Living on the Edge of the Community: Factors Associated with Discontinuation of Community Living Among People with Cognitive Impairment

Abstract BackgroundThe experiences of people with cognitive impairment in the real world have not been fully explored because of methodological difficulties. This study re-accessed people with cognitive impairment identified in a previous epidemiological survey to explore their current situation and the risk factors associated with all-cause discontinuation of community living.MethodsIn 2016, a three-step survey was conducted of 7,614 older residents. In the last step of the survey, a research team visited the homes of 198 participants with a Mini-Mental State Examination score <24. In 2019, we re-accessed these people. We ran a community space in the study area for 3 years to build partnerships with community residents and community workers, and were able to re-access the participants using multiple methods.ResultsWe found that 126 (63.6%) participants had continued living in the same community, but 58 (29.3%) had discontinued community living. Of these, 18 (9.1%) had died, 18 (9.1%) were institutionalized, 9 (4.5%) were hospitalized, and 13 (6.6%) had moved out of the community. A multiple logistic regression analysis identified the following risk factors associated with discontinuation of community living: being certified under long-term insurance, needing housing support, and needing rights protection.ConclusionsThree years after the baseline survey, 29.3% people with cognitive impairment had discontinued community living. Despite having dementia or living alone, older people could continue to live in the community if their needs for housing support and rights protection were met. Both social interventions and medical interventions are important to build age-friendly communities.Trial registrationUMIN, UMIN000038189,　Registered 3 October 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521

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Living on the edge of the community: factors associated with discontinuation of community living among people with cognitive impairment

BMC Geriatrics ◽

10.1186/s12877-021-02084-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chiaki Ura ◽

Tsuyoshi Okamura ◽

Mika Sugiyama ◽

Fumiko Miyamae ◽

Mari Yamashita ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

High Risk ◽

Older People ◽

Community Action ◽

Community Living ◽

Term Care ◽

Factors Associated ◽

Rights Protection ◽

Risk Approach

Abstract Background As Japanese society continues to age, the isolation of older people is increasing, and community living for people with cognitive impairment is becoming more difficult. However, the challenges faced by people with cognitive impairment living in the community have not been fully explored because of methodological difficulties. This study re-accessed people with cognitive impairment identified in a previous epidemiological survey to explore their current situation and the risk factors associated with all-cause discontinuation of community living. Methods Under a community-based participatory framework, we examined a high-risk approach for people with cognitive impairment and a community action approach in parallel, to build a dementia-friendly community. For the high-risk approach, we achieved stepwise access to 7614 older residents, which enabled us to select and visit the homes of 198 participants with a Mini-Mental State Examination score < 24 in 2016. In 2019, we re-accessed these individuals. For the community action approach, we built a community space in the study area to build partnerships with community residents and community workers and were able to re-access participants using multiple methods. Results We found that 126 (63.6%) participants had continued living in the same community, but 58 (29.3%) had discontinued community living. Of these, 18 (9.1%) had died, 18 (9.1%) were institutionalized, 9 (4.5%) were hospitalized, and 13 (6.6%) had moved out of the community. A multiple logistic regression analysis identified the following risk factors associated with discontinuation of community living: being certified under long-term care insurance, needing housing support, and needing rights protection. Conclusions Three years after the baseline survey, 29.3% of people with cognitive impairment had discontinued community living. Despite having cognitive impairment or living alone, older people were able to continue living in the community if their needs for housing support and rights protection were met. Both social interventions and medical interventions are important to build age-friendly communities. Trial registration UMIN, UMIN000038189, Registered 3 October 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521

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Prevalence of Mild Cognitive Impairment in Rural Thai Older People, Associated Risk Factors and their Cognitive Characteristics

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000506279 ◽

2020 ◽

Vol 10 (1) ◽

pp. 38-45 ◽

Cited By ~ 2

Author(s):

Jiranan Griffiths ◽

Lakkana Thaikruea ◽

Nahathai Wongpakaran ◽

Peeraya Munkhetvit

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Older People ◽

Significant Risk ◽

Depression Scale ◽

Cross Sectional ◽

Factors Associated ◽

Low Education ◽

Rural Thailand

Introduction: Mild cognitive impairment (MCI) is a transitional stage between normal cognition and dementia. A review showed that 10–15% of those with MCI annually progressed to Alzheimer’s disease. Objective: This study aimed to investigate the prevalence and risk factors associated with MCI as well as the characteristics of cognitive deficits among older people in rural Thailand. Methods: A cross-sectional study in 482 people who were 60 years old and over was conducted in northern Thailand. The assessments were administered by trained occupational therapists using demographic and health characteristics, Mental Status Examination Thai 10, Activities of Daily Living – Thai Assessment Scale, 15-item Geriatric Depression Scale and the Montreal Cognitive Assessment-Basic (MoCA-B, Thai version). Results: The mean age of MCI was 68.3 ± 6.82 years, and most had an education ≤4 years. The prevalence of MCI in older people was 71.4% (344 out of 482), and it increased with age. Low education and diabetes mellitus (DM) were the significant risk factors associated with cognitive decline. Older people with MCI were more likely to have an education ≤4 years (RR 1.74, 95% CI 1.21–2.51) and DM (RR 1.19, 95% CI 1.04–1.36) than those who did not. The 3 most common cognitive impairments according to MoCA-B were executive function (86%), alternating attention (33.1%) and delayed recall (31.1%). Conclusion: The prevalence of MCI in older Thai people in a rural area is high compared with that in other countries. The explanation might be due to low education and underlying disease associated with MCI. A suitable program that can reduce the prospects of MCI in rural Thailand is needed.

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Risk factors for cognitive impairment in older people with diabetes: a community-based study

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018819836640 ◽

2019 ◽

Vol 10 ◽

pp. 204201881983664 ◽

Cited By ~ 3

Author(s):

Shuangling Xiu ◽

Qiuju Liao ◽

Lina Sun ◽

Piu Chan

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cognitive Impairment ◽

Older People ◽

Multiple Logistic Regression Analysis ◽

Apoe Genotype ◽

Community Dwelling ◽

Urban Living ◽

Obesity Hypertension

Aim: The aim of this study was to investigate the risk factors for cognitive impairment in older people with diabetes. Methods: This cross-sectional study included 2626 community-dwelling participants with diabetes aged ⩾55 years, living in Beijing, China. The participants were screened for risk factors, including smoking, obesity, hypertension, stroke, coronary heart disease, dyslipidemia, depression, apolipoprotein E (APOE) genotype, and low physical activity. Cognitive function was assessed with the scholarship-adjusted Mini-Mental State Examination (MMSE): MMSE ⩽17 for iliterate participants; MMSE ⩽20 for primary school graduates (⩾6 years of education); and MMSE ⩽24 for junior school graduates or above (⩾9 years of education). Results: The prevalence of cognitive impairment in older people with diabetes was 9.90%. Multiple logistic regression analysis demonstrated that stroke [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.20–2.43], less than 0.5 h exercise per day (OR = 1.89, 95% CI = 1.37–2.61), and depression (OR = 1.64, 95% CI = 1.06–2.54), but not smoking, obesity, hypertension, dyslipidemia, and coronary heart disease, were independent risks for cognitive impairment in older people with diabetes. In addition, being married (OR = 0.66, 95% CI = 0.47–0.93) and urban living (OR = 0.33, 95% CI = 0.22–0.48) could decrease the risk of cognitive impairment. Conclusions: Stroke, depression, and less than 0.5 h exercise per day were independent risks for cognitive impairment in older people with diabetes, whereas being married and urban living were protective.

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Risk factors for pre-eclampsia among women at antenatal booking in Kano, Northern Nigeria

Healthcare in Low-resource Settings ◽

10.4081/hls.2013.e12 ◽

2013 ◽

Vol 1 (1) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Ibrahim A. Yakasai ◽

Imran O. Morhason-Bello

Keyword(s):

Risk Factors ◽

Early Onset ◽

Multiple Logistic Regression Analysis ◽

Control Group ◽

Northern Nigeria ◽

Degree Relative ◽

Factors Associated ◽

Increased Risk ◽

History Of ◽

At Home

Pre-eclampsia (PE) is an important cause of maternal mortality. There have been several studies on risk factors assessment with conflicting reports across the globe on this disease; however, rigorous recent evaluation of these factors is uncommon in this region. The aim of the present study was to determine the risks factors in the early-onset PE in Aminu Kano Teaching Hospital (AKTH), Kano (Northern Nigeria). We conducted a case-control study in Nigeria between April 2009 and January 2010 to identify the risk factors associated with the early-onset PE in women attending antenatal clinic in AKTH. Information on socio-cultural characteristics, medical history, previous obstetrics history, level of stress at home, and type of family were obtained and recorded in a proforma designed for the study. Multiple logistic regression analysis was used to determine the risk factors for PE at 95% confidence level. Pregnant women with early-onset PE (150 in each case and control group). Risk factors associated with increased risk of early-onset PE were: history of pre-eclampsia/eclampsia (PE/E) in a previous pregnancy [adjusted odds ratio (AOR) 2.09]; exposure to passive smoking (AOR 1.34); inadequate antenatal supervision (AOR 15.21); family history of hypertension in one or more 1st-degree relative (AOR 8.92); living in a joint family (AOR 6.93); overweight (120% to 150% of pre-pregnancy ideal body weight, AOR 4.65). Risk factors among women in Northern Nigeria are similar to those reported from other studies. Good antenatal cares, early detection, reduction of stressful conditions at home are the most important preventive measures of early-onset severe PE among these women.

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