scholarly journals Online Multi-Domain Geriatric Health Screening in Urban Community Dwelling Older Malaysians: A Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Deepa Alex ◽  
Adhhani Binti Fauzi ◽  
Devi Mohan
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Urinary Incontinence ◽  
Cognitive Impairment ◽  
Pilot Study ◽  
Geriatric Assessment ◽  
Urban Community ◽  
Community Dwelling ◽  
Geriatric Syndromes ◽  
Online Surveys

Introduction: With a rapidly aging population, the Malaysian health care system needs to develop solutions to address the lack of resources that are required for the assessment of the older person. The complex nature of geriatric syndromes coupled with the occurrence of multiple comorbid illnesses with aging, make geriatric assessment a resource intensive process. Digital health solutions could play an important role in supporting existing health care systems, especially in low and middle income countries, with limited speciality services in geriatrics.Objective: This is a pilot study aimed at screening for geriatric syndromes through self-administered online surveys in urban community dwelling older Malaysians and assessing the pattern of geriatric syndromes in relation to the frailty status of the study participants.Methods: This is a cross-sectional pilot study conducted between July-September 2020. Community dwelling adults aged 60 years and over were invited to take part in an online survey. Information on sociodemographic variables, comorbidities, and the self-reported results of geriatric syndromes (frailty, sarcopenia, anorexia of aging, urinary incontinence, falls, and cognitive impairment), were collected through the survey.Results: Data was collected for 162 participants over a period of 2 months. The mean (SD) age of the respondents was 66.42 (5.25) years with 64.9% females. Majority of the respondents were of Chinese ethnic origin (67.9%) and had tertiary level of education (75.9%). The average time taken by participants to complete the survey was 16.86 min. Urinary incontinence was the highest reported geriatric syndrome (55.1%) followed by falls (37.6%), anorexia of aging (32.8%), cognitive impairment (27.8%), and sarcopenia (8.3%). Frailty was detected in 4.5% of the study population. Loss of weight in the previous year was the highest reported component of the frailty assessment tool. The presence of sarcopenia, anorexia of aging, poor/fair self-rated health, urinary incontinence, and multimorbidity were significantly higher in older adults who were frail or prefrail.Conclusion: Screening for geriatric syndromes through online surveys is a feasible approach to identify older adults in the community who are likely to benefit from geriatric assessment. However, the demographic profile of the older population that are accessible through such digital platforms is limited.

Identifying Barriers in the Home Environment among Urban Community-Dwelling Older Adults with Functional Difficulty: A Multi-Method Pilot Study

2018 ◽  
Vol 43 (4) ◽  
pp. 315-333 ◽  
Author(s):  
David Russell ◽  
Mia R. Oberlink ◽  
Nicole Onorato ◽  
Jodi L. Feinberg ◽  
Kathryn H. Bowles ◽  
...  
Keyword(s):  
Older Adults ◽  
Pilot Study ◽  
Home Environment ◽  
Urban Community ◽  
Community Dwelling ◽  
Community Dwelling Older Adults

Evaluating the role of baseline geriatric assessment in predicting adherence to oral targeted therapies and outcomes in older adults with non-Hodgkin lymphoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12043-12043
Author(s):  
Othman Salim Akhtar ◽  
Desi Carozza ◽  
Tanya Marya Wildes ◽  
Shilpa Chowdhry ◽  
Elizabeth R. Gage-Bouchard ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hodgkin Lymphoma ◽  
Geriatric Assessment ◽  
Targeted Therapies ◽  
Adherence Rate ◽  
Geriatric Syndromes ◽  
Non Hodgkin Lymphoma ◽  
Pill Counts

12043 Background: Oral targeted therapies (OTT) have transformed the treatment landscape of Non-Hodgkin lymphoma (NHL). However, measuring, defining and optimizing adherence to OTT remains a challenge. Prior studies have reported variable adherence rates (12-100%) to OTT in cancer patients (pts), with suboptimal adherence associated with inferior outcomes. In older adults (OA), geriatric syndromes (GS) such as polypharmacy and cognitive impairment can impact adherence. While geriatric assessment (GA) can predict chemotherapy-related toxicity in OA, its utility in NHL pts on OTT is unknown. In this pilot study, we evaluate the role of GA in predicting adherence and outcomes in NHL pts on OTT. We also report the feasibility of using MEMS Cap, an electronic event monitoring system, to measure adherence in this population. Methods: Pts ≥70 years (yrs) with NHL, initiating/receiving OTT were included. A GA was performed at baseline; pt, disease, and OTT characteristics were recorded. Pts were followed monthly for the first 3 months (mos), then every 3 mos for 1 year. Primary endpoint was treatment adherence rate, measured using both subjective [brief adherence rating scale (BARS)] and objective (pill counts and MEMS cap) methods. Progression free survival (PFS) was measured from time of therapy initiation to disease progression or death. Results: Of the 54 pts screened, 25 were enrolled. Median age was 77 yrs (71-93 yrs), 21 pts had chronic lymphocytic leukemia, 3 had mantle cell lymphoma and 1 had marginal zone lymphoma. Most frequently used OTT were ibrutinib (n = 17) and venetoclax (n = 5). Most pts (72%) were on OTT at study entry. Median time on therapy was 16.4 mos (1.9-44.6 mos). GS included cognitive impairment (28%), depression (24%), polypharmacy (92%) and recent falls (12%); 48% pts had ≥2 GS. Nine pts (36%) had impaired 4-meter gait speed and/or timed-up-and-go; 20 pts (80%) had an adjusted CIRS-G score of ≥6. So far, pts have completed a median follow up of 3.3 mos. BARS was the most consistent measure of adherence used (63/63 visits, 100%). MEMS Cap and pill counts were used at 13% and 8% visits respectively. Only 5 pts used the MEMS Cap, mostly due to packaging incompatibility (44%-pill box, 32%-blister packs). Median adherence was 100% (range, 70%-100%) with no pts missing > 7 days of prescribed doses. Five pts (20%) required dose interruptions, mostly due to adverse events. Six pts discontinued therapy and 2 pts died of unrelated causes. Median PFS was not reached. Chronological age and presence of a GS were not associated with adherence rate or outcomes. Conclusions: Despite presence of ≥2 geriatric syndromes in 48% of older adults with NHL on OTT, self-reported adherence remains high ( > 99%) in this group. The MEMS Cap device has poor applicability in measuring adherence to OTT due to pill package incompatibility and increasing use of virtual/tele visits.

scholarly journals Utility of Geriatric Syndrome Indicators for Predicting Subsequent Health Care Utilization in Older Adults in Taiwan

2019 ◽  
Vol 16 (3) ◽  
pp. 456
Author(s):  
Ching-Ju Chiu ◽  
Ya-Yun Cheng
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Geriatric Syndromes ◽  
Emergency Visits ◽  
Old Patients ◽  
Young Old ◽  
Diabetes Patients

Background: The predictive utility of both individual and combined indicators of geriatric syndromes on subsequent emergency use and hospitalization is not clear. Methods: Nationally representative data on adults aged 65+ (N = 2345) (with 1148 male, 1197 female) in Taiwan were analyzed. The receiver operating characteristic (ROC) curve examined the diagnostic accuracy of the combined effects of geriatric syndromes on predicting health care utilization in three years. Negative binomial regressions identified the individual effect of each indicator with the control of sociodemographic and baseline health status. Results: The combined indicators of geriatric syndromes predicted future hospitalization of old-old (75+ yrs) diabetes patients, with area under the curve (AUC) = 0.709, 95% confidence interval (CI) = 0.635–0.782, and young-old patients (65–74 yrs) with mild cognitive impairment (AUC = 0.727, 95% CI = 0.610–0.845 for hospitalization and AUC = 0.770, 95% CI = 0.664–0.877 for emergency visits). As for individual indicators, while incontinence was the indicator having the most influence on hospitalization (incidence rate ratio (IRR) = 1.81, 95% CI = 1.21–2.72) and emergency visits (IRR = 1.78, 95% CI = 1.23–2.59) for general older adults (65+), and for old-old emergency visits, especially (IRR = 2.21, 95% CI = 1.39–3.49), falls was the most prominent indicator of hospitalization for young-old (65-74) adults (IRR = 1.61, 95% CI = 1.13–2.28). In addition, pain was another significant indicator for predicting future hospitalization of old-old diabetes patients (IRR = 1.61, 95% CI= 1.07–2.44). Conclusions: Combined indicators of geriatric syndromes effectively predict hospitalization in old-old (75+ yrs) diabetes patients and hospitalization and emergency visits in young-old (65–74 yrs) patients with cognitive impairment. Incontinence, falls, and pain were the most predictive independent geriatric assessment indicators.

Music therapy intervention in community-dwelling older adults with mild cognitive impairment: A pilot study

2019 ◽  
Vol 40 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Claudia Jennifer Domínguez-Chávez ◽  
Carolyn J. Murrock ◽  
Patricia I. Cavazos Guerrero ◽  
Bertha Cecilia Salazar-González
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Pilot Study ◽  
Music Therapy ◽  
Community Dwelling ◽  
Community Dwelling Older Adults ◽  
Therapy Intervention

scholarly journals Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults

2021 ◽  
pp. 1-8
Author(s):  
M. Ong ◽  
K. Pek ◽  
C.N. Tan ◽  
J. Chew ◽  
J.P. Lim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Executive Dysfunction ◽  
Community Dwelling ◽  
Geriatric Syndromes ◽  
Life Space ◽  
Community Dwelling Older Adults

Background: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults. Objectives: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition. Methods: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups. Results: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4). Conclusion: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.

scholarly journals Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

2021 ◽  
Vol 18 (4) ◽  
pp. 1603
Author(s):  
Tran Dai Tri Han ◽  
Keiko Nakamura ◽  
Kaoruko Seino ◽  
Vo Nu Hong Duc ◽  
Thang Van Vo
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Vision Loss ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Ordinal Logistic Regression Analysis ◽  
Communication Devices ◽  
Community Dwelling Older Adults

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

scholarly journals Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

2021 ◽  
pp. 089826432199332
Author(s):  
Wanda Rietkerk ◽  
Jannet de Jonge-de Haan ◽  
Joris P. J. Slaets ◽  
Sytse U. Zuidema ◽  
Debby L. Gerritsen
Keyword(s):  
Older Adults ◽  
Behavior Change ◽  
Older Adult ◽  
Goal Setting ◽  
Geriatric Assessment ◽  
Well Being ◽  
Community Dwelling ◽  
Implementation Processes ◽  
Adult Involvement ◽  
Community Dwelling Older Adults

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

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