scholarly journals A Longitudinal Study of Functional Unmet Need Among People with Dementia

2021 ◽  
pp. 1-12
Author(s):  
Sanna Read ◽  
Bo Hu ◽  
Raphael Wittenberg ◽  
Nicola Brimblecombe ◽  
Louise Robinson ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Unmet Needs ◽  
Functional Limitations ◽  
Care Home ◽  
Functional Decline ◽  
Unmet Need ◽  
Community Dwelling ◽  
Latent Growth Curves ◽  
People With Dementia ◽  
Over Time

Background: Understanding the changes of unmet need in dementia may enable effective targeting of help and allow people to stay in their homes longer. Objective: We investigated changes in unmet need and functioning over a 4-year period and the role of socio-demographic factors in these changes among people with dementia. Methods: 234 community-dwelling people with dementia at baseline were studied in three consecutive waves (four years) of the English Longitudinal Study of Ageing (ELSA). Unmet needs (self/informant-reported limitations for which no help was received) and functional limitations (self/informant-reported difficulties in activities/instrumental activities of daily living and mobility) were modelled with latent growth curves. Sex, age, partnership, and socioeconomic status at baseline were used as predictors. Admission to a care home was an additional outcome. Results: Unmet needs increased over time, especially among those who initially had more functional limitations. Unmet needs contributed to faster decline in functional capability, except among those with many limitations initially. The major driver of increased unmet needs was not having a partner (direct effect). Age, sex, and wealth contributed indirectly via the initial level of functional limitations and/or unmet need. Those with several functional limitations but few unmet needs were most likely to move to a care home. Conclusion: Unmet need increases over time in those with dementia with mitigating effects of having a partner and initial levels of functioning. Meeting needs at early stages of dementia, especially for those living alone and when functional limitations are low may help slow functional decline.

scholarly journals 409 - Trends in Involvement, Perceived Role, Role Overload and Self-efficacy of Family Carers of People with Dementia in Care Homes

2020 ◽  
Vol 32 (S1) ◽  
pp. 125-125
Author(s):  
Marleen Prins ◽  
Bernadette Willemse ◽  
Marlous Tuithof ◽  
Henriëtte van der Roest ◽  
Anne Margriet Pot
Keyword(s):  
Self Efficacy ◽  
Care Home ◽  
Care Homes ◽  
Role Overload ◽  
Family Carers ◽  
Change Over Time ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care ◽  
Over Time

IntroductionThe quality of long-term care provided to people with dementia (PwD) in care homes can be improved by implementing person-centered care. Family carers of PwD living in care homes are an important part of person-centered care. However, they often experience high levels of burden, even when a family member with dementia lives in a care home. This study examines trends in the involvement of family carers and their perceived role, role overload and self-efficacy.MethodsData from the Living Arrangements for People with Dementia study, a cross-sectional monitoring study that evaluates developments in care for PwD in care homes in the Netherlands, with four measurement cycles between 2008-2017 was used. Data from the three most current measurement cycles were used, with respectively 144, 47 and 49 participating care homes and 888, 392 and 401 participating family carers. Family involvement was measured by the number of hours per week that family carers visited the PwD and the type of activities they undertook. Perceived caregiving role was measured with the Family Perceptions of Caregiving Role instrument. We used the Self-Perceived Pressure by Informal Care to measure role overload and a 37-item questionnaire was used to measure self-efficacy. We investigated the changes over time (e.g., measurement cycles) of these measures.ResultsThe number of hours that family carers visited the PwD did not change over time. However, there was a trend towards an increase in the variety of activities they undertook. Their perceived caregiving role did not change over time. Self-efficacy of family carers increased over time and they reported more feelings of role overload.ConclusionsDuring the past decade, there has been an increasing trend towards family carers doing more diverse activities with PwD in carer homes. Family carers did feel more competent in their caring role, although their feelings of role overload also increased. Continuing attention is therefore needed for the psychological well-being of family carers after a person with dementia moves to a care home.

scholarly journals Compassion toward others and self-compassion predict mental and physical well-being: a 5-year longitudinal study of 1090 community-dwelling adults across the lifespan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ellen E. Lee ◽  
Tushara Govind ◽  
Marina Ramsey ◽  
Tsung Chin Wu ◽  
Rebecca Daly ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Health Outcomes ◽  
Rating Scales ◽  
Well Being ◽  
Community Dwelling ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Adult Lifespan ◽  
Mental Well Being ◽  
Over Time

AbstractThere is growing interest in the role of compassion in promoting health and well-being, with cross-sectional data showing an inverse correlation with loneliness. This is the first longitudinal study examining both compassion toward others (CTO) and compassion toward self (CTS) as predictors of mental and physical health outcomes including loneliness, across adult lifespan. We followed 552 women and 538 men in San Diego County for up to 7.5 (mean 4.8 and SD 2.2) years, using validated rating scales for CTO, CTS, and loneliness. Linear mixed-effects models were employed to examine age- and sex-related trajectories of CTO and CTS over time. Linear regression models were used to evaluate baseline and longitudinal relationships of CTO and CTS with mental well-being, physical well-being, and loneliness. CTS and CTO were weakly intercorrelated. Women had higher baseline CTO than men. While CTO was stable over time and across the lifespan, CTS scores had an inverse U-shaped relationship with age, peaking around age 77. There were significant baseline × slope interactions of both CTO and CTS predicting improvements in physical well-being in adults <60 years old. Increases in CTO and CTS predicted improvements in mental well-being. Higher baseline CTO and CTS as well as increases in CTO and CTS scores predicted lower loneliness scores at follow-up. Thus, CTO and CTS were associated with better mental well-being and loneliness across the adult lifespan, and physical well-being in younger adults, and are promising targets for interventions to improve health outcomes.

scholarly journals Necessidades de Cuidados e Recurso aos Serviços na Demência: Avaliação Inicial da Coorte Portuguesa no Estudo Actifcare

2019 ◽  
Vol 32 (5) ◽  
pp. 355 ◽  
Author(s):  
Manuel Gonçalves-Pereira ◽  
Maria J. Marques ◽  
Conceição Balsinha ◽  
Alexandra Fernandes ◽  
Ana Sá Machado ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Unmet Needs ◽  
Community Support ◽  
Community Dwelling ◽  
Formal Care ◽  
Needs For Care ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Formal Services ◽  
Timely Access

Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments.Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia.Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present, were frequently due to attitudes or lack of knowledge of any or both members of the dyad.Discussion: The recruitment process was challenging, since the inclusion criteria were restrictive. Not claiming generalizability, we recruited a typical sample of Portuguese people with mild to moderate dementia and no significant formal community support. Levels and type of unmet needs found in some participants would call for formal support, were it not for problems regarding access or use.Conclusion: There are difficulties regarding timely access and effective use of formal care in dementia, along with relevant unmet needs.

scholarly journals The Longitudinal Relationships Between Social Isolation, Frailty, and Health Outcomes Among Canadian Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 173-174
Author(s):  
Fereshteh Mehrabi ◽  
François Béland
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Longitudinal Study ◽  
Health Outcomes ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Social Participation ◽  
Community Dwelling ◽  
Global Public Health ◽  
Over Time

Abstract Social isolation and frailty are global public health issues that may lead to poor health outcomes. We tested the two following hypotheses: 1) changes in social isolation and frailty are associated with adverse health outcomes over two years, 2) the associations between social isolation and health vary across different levels of frailty. We estimated a series of latent growth models to test our hypotheses using data from the FRéLE longitudinal study among 1643 Canadian community-dwelling older adults aged 65 years and over. Missing data were handled by pattern mixture models with the assumption of missing not at random. We measured social isolation through social participation, social networks, and social support from different social ties. We assessed frailty using Fried’s criteria. Our results revealed that higher frailty at baseline was associated with a higher rate of comorbidity, depression, and cognitive decline over two years. Less social participation at baseline was associated with comorbidity, depression, and changes in cognitive decline. Less social support from friends, children, partner, and family at baseline was associated with comorbidity, cognitive decline, and changes in depression. Fewer contacts with grandchildren were related to cognitive decline over time. The associations of receiving less support from partner with depression and participating less in social activities with comorbidity, depression, and cognitive decline were higher among frail or prefrail than robust older adults over time. This longitudinal study suggests that intimate connectedness and social participation may ameliorate health status in frail older populations, highlighting the importance of age-friendly city policies.

scholarly journals Hospitalization-Associated Change in Gait Speed and Risk of Functional Limitations for Older Adults

2019 ◽  
Vol 74 (10) ◽  
pp. 1657-1663 ◽  
Author(s):  
Wei Duan-Porter ◽  
Tien N Vo ◽  
Kristen Ullman ◽  
Lisa Langsetmo ◽  
Elsa S Strotmeyer ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Odds Ratio ◽  
Functional Limitations ◽  
Functional Decline ◽  
Community Dwelling ◽  
Black And White ◽  
Body Composition Study ◽  
Health Aging ◽  
Health Related

Abstract Background Hospitalization-associated functional decline is a common problem for older adults, but it is unclear how hospitalizations affect physical performance measures such as gait speed. We sought to determine hospitalization-associated change in gait speed and likelihood of new limitations in mobility and activities of daily living (ADLs). Methods We used longitudinal data over 5 years from the Health, Aging and Body Composition Study, a prospective cohort of black and white community-dwelling men and women, aged 70–79 years, who had no limitations in mobility (difficulty walking 1/4 mile or climbing 10 steps) or ADLs (transferring, bathing, dressing, and eating) at baseline. Gait speed, and new self-reported limitations in mobility and ADLs were assessed annually. Selected participants (n = 2,963) had no limitations at the beginning of each 1-year interval. Hospitalizations were self-reported every 6 months and verified with medical record data. Generalized estimating equations were used to examine hospitalization-associated change in gait speed and odds of new limitations over each 1-year interval. Fully adjusted models included demographics, hospitalization within the past year, health conditions, symptoms, body mass index, and health-related behaviors. Results In fully adjusted models, any hospitalization was associated with decrease in gait speed (−0.04 m/s; 95% confidence interval [CI]: −0.05 to −0.03) and higher odds of new limitations in mobility or ADLs (odds ratio = 1.97, 95% CI: 1.70–2.28), and separately with increased odds of new mobility limitation (odds ratio = 2.22, 95% CI: 1.90–2.60) and new ADL limitations (odds ratio = 1.84, 95% CI: 1.53–2.21). Multiple hospitalizations within a year were associated with gait speed decline (−0.06 m/s; 95% CI: −0.08 to −0.04) and greater odds of new limitations in mobility or ADLs (odds ratio = 2.96, 95% CI: 2.23–3.95). Conclusions Functionally independent older adults experienced hospitalization-associated declines in gait speed and new limitations in mobility and ADLs.

ALBUMIN, HEMOGLOBIN, AND THE TRAJECTORY OF COGNITIVE FUNCTION IN COMMUNITY-DWELLING OLDER JAPANESE: A 13-YEAR LONGITUDINAL STUDY

2016 ◽  
pp. 1-7 ◽  
Author(s):  
H. Murayama ◽  
S. Shinkai ◽  
M. Nishi ◽  
Y. Taniguchi ◽  
H. Amano ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Cognitive Function ◽  
Hierarchical Linear Modeling ◽  
Cognitive Change ◽  
Albumin Level ◽  
Community Dwelling ◽  
Health Examination ◽  
Linear Modeling ◽  
Function Design ◽  
Over Time

Background: Cognitive function can substantially decline over a long period, and understanding the trajectory of cognitive function is important. However, little is known about the linkage between nutritional biomarkers and long-term cognitive change. Objectives: We analyzed 13-year longitudinal data for older Japanese to examine the associations of serum albumin and hemoglobin levels with the trajectory of cognitive function. Design: Longitudinal study. Setting: Community-based. Participants: A total of 1,744 community-dwelling adults aged 65 years or older who participated in annual health examinations in Kusatsu town, Gunma Prefecture, Japan, from 2002–2014. Measurements: Cognitive function was assessed annually by the Mini-Mental State Examination (MMSE). Albumin and hemoglobin levels at baseline (the year when a respondent first participated in the health examination) were divided into quartiles. Hierarchical linear modeling was used to analyze intrapersonal and interpersonal differences in cognitive function. Results: Participants’ MMSE scores decreased at an accelerated rate over the 13-year period. Participants with the lowest baseline albumin level (below the first quartile line) showed a greater accelerated decline in MMSE scores over time, compared with those with the highest level (above the third quartile line). Moreover, MMSE scores in participants with a lower hemoglobin level and lower MMSE score at baseline tended to decline faster over time at an accelerated rate. Conclusions: These findings yield new insights about the complex and diverse roles of these nutritional biomarkers on the trajectory of cognitive function in old age.

scholarly journals Factors associated with functional loss among community-dwelling Mexican older adults

Biomédica ◽  
2020 ◽  
Vol 40 (3) ◽  
pp. 546-556
Author(s):  
Nicolás Castellanos-Perilla ◽  
Miguel Germán Borda ◽  
Álvaro Fernández-Quilez ◽  
Vera Aarsland ◽  
Hogne Soennesyn ◽  
...  
Keyword(s):  
Functional Status ◽  
Daily Living ◽  
Functional Limitations ◽  
Functional Decline ◽  
Community Dwelling ◽  
Financial Status ◽  
Aging Study ◽  
Lower Education ◽  
Relationship Of ◽  
The Relationship

Introduction: Functional status decline is related to many negative outcomes.Objective: To explore the relationship of sociodemographic, medical, and psychological factors with the incidence of functional status decline in Mexican older adults.Materials and methods: Data from the 2012 and 2015 waves of the Mexican Health and Aging Study (MHAS) survey were analyzed. Participants with previous functional status decline at baseline were excluded. We assessed functional status decline individually with activities of daily living (ADL) and instrumental ADL (IADLs) in an individual way.Results: Age was associated with functional limitations in ADL. Being male had an association with limitations for IADL. A poor financial situation and lower education related to higher limitations for ADL. Furthermore, pain, comorbidities, and depression were found to be independently associated with limitations in ADL. IADL limitation was associated with age, poor education, comorbidities, and depression, as well as cognitive impairment.Conclusions: We found that factors such as age, financial status, educational level, pain, and the number of comorbidities were associated with the incidence of functional status decline. Pain had a greater association in the 3-year functional ADL decline incidence when compared with cognitive impairment. Studying functional decline by domains allowed us to find more detailed information to identify factors susceptible to intervention with the aim to reduce the incidence of functional status decline and dependence.

scholarly journals Developing an intervention to promote person-centred care to improve management of behaviours that challenge among people living with dementia

2020 ◽  
Author(s):  
Rachel Shaw ◽  
Niyah Campbell ◽  
Kirsty Killick ◽  
Nichola Seare ◽  
Ian Maidment
Keyword(s):  
Care Home ◽  
Unmet Need ◽  
Training Session ◽  
Complex Interventions ◽  
Care Staff ◽  
Training Intervention ◽  
Financial Investment ◽  
Care Home Staff ◽  
People With Dementia ◽  
The Uk

Abstract Background: This paper reports the development work conducted for a feasibility study (MEDREV) conducted in the UK evaluating: (i) a medication review to reduce the prescription of psychotropic medication for managing behaviours that challenge among people living with dementia: and (ii) a training intervention for care home staff designed to improve the management of behaviours that challenge without medication using person-centred care. This paper reports the development of (ii) the training intervention for care home staff.Methods: The intervention development was informed by the MRC guidelines for complex interventions and the phases of the Behaviour Change Wheel. We used an iterative approach responding to and consultations with stakeholders throughout the process. Results: The target behaviours of the intervention were: responding to challenging behaviour as an expression of unmet need; communicating with compassion. The intervention was required to educate about psychotropics and their side-effects, to help care staff relate to people with dementia as individuals with individual needs and wants, to reflect upon how one might deliver the values of person-centred care in care scenarios, and to promote good team communication and self-care. An interactive, brief, in-house training session was developed with a number of recommendations for systemic change. Conclusions: The intervention was developed in a systematic way taking into account the particularities of the care home context and the target population. These factors prompted many challenges as did the manner in which residential care home interventions are funded in the UK. An ideal intervention package would have incorporated environmental elements, more systemic support from the care home management, and more financial investment to offer a more detailed, longer lasting training intervention.

scholarly journals The Benefits of Physical Activity on Indicators of Cardiovascular Risk in Community-Dwelling Older Adults with Hypertension in Korea: A Longitudinal Study

2021 ◽  
Author(s):  
Jeong-Ah Ahn ◽  
Deulle Min
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Longitudinal Study ◽  
Fasting Blood Glucose ◽  
Community Dwelling ◽  
Uncontrolled Hypertension ◽  
Group I ◽  
Community Dwelling Older Adults ◽  
Over Time

Abstract Purpose: The study aimed to explore the effects of physical activity on indicators for cardiovascular risk in a sample of community-dwelling older adults with hypertension.Methods: This longitudinal study used data collected from the Elderly Cohort Database of the National Health Insurance Service in South Korea between 2002 and 2013. Participants included 10,588 older adults (≥ 60 years) with hypertension. Data assessing self-reported physical activity, blood pressure, fasting blood glucose, body mass index, and total cholesterol levels throughout the 12-year study were extracted from the original database and analyzed. Participants were categorized into 4 groups based on the reported changes in physical activity over time; Group I (totally inactive), II (inactive to active), III (active to inactive), and IV (totally active). Cox proportional hazard model was used to confirm the risk of cardiovascular indicators over time in each group.Results: Participants’ mean age was 64.2 years in the initial year of 2002. The number of participants in Groups I, II, III, and IV was 4032, 2697, 1919, and 1940, respectively. Group IV showed a significant decline in risk for uncontrolled hypertension compared to Group I (HR = 0.87, 95% CI [0.800-0.948]). Group II showed a significant decrease in risk for uncontrolled diabetes compared to Group I (HR = 0.94, 95% CI [0.888-0.999]).Conclusions: Physical activity is an essential non-pharmacological and self-management intervention that can be easily implemented among older adults with hypertension. Healthcare providers should be aware of the importance of older adults’ physical activity and encourage them to perform and maintain it steadily for better long-term cardio-metabolic outcomes.

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