Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment

2017 ◽  
Vol 32 (7) ◽  
pp. 408-417 ◽  
Author(s):  
Siran M. Koroukian ◽  
Nicholas K. Schiltz ◽  
David F. Warner ◽  
Kurt C. Stange ◽  
Kathleen A. Smyth
Keyword(s):  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Functional Limitations ◽  
Detailed Characterization ◽  
Health Care Improvement ◽  
Using Data ◽  
Definition Of ◽  
Care Improvement ◽  
Retirement Study

Introduction: This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI). Methods: Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes. Results: In a sample of 18 913 participants (weighted n = 87.5 million), 1.93% and 1.84% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9%, 39.3%, and 71.3% among those with no CI, mild CI, and moderate/severe CI, respectively. Discussion: Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.

scholarly journals CHRONIC CONDITIONS, FUNCTIONAL LIMITATIONS, AND DEPRESSION IN OLDER ADULTS: ANALYSIS OF A LONGITUDINAL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S572-S572
Author(s):  
Jyotsana Parajuli ◽  
Diane Berish ◽  
Ying-Ling Jao
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Direct Effect ◽  
Chronic Conditions ◽  
Functional Limitations ◽  
Mediation Effect ◽  
High Risk Population ◽  
Longitudinal Impact ◽  
The Relationship ◽  
Retirement Study

Abstract Background: Chronic conditions, functional limitations, and depression are highly prevalent in older adults. Evidence suggests the links between chronic conditions, functional limitations, and depressive symptoms separately. However, few studies have considered these three conditions together longitudinally. This study examined the longitudinal relationship between chronic conditions and depressive symptoms and evaluated the mediation effect of functional limitations on the relationship between chronic conditions and depressive symptoms in older adults. Methods: This study analyzed longitudinal data from the Health and Retirement Study collected in 2012 and 2014. Mediation analysis was used to examine the direct and indirect effects of chronic conditions and functional limitations measured at the year 2012 on depressive symptoms measured at the year 2014 controlling for demographics. Results: Results revealed that chronic conditions predicted depressive symptoms. Specifically, one additional chronic condition in 2012 corresponded to an increase of 0.35 in depressive symptoms in 2014 (p<.001). After adding functional limitations as a mediator, the direct effect was reduced to 0.26 and the indirect effect was .088 (p<.001). In other words, functional limitations explained approximately 25% of the direct effect of chronic diseases on depression. Discussion: Findings reveal the longitudinal impact of chronic conditions and functional limitations on depressive symptoms in older adults. Findings help identify the high-risk population of depressive symptoms and intervene early.

scholarly journals Cognitive Impairment, Depression, and Cooccurrence of Both among the Elderly in Panama: Differential Associations with Multimorbidity and Functional Limitations

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Alcibiades E. Villarreal ◽  
Shantal Grajales ◽  
Lineth Lopez ◽  
Gabrielle B. Britton ◽  
Panama Aging Research Initiative
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Chronic Conditions ◽  
Mental Health Problems ◽  
Functional Limitations ◽  
Depression Scale ◽  
The Elderly ◽  
Community Dwelling ◽  
Multinomial Regression

Cognitive impairment and depression are common mental health problems among the elderly, although few studies have examined their cooccurrence in older adults in Latin America. The purpose of this study was to examine cognitive impairment, depression, and cooccurrence of the two conditions and associated factors in a sample of older adults in Panama. This study included 304 community-dwelling elderly (≥65 years) individuals. Participants underwent a clinical interview and assessments of cognitive function by the Minimental State Examination and depressive symptoms by the Geriatric Depression Scale. Limitations in basic (BADL) and instrumental (IADL) activities in daily living and the presence of chronic illnesses were recorded. Multinomial regression analysis revealed that cooccurrence of cognitive impairment and depressive symptoms was explained by increasing age (OR: 3.2, 95% CI: 1.20, 8.30), low education (OR: 3.3, 95% CI: 1.33, 8.38), having four or more chronic conditions (OR: 11.5, 95% CI: 2.84, 46.63), and BADL limitations (OR: 5.0, 95% CI: 1.26, 19.68). Less education and limitations in BADL and IADL increased the odds of cognitive impairment alone, while less education and three or more chronic conditions increased the odds of depression alone. These findings underscore the relevance of assessing cognitive impairment in the elderly as part of a long-term approach to managing depression and vice versa.

What are the Methods for Diagnosing MCI?

2013 ◽  
Vol 23 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Sarah Key-DeLyria
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Diagnostic Criteria ◽  
Cognitive Dysfunction ◽  
Early Identification ◽  
Speech Language Pathologists ◽  
Detailed Characterization ◽  
Unique Position ◽  
Speech Language Pathologist

Speech-language pathologists will be increasingly called upon to screen for, identify, and assess mild cognitive impairment (MCI) as the population ages. The diagnosis of MCI involves several professionals and requires an evaluation of normal and abnormal cognition and cognitive-communication, which a speech-language pathologist is in a unique position to provide. The general diagnostic criteria for MCI diagnosis are largely agreed upon at this point in time, and subtypes of MCI are receiving increasing attention. Early identification of MCI and detailed characterization of functioning will be more important as therapy targeting prevention of dementia and early cognitive dysfunction is developed. Speech-language pathologists should have a working knowledge of the diagnostic criteria and currently accepted subtypes in order to serve this population.

Socioeconomic Position and Health: The Differential Effects of Education versus Income on the Onset versus Progression of Health Problems

2007 ◽  
Vol 48 (3) ◽  
pp. 223-238 ◽  
Author(s):  
Pamela Herd ◽  
Brian Goesling ◽  
James S. House
Keyword(s):  
Socioeconomic Position ◽  
Chronic Conditions ◽  
Functional Limitations ◽  
Health Problems ◽  
Biomedical Literature ◽  
Science Literature ◽  
The Social ◽  
Social Science Literature ◽  
Using Data ◽  
The Relationship

This article seeks to elucidate the relationship between socioeconomic position and health by showing how different facets of socioeconomic position (education and income) affect different stages (onset vs. progression) of health problems. The biomedical literature has generally treated socioeconomic position as a unitary construct. Likewise, the social science literature has tended to treat health as a unitary construct. To advance our understanding of the relationship between socioeconomic position and health, and ultimately to foster appropriate policies and practices to improve population health, a more nuanced approach is required—one that differentiates theoretically and empirically among dimensions of both socioeconomic position and health. Using data from the Americans' Changing Lives Study (1986 through 2001/2002), we show that education is more predictive than income of the onset of both functional limitations and chronic conditions, while income is more strongly associated than education with the progression of both.

scholarly journals Counterpoint as a contentive and stylistic device in the intermedial genre (about Viktor Shenderovich’s A Flute Solo)

Literatūra ◽  
2019 ◽  
Vol 61 (2) ◽  
pp. 110-124
Author(s):  
Eleonora Lassan
Keyword(s):  
Publishing House ◽  
The Other ◽  
Political Satire ◽  
Detailed Characterization ◽  
Other Hand ◽  
Symbolic Value ◽  
The One ◽  
Definition Of ◽  
Stylistic Device

In 2015, Vremya Publishing House issued A Flute Solo, a book by V. Shenderovich, a multigenre and, according to the author of the article, intermedial work, since the peculiarities of the content of a political satire and a tragedy, a farce and a fantasy on the one hand and some features of musical pieces, a fugue in particular, on the other hand, have merged there. The author provides a detailed characterization of the plot, constructed as a grotesque depiction of the reality, the composition as relating a verbal text to a piece of music, and the symbolic value of certain elements, allowing not to agree to the definition of the book as being “desperately hopeless”.

scholarly journals Microstratigraphic Analysis of Fossil Distribution in the Lower Hornerstown and Upper Navesink Formations at the Edelman Fossil Park, NJ

2021 ◽  
Vol 9 ◽  
Author(s):  
Kristyn K. Voegele ◽  
Paul V. Ullmann ◽  
Tara Lonsdorf ◽  
Zachary Christman ◽  
Michael Heierbacher ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Taxonomic Diversity ◽  
Time Averaging ◽  
Taxonomic Richness ◽  
Detailed Characterization ◽  
Future Studies ◽  
Rowan University ◽  
Definition Of ◽  
Excavation Area

Maastrichtian–Danian sediments of the Navesink and Hornerstown formations at the Jean and Ric Edelman Fossil Park of Rowan University in Mantua Township, New Jersey, have long intrigued paleontologists. Within the basal Hornerstown Formation occurs the Main Fossiliferous Layer (MFL), a regionally well-known and diverse bonebed. The lithostratigraphic and chronostratigraphic position of this fossil layer have been debated for more than 50 years, fueling debate over its origin. Herein, we present the results of a microstratigraphic analysis of the fossil composition and distribution of the MFL undertaken to rectify these discrepancies. Through methodical top-down excavation, we recorded the three-dimensional position of every fossil encountered. Three-dimensional visualization and analyses of these data in ArcGIS Pro yielded an unprecedented view of this bonebed. Most reported discrepancies about the stratigraphic placement and thickness of the MFL can be explained by the presence of two distinct fossil assemblages within this interval that are occasionally combined into a single bonebed. The stratigraphically-lower assemblage, herein termed an “oyster layer”, is geometrically-tabular and exhibits low taxonomic diversity, high abundance of the oyster Pycnodonte, and moderate taxonomic richness. The stratigraphically-higher assemblage, the MFL, occurs approximately 9 cm higher in section and exhibits high values of taxonomic diversity, fossil abundance, and taxonomic richness. Sedimentological homogeneity throughout this interval suggests that these faunal contrasts arise from the two assemblages having formed via independent taphonomic pathways. Specifically, prevalence of Pycnodonte in the oyster layer implies formation by a selective mortality event, whereas the diversity of the MFL appears to reflect a more universal agent of mortality. Spatial variations in the stratigraphic distribution of fossils within the MFL in our excavation area indicate this assemblage does not form a simple, tabular layer as previously thought and may, in part, record original bathymetry. Importantly, our definition of the MFL and detailed characterization of its stratigraphic placement are essential for future studies on the taphonomic origin and chronostratigraphy of this bonebed. Universal use of this definition would allow researchers to confidently elucidate the exact lithostratigraphic positions of precise chronostratigraphic indicators within the MFL and accurately estimate the degree of time averaging of its fossils.

BEHAVIORAL VALUE ADJUSTMENTS

2017 ◽  
Vol 20 (08) ◽  
pp. 1750050
Author(s):  
MATTEO BISSIRI ◽  
RICCARDO COGO
Keyword(s):  
Risk Premium ◽  
Cash Flows ◽  
Behavioral Risk ◽  
Additional Source ◽  
Detailed Characterization ◽  
Individual Decisions ◽  
Definition Of ◽  
Credit Portfolio ◽  
Future Cash Flows

Assets or liabilities with embedded prepayment/extension options can be subject to behavioral risk, due to the unpredictable exercise strategy followed by the option holder who does not act purely on the strength of financial convenience. When seen from the viewpoint of the option seller, such behavior results in a lower option value and an additional source of uncertainty in future cash flows. In this paper, we propose a general framework to model behavioral risk by taking advantage of a full parallel with credit portfolio modeling and by combining the features of option-based and intensity models. Our approach is micro-structural, meaning that the aggregate prepayment rate derives from the sum of individual decisions. In principle, a detailed characterization of the behavior of a pool of investors can be performed depending on available data. A particular emphasis is placed on the precise definition of behavioral risk and on the modeling of nonmarket factors, which may contribute significantly to the variance of future cash flows. Finally, we discuss the calibration of a behavioral risk premium and the pricing of contracts with embedded options by introducing the concept of behavioral risk adjustment ([Formula: see text]VA), in line with the recent development of XVA methodology.

scholarly journals Biblical garden – a review, characteristics and definition based on twenty years of research

2018 ◽  
Vol 30 (2) ◽  
pp. 229-248 ◽  
Author(s):  
Zofia Włodarczyk
Keyword(s):  
Public Space ◽  
Detailed Data ◽  
Plant Selection ◽  
Detailed Characterization ◽  
The Public ◽  
The Bible ◽  
Depth Analysis ◽  
Semantic Value ◽  
Definition Of

Abstract Biblical gardens have existed in the public space for almost 80 years, and yet still up to this moment no scientific definition of this type of garden layout has been developed, nor has any detailed characterization of them been published. Multifaceted, interdisciplinary research carried out in the years 1996-2017 made it possible to gather detailed data pertaining to 63 biblical gardens all over the world, primarily including the oldest ones. The fundamental characteristics of existing sites were determined on the basis of these results, including their naming in different languages, presentation through a logo and motto, plant selection along with the manner of its presentation, the symbols that they employ, street and garden furniture being used and the arrangements of miniature landscapes. An in-depth analysis of the material that had been gathered made it possible to formulate a scientific definition of a biblical garden as a specific type of greenery arrangement. The specifics of biblical gardens lie in the fact that they possess significant semantic value and are an illustration of the sacred texts of the Bible, one of the greatest works of literature. Various artistic works are being used in their arrangement, in addition to modern forms of design, which highlight sensory values through referring to the senses: sight, touch, hearing, smell and taste.

Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998–2016 Health and Retirement Study

2021 ◽  
pp. 1-17
Author(s):  
Benson Wu ◽  
Mohammad Usama Toseef ◽  
Ariana M. Stickel ◽  
Hector M. González ◽  
Wassim Tarraf
Keyword(s):  
Cognitive Impairment ◽  
Physical Function ◽  
Cognitive Aging ◽  
Multinomial Logistic Regression ◽  
Functional Limitations ◽  
Later Life ◽  
Cognitive Status ◽  
Health And Retirement Study ◽  
Reported Health ◽  
Retirement Study

Background: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging. Objective: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age. Methods: We used data from the Health and Retirement Study (1998–2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50–64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications. Results: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment. Conclusion: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

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