scholarly journals Physical frailty and cognitive impairment in older nursing home residents: a latent class analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yiyang Yuan ◽  
Kate L. Lapane ◽  
Jennifer Tjia ◽  
Jonggyu Baek ◽  
Shao-Hsien Liu ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Nursing Home Residents ◽  
Class Analysis ◽  
Physical Frailty ◽  
Data Set ◽  
Severe Cognitive Impairment ◽  
Moderate Cognitive Impairment

Abstract Background Little is known about the heterogeneous clinical profile of physical frailty and its association with cognitive impairment in older U.S. nursing home (NH) residents. Methods Minimum Data Set 3.0 at admission was used to identify older adults newly-admitted to nursing homes with life expectancy ≥6 months and length of stay ≥100 days (n = 871,801). Latent class analysis was used to identify physical frailty subgroups, using FRAIL-NH items as indicators. The association between the identified physical frailty subgroups and cognitive impairment (measured by Brief Interview for Mental Status/Cognitive Performance Scale: none/mild; moderate; severe), adjusting for demographic and clinical characteristics, was estimated by multinomial logistic regression and presented in adjusted odds ratios (aOR) and 95% confidence intervals (CIs). Results In older nursing home residents at admission, three physical frailty subgroups were identified: “mild physical frailty” (prevalence: 7.6%), “moderate physical frailty” (44.5%) and “severe physical frailty” (47.9%). Those in “moderate physical frailty” or “severe physical frailty” had high probabilities of needing assistance in transferring between locations and inability to walk in a room. Residents in “severe physical frailty” also had greater probability of bowel incontinence. Compared to those with none/mild cognitive impairment, older residents with moderate or severe impairment had slightly higher odds of belonging to “moderate physical frailty” [aOR (95%CI)moderate cognitive impairment: 1.01 (0.99–1.03); aOR (95%CI)severe cognitive impairment: 1.03 (1.01–1.05)] and much higher odds to the “severe physical frailty” subgroup [aOR (95%CI)moderate cognitive impairment: 2.41 (2.35–2.47); aOR (95%CI)severe cognitive impairment: 5.74 (5.58–5.90)]. Conclusions Findings indicate the heterogeneous presentations of physical frailty in older nursing home residents and additional evidence on the interrelationship between physical frailty and cognitive impairment.

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.

scholarly journals Depression symptoms and cognitive impairment in older nursing home residents in the USA : A latent class analysis

2020 ◽  
Vol 35 (7) ◽  
pp. 769-778 ◽  
Author(s):  
Yiyang Yuan ◽  
Hye Sung Min ◽  
Kate L. Lapane ◽  
Anthony J. Rothschild ◽  
Christine M. Ulbricht
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Nursing Home Residents ◽  
Depression Symptoms ◽  
Class Analysis ◽  
The Usa

scholarly journals Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment

2020 ◽  
Vol 49 (3) ◽  
pp. 243-251
Author(s):  
Reynolds A. Morrison ◽  
Bill M. Jesdale ◽  
Catherine E. Dubé ◽  
Anthony P. Nunes ◽  
Carol A. Bova ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Facial Expressions ◽  
Nursing Home Residents ◽  
Self Report ◽  
Data Set ◽  
Pain Behaviors ◽  
Severe Cognitive Impairment ◽  
Adverse Health Outcomes

<b><i>Objective:</i></b> Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. <b><i>Methods:</i></b> The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010–2016, <i>n</i> = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. <b><i>Results:</i></b> Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93–0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85–0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. <b><i>Conclusions:</i></b> The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners’ perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.

scholarly journals Multiple imputation to quantify misclassification in observational studies of the cognitively impaired: an application for pain assessment in nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anthony P. Nunes ◽  
Danni Zhao ◽  
William M. Jesdale ◽  
Kate L. Lapane
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Observational Studies ◽  
Nursing Home Residents ◽  
Inverse Association ◽  
Cross Sectional ◽  
Data Set ◽  
Severe Cognitive Impairment ◽  
Differential Misclassification ◽  
The Difference

Abstract Background Despite experimental evidence suggesting that pain sensitivity is not impaired by cognitive impairment, observational studies in nursing home residents have observed an inverse association between cognitive impairment and resident-reported or staff-assessed pain. Under the hypothesis that the inverse association may be partially attributable to differential misclassification due to recall and communication limitations, this study implemented a missing data approach to quantify the absolute magnitude of misclassification of pain, pain frequency, and pain intensity by level of cognitive impairment. Methods Using the 2016 Minimum Data Set 3.0, we conducted a cross-sectional study among newly admitted US nursing home residents. Pain presence, severity, and frequency is assessed via resident-reported measures. For residents unable to communicate their pain, nursing home staff document pain based on direct resident observation and record review. We estimate a counterfactual expected level of pain in the absence of cognitive impairment by multiply imputing modified pain indicators for which the values were retained for residents with no/mild cognitive impairment and set to missing for residents with moderate/severe cognitive impairment. Absolute differences (∆) in the presence and magnitude of pain were calculated as the difference between documented pain and the expected level of pain. Results The difference between observed and expected resident reported pain was greater in residents with severe cognitive impairment (∆ = -10.2%, 95% Confidence Interval (CI): -10.9% to -9.4%) than those with moderate cognitive impairment (∆ = -4.5%, 95% CI: -5.4% to -3.6%). For staff-assessed pain, the magnitude of apparent underreporting was similar between residents with moderate impairment (∆ = -7.2%, 95% CI: -8.3% to -6.0%) and residents with severe impairment (∆ = -7.2%, 95% CI: -8.0% to -6.3%). Pain characterized as “mild” had the highest magnitude of apparent underreporting. Conclusions In residents with moderate to severe cognitive impairment, documentation of any pain was lower than expected in the absence of cognitive impairment. This finding supports the hypothesis that an inverse association between pain and cognitive impairment may be explained by differential misclassification. This study highlights the need to develop analytic and/or procedural solutions to correct for recall/reporter bias resulting from cognitive impairment.

scholarly journals Advanced cognitive impairment among older nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tadeja Gracner ◽  
Patricia W. Stone ◽  
Mansi Agarwal ◽  
Mark Sorbero ◽  
Susan L Mitchell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Advanced Disease ◽  
Nursing Home Residents ◽  
Functional Score ◽  
Data Set

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

scholarly journals Feasibility of the cognitive assessment of nursing home residents with mild-to-moderate cognitive impairment using the intelligent voice-guided digital assistant THALIE: A pilot study

2020 ◽  
Vol 19 (4) ◽  
pp. 1-9
Author(s):  
Patricia Sagaspe ◽  
Véronique Lespinet-Najib ◽  
Sylvie Poulette ◽  
Jean-Christophe Vasselon ◽  
Amélie Roche ◽  
...  
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Pilot Study ◽  
Cognitive Assessment ◽  
Nursing Home Residents ◽  
Moderate Cognitive Impairment

scholarly journals Factors Influencing the Deterioration from Cognitive Decline of Normal Aging to Dementia among Nursing Home Residents

2020 ◽  
Author(s):  
Audai A. Hayajneh ◽  
Mohammad Rababa ◽  
Alia A. Alghwiri ◽  
Dina Masha'al
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Bivariate Analysis ◽  
Medical Factors ◽  
Moderate Cognitive Impairment

Abstract Background: A dearth of differential research exists regarding the determinants of mild cognitive impairment (MCI) and moderate cognitive impairment or dementia among nursing home residents. This study aimed to identify and examine the association between medical factors (number of comorbidities, hospitalization, disability, depression, frailty and quality of life) and moderate cognitive impairment or dementia in nursing homes residents.Methods: A cross-sectional design was used in this study. Convenience sampling of 182 participants was conducted in nursing homes located in the central part of Jordan. Montreal cognitive assessment (MoCA) was used to screen both MCI and moderate cognitive impairment or dementia. Bivariate analysis, including t-test and ANOVA test, and logistic and linear regression models were used to examine and identify the medical factors associated with moderate cognitive impairment or dementia compared to mild cognitive impairment.Results: Most nursing home residents had MCI (87.4%) compared to a few with moderate cognitive impairment or dementia. Age (t = -2.773), number of comorbidities (t = -4.045), depression (t = -4.809), frailty (t = -4.038), and quality of life physical (t = 3.282) and mental component summaries (t = 2.469) were significantly different between the stages of cognitive impairment. Marital status (t = -4.050, p < 0.001), higher-income (t = 3.755, p < 0.001), recent hospitalization (t = 2.622,p = 0.01), depression (t = -2.737, p = 0.007), and frailty (t = 2.852, p = 0.005) were significantly associated with mental ability scores among nursing home residents.Conclusion: The coexistence of comorbidities and depression among nursing home residents with MCI necessitates prompt management by healthcare providers to combat depressive symptoms in order to delay the dementia trajectory among at-risk residents.Trail registration number: ClinicalTrials.gov Identifier: NCT04589637

scholarly journals Factors influencing the deterioration from cognitive decline of normal aging to dementia among nursing home residents

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Audai A. Hayajneh ◽  
Mohammad Rababa ◽  
Alia A. Alghwiri ◽  
Dina Masha’al
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Bivariate Analysis ◽  
Medical Factors ◽  
Moderate Cognitive Impairment

Abstract Background A dearth of differential research exists regarding the determinants of mild cognitive impairment (MCI) and moderate cognitive impairment or dementia among nursing home residents. This study aimed to identify and examine the association between medical factors (number of comorbidities, hospitalization, disability, depression, frailty and quality of life) and moderate cognitive impairment or dementia in nursing homes residents. Methods A cross-sectional design was used in this study. Convenience sampling of 182 participants was conducted in nursing homes located in the central part of Jordan. Montreal cognitive assessment (MoCA) was used to screen both MCI and moderate cognitive impairment or dementia. Bivariate analysis, including t-test and ANOVA test, and logistic and linear regression models were used to examine and identify the medical factors associated with moderate cognitive impairment or dementia compared to mild cognitive impairment. Results Most nursing home residents had MCI (87.4%) compared to a few with moderate cognitive impairment or dementia. Age (t = − 2.773), number of comorbidities (t = − 4.045), depression (t = − 4.809), frailty (t = − 4.038), and quality of life physical (t = 3.282) and mental component summaries (t = 2.469) were significantly different between the stages of cognitive impairment. Marital status (t = − 4.050, p <  0.001), higher-income (t = 3.755, p <  0.001), recent hospitalization (t = 2.622,p = 0.01), depression (t = − 2.737, p = 0.007), and frailty (t = 2.852, p = 0.005) were significantly associated with mental ability scores among nursing home residents. Conclusion The coexistence of comorbidities and depression among nursing home residents with MCI necessitates prompt management by healthcare providers to combat depressive symptoms in order to delay the dementia trajectory among at-risk residents. Trail registration ClinicalTrials.gov NCT04589637, October 15,2020, Retrospectively registered.

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