground:This study investigated gender differences in the relationship between alcohol consumption and cognitive impairment among older adults in South Korea.Methods:Using data from the Korean Longitudinal Study of Ageing, 2,471 females and 1,657 males were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam score. Logistic regression was conducted to examine the relationship between alcohol consumption and cognitive impairment among Korean older adults.Results:Multivariate analysis showed that compared to moderate drinkers, past drinkers were more likely to be cognitively impaired for women, while heavy drinkers were more likely to be cognitively impaired for men.Conclusions:Findings suggest that the relationship between alcohol consumption and cognition varies with gender. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

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<.001) and the CF (F=4.95, p<.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<.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.

Perceived loneliness among older adults with mild cognitive impairment

2016 ◽  
Vol 28 (10) ◽  
pp. 1681-1685 ◽  
Author(s):  
Junhong Yu ◽  
Charlene L. M. Lam ◽  
Tatia M. C. Lee
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Impairments ◽  
Community Sample ◽  
Objective Measures ◽  
Subjective Measures ◽  
High Prevalence ◽  
The Relationship

ABSTRACTBackground:The high prevalence of mild cognitive impairment (MCI) in Hong Kong, as previously reported, requires verification. Furthermore, the relationship between loneliness, depression, and cognitive impairment with regards to MCI are unclear. The present study aims to establish the prevalence of MCI in a community sample in Hong Kong and determine if participants with MCI feel significantly lonelier, even after depression has been taken into consideration.Methods:Participants from a community sample (N = 376) were assessed with subjective and objective measures of cognitive impairments to determine whether the criteria had been met for MCI. The MCI cases are then compared with age, sex, and education-matched controls on subjective measures of loneliness and depression.Results:A total of 66 (17.6%) participants were diagnosed with MCI. These participants reported significantly higher levels of perceived loneliness and depression compared to the matched controls. Differences between groups in loneliness remained significant, even after depression levels have been controlled.Conclusions:Loneliness is implicated in MCI. The relationship between loneliness and MCI is, at least, partially independent of depression. The implications of these finding are discussed.

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