scholarly journals Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline

2021 ◽  
Vol 24 (2) ◽  
pp. 138-143
Author(s):  
Chantel D. Mayo ◽  
Rebecca Kenny ◽  
Vanessa Scarapicchia ◽  
Lisa Ohlhauser ◽  
Robin Syme ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Daily Living ◽  
Aging In Place ◽  
Cognitive Change ◽  
Structured Interviews ◽  
Emotional Challenges ◽  
Targeted Interventions ◽  
Increased Risk

Background An emergent concern related to the aging and the increased risk of cognitive decline is the institutionalization of older adults. Evidence has shown that aging in place leads to many benefits, including higher quality of life. In order to support older adults, it is imperative that we understand the challenges people with changes in cognition face while aging in place. Methods A total of sixteen older adults with self-reported cognitive decline and six informal caregivers of individuals reporting cognitive decline, all of whom are living in independent residences, participated. Focus group sessions with semi-structured interviews were conducted, followed by thematic qualitative data analyses. Results Thematic analyses led to the identification of six challenges to aging in place, including: 1) memory decline, 2) emotional challenges/low mood, 3) social isolation/loneliness, 4) difficulty with mobility and physical tasks, 5) difficulties with activities of daily living/instrumental activities of daily living, and 6) lack of educational resources on cognitive change. Conclusion The themes identified in the current study represent common challenges in aging in place for older adults with self-reported cognitive decline. Identification of these themes allows for important next steps, which can focus on supports through targeted interventions.

scholarly journals Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Shobhit Srivastava ◽  
T. V. Sekher
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Psychological Health ◽  
Daily Living ◽  
Basic Needs ◽  
Well Being ◽  
Asset Ownership ◽  
Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

ASSESSMENT OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN OLDER ADULTS WITH SUBJECTIVE COGNITIVE DECLINE USING THE VIRTUAL REALITY FUNCTIONAL CAPACITY ASSESSMENT TOOL (VRFCAT)

2018 ◽  
pp. 1-9
Author(s):  
A.S. Atkins1 ◽  
A. Khan ◽  
D. Ulshen ◽  
A. Vaughan ◽  
D. Balentin ◽  
...  
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Functional Capacity ◽  
Daily Living ◽  
Assessment Tool ◽  
Subjective Cognitive Decline ◽  
Capacity Assessment ◽  
Instrumental Activities

Background: Continuing advances in the understanding of Alzheimer’s disease progression have inspired development of disease-modifying therapeutics intended for use in preclinical populations. However, identification of clinically meaningful cognitive and functional outcomes for individuals who are, by definition, asymptomatic remains a significant challenge. Clinical trials for prevention and early intervention require measures with increased sensitivity to subtle deficits in instrumental activities of daily living (IADL) that comprise the first functional declines in prodromal disease. Validation of potential endpoints is required to ensure measure sensitivity and reliability in the populations of interest. Objectives: The present research validates use of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for performance-based assessment of IADL functioning in older adults (age 55+) with subjective cognitive decline. Design: Cross-sectional validation study. Setting: All participants were evaluated on-site at NeuroCog Trials, Durham, NC, USA. Participants: Participants included 245 healthy younger adults ages 20-54 (131 female), 247 healthy older adults ages 55-91 (151 female) and 61 older adults with subjective cognitive decline (SCD) ages 56-97 (45 female). Measures: Virtual Reality Functional Capacity Assessment Tool; Brief Assessment of Cognition App; Alzheimer’s Disease Cooperative Study Prevention Instrument Project – Mail-In Cognitive Function Screening Instrument; Alzheimer’s Disease Cooperative Study Instrumental Activities of Daily Living – Prevention Instrument, University of California, San Diego Performance-Based Skills Assessment – Validation of Intermediate Measures; Montreal Cognitive Assessment; Trail Making Test- Part B. Results: Participants with SCD performed significantly worse than age-matched normative controls on all VRFCAT endpoints, including total completion time, errors and forced progressions (p≤0001 for all, after Bonferonni correction). Consistent with prior findings, both groups performed significantly worse than healthy younger adults (age 20-54). Participants with SCD also performed significantly worse than controls on objective cognitive measures. VRFCAT performance was strongly correlated with cognitive performance. In the SCD group, VRFCAT performance was strongly correlated with cognitive performance across nearly all tests with significant correlation coefficients ranging from 0.3 to 0.7; VRFCAT summary measures all had correlations greater than r=0.5 with MoCA performance and BAC App Verbal Memory (p<0.01 for all). Conclusions: Findings suggest the VRFCAT provides a sensitive tool for evaluation of IADL functioning in individuals with subjective cognitive decline. Strong correlations with cognition across groups suggest the VRFCAT may be uniquely suited for clinical trials in preclinical AD, as well as longitudinal investigations of the relationship between cognition and function.

scholarly journals Meanings of Care Convoys: The Structure, Function, and Adequacy of Care Networks Among Frail, Community-Dwelling Older Adults

2019 ◽  
Vol 30 (4) ◽  
pp. 583-597
Author(s):  
Deborah Lambotte ◽  
An-Sofie Smetcoren ◽  
G. A. Rixt Zijlstra ◽  
Jan De Lepeleire ◽  
Liesbeth De Donder ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Community Dwelling ◽  
Older Individuals ◽  
Structured Interviews ◽  
Wide Range ◽  
Relational Aspect ◽  
Health Care Monitoring ◽  
Community Dwelling Older Adults

Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults’ experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.

scholarly journals Association of late-life depression with cognitive impairment: evidence from a cross-sectional study among older adults in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Trupti Meher
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Urban Areas ◽  
Daily Living ◽  
Short Form ◽  
Late Life ◽  
Older Individuals ◽  
Late Life Depression ◽  
Increased Risk

Abstract Background Late-life depression (LLD) is considered as a prodrome to dementia and plays a major role in the development of long-term cognitive disabilities. We aimed to estimate the prevalence and correlates of LLD and cognitive impairment and to explore their associations among older adults in India. Methods Data for this study was derived from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-18). The total sample included 31,464 (15,098 male and 16,366 female) older individuals aged 60 years and above. Cognitive impairment measured from various domains derived from the cognitive module of the Health and Retirement Study (HRS), and major depression measured by the CIDI-SF (Composite International Diagnostic Interview- Short Form) were the outcome variables. Descriptive, bivariate, and multivariable analyses were performed to fulfill the objectives of the study. Results The overall prevalence of LLD and cognitive impairment for the current sample was 8.7% and 13.7 % respectively. Among older individuals who have rated their health status as poor were 2.59 times more likely to suffer from LLD [OR: 2.59, CI: 2.24–2.99] as compared to their counterparts. The older adults who had difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) were 74% and 69 % more likely to suffer from LLD. Similarly, older adults who were depressed had higher odds of cognitive impairment [OR: 1.22, CI: 1.01–1.48] compared to their counterparts. Also, older adults who were depressed and belonged to rural areas were 2.58 times [AOR: 2.58, CI: 1.95–3.41] more likely to be cognitively impaired than those who were not depressed and resided in urban areas. Conclusions Depression is linked to an increased risk of cognitive decline and dementia; therefore, failing to diagnose and treat LLD in later life may have significant health implications. Moreover, treatment under the care of a cognitive neurologist or geriatric psychiatrist is recommended for people with LLD and cognitive disability due to both the disorders' complex existence.

scholarly journals A web-based dynamic Nomogram for predicting instrumental activities of daily living disability in older adults: a nationally representative survey in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Li Zhang ◽  
Huijie Cui ◽  
Qiuzhi Chen ◽  
Yan Li ◽  
Chunxia Yang ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Validation Cohort ◽  
Self Report ◽  
Web Based ◽  
Training Cohort ◽  
Targeted Interventions ◽  
Instrumental Activities ◽  
Iadl Disability

Abstract Background Instrumental Activities of Daily Living (IADL) disability is a common health burden in aging populations. The identification of high-risk individuals is essential for timely targeted interventions. Although predictors for IADL disability have been well described, studies constructing prediction tools for IADL disability among older adults were not adequately explored. Our study aims to develop and validate a web-based dynamic nomogram for individualized IADL disability prediction in older adults. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We included 4791 respondents aged 60 years and over, without IADL disability at baseline in the 2011 to 2013 cohort (training cohort) and 371 respondents in the 2013 to 2015 cohort (validation cohort). Here, we defined IADL disability as needing any help in any items of the Lawton and Brody’s scale. A web-based dynamic nomogram was built based on a logistic regression model in the training cohort. We validated the nomogram internally with 1000 bootstrap resamples and externally in the validation cohort. The discrimination and calibration ability of the nomogram was assessed using the concordance index (C-index) and calibration plots, respectively. Results The nomogram incorporated ten predictors, including age, education level, social activity frequency, drinking frequency, smoking frequency, comorbidity condition, self-report health condition, gait speed, cognitive function, and depressive symptoms. The C-index values in the training and validation cohort were 0.715 (bootstrap-corrected C-index = 0.702) and 0.737, respectively. The internal and external calibration plots for predictions of IADL disability were in excellent agreement. An online web server was built (https://lilizhang.shinyapps.io/DynNomapp/) to facilitate the use of the nomogram. Conclusions We developed a dynamic nomogram to evaluate the risk of IADL disability precisely and expediently. The application of this nomogram would be helpful for health care physicians in decision-making.

scholarly journals Dependency Change with Aging and Associated Factors in Uruguay: A Cohort Study

2021 ◽  
pp. 089826432110177
Author(s):  
Alejandra Marroig ◽  
Maximiliano Machado ◽  
Graciela Muniz-Terrera
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Activities Of Daily Living ◽  
Chronic Conditions ◽  
Daily Living ◽  
Associated Factors ◽  
Social Care ◽  
Representative Study ◽  
Increased Risk ◽  
Using Data

Objectives: To assess the heterogeneity of transitions toward dependency in older adults and to explore the robustness of results to different operationalizations of dependency. Method: Using data from people aged 60 years and older from a national representative study in Uruguay ( Encuesta Longitudinal de Protección Social, N = 5071), we fitted multinomial regressions adjusted by sociodemographic and health characteristics to model transitions into dependency and death. We used a harder operationalization with basic activities of daily living (Katz-dependency) and Comprehensive-dependency with basic, instrumental, and advanced activities. Results: Increasing age (RRR = 1.08, CI = [1.05; 1.12], p < .001) and having comorbidities (RRR = 2.16, CI = [1.31; 3.57], p = .003) increased the risk of transition from nondependent to dependent using Katz-dependency. Women with at least two chronic conditions have increased risk of Comprehensive-dependency (RRR = 1.79, CI = [1.15; 2.80], p = .010). Discussion: Inconsistencies in findings emerged when evaluating transitions into dependency with the different measures, which may have social care implications.

scholarly journals Complexity of care of hospitalized older adults and its relationship with sociodemographic characteristics and functional independence

2019 ◽  
Vol 22 (6) ◽  
Author(s):  
Beatriz Aparecida Ozello Gutierrez ◽  
Henrique Salmazo da Silva ◽  
Rosa Yuka Sato Chubaci ◽  
Caroline Ribeiro Borja-Oliveira
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Daily Living ◽  
Functional Independence ◽  
Sao Paulo ◽  
São Paulo ◽  
Term Care ◽  
Female Sex ◽  
Hospitalized Older Adults

Abstract Objectives: To investigate the relationship between the complexity of care of hospitalized older adults and sociodemographic and functional independence characteristics. Method: A quantitative cross-sectional and descriptive study was carried out in the medical and surgical clinics of the University Hospital of the Universidade de São Paulo, in the state of São Paulo SP, Brazil. A total of 382 older adults were assessed through a socio-demographic inventory, the Mini Mental State Exam, the Katz Index of Independence in Activities of Daily Living and the Interdisciplinary Medicine Instrument Method. Results: The complexity of care of participants was associated with the female sex (p=0.003), not having a partner (p=0.003), having a lower income (p=0.022), cognitive decline (p<0.001) and dependence in basic activities of daily living (BADL) (p<0.001). In the multiple logistic regression model, variables such as the female sex (OR=1.76; p=0.018), dependence in one or more activities of daily living (OR=1.26; p<0.001) and cognitive decline (OR=3.31; p<0.001) remained associated with complexity of care. Conclusion: The complexity of care of hospitalized older adults, as it is associated with limitations in BADL and cognitive decline, requires actions by the interprofessional team to ensure the rehabilitation, integration of long-term care and planning of care resources for older patients. Thus, it is necessary to adopt integrated services that include home care and care networks for the elderly, in order to provide qualified post-hospital discharge care and promote the health of the hospitalized older population.

scholarly journals Regional atrophy and cognitive decline depend on definition of subjective cognitive decline

2021 ◽  
Author(s):  
Cassandra Morrison ◽  
Mahsa Dadar ◽  
Neda Shafiee ◽  
Sylvia Villeneuve ◽  
D. Louis Collins ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Cognitive Change ◽  
Disease Assessment ◽  
Subjective Cognitive Decline ◽  
Cognitively Normal ◽  
Increased Risk ◽  
Definition Of

AbstractBackgroundPeople with subjective cognitive decline (SCD) may be at increased risk for Alzheimer’s disease (AD). However, not all studies have observed this increased risk. Inconsistencies may be related to different methods used to define SCD. The current project examined whether four methods of defining SCD (applied to the same sample) results in different patterns of atrophy and future cognitive decline between cognitively normal older adults with (SCD+) and without SCD (SCD-).MethodsMRI scans and questionnaire data for 273 cognitively normal older adults from Alzheimer’s Disease Neuroimaging Initiative were examined. To operationalize SCD we used four common methods: Cognitive Change Index (CCI), Everyday Cognition Scale (ECog), ECog + Worry, and Worry only. A previously validated MRI analysis method (SNIPE) was used to measure hippocampal volume and grading. Deformation-based morphometry was performed to examine volume at regions known to be vulnerable to AD. Logistic regressions were completed to determine whether diagnostic method was associated with volume differences between SCD- and SCD+. Linear mixed effects models were performed to examine the relationship between the definitions of SCD and future cognitive decline.ResultsResults varied between the four methods of defining SCD. Left hippocampal grading was lower in SCD+ than SCD-when using the CCI (p=.041) and Worry (p=.021) definitions. The right (p=.008) and left (p=.003) superior temporal regions were smaller in SCD+ than SCD-, but only with the ECog. SCD+ was associated with greater future cognitive decline measured by Alzheimer’s Disease Assessment Scale, but only with the CCI definition. In contrast, only the ECog definition of SCD was associated with future decline on the Montreal Cognitive Assessment.ConclusionThe current findings suggest that the various methods used to differentiate between SCD- and SCD+ influence whether volume differences and findings of cognitive decline are observed between groups in this retrospective analysis.

scholarly journals Type and Severity of Cognitive Decline in Older Adults after Noncardiac Surgery

2008 ◽  
Vol 108 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Catherine C. Price ◽  
Cynthia W. Garvan ◽  
Terri G. Monk
Keyword(s):  
Older Adults ◽  
Executive Function ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Daily Living ◽  
Noncardiac Surgery ◽  
Future Research ◽  
Equal Distribution ◽  
Memory Decline ◽  
Instrumental Activities

Background The authors investigated type and severity of cognitive decline in older adults immediately and 3 months after noncardiac surgery. Changes in instrumental activities of daily living were examined relative to type of cognitive decline. Methods Of the initial 417 older adults enrolled in the study, 337 surgery patients and 60 controls completed baseline, discharge, and/or 3-month postoperative cognitive and instrumental activities of daily living measures. Reliable change methods were used to examine three types of cognitive decline: memory, executive function, and combined executive function/memory. SD cutoffs were used to grade severity of change as mild, moderate or severe. Results At discharge, 186 (56%) patients experienced cognitive decline, with an equal distribution in type and severity. At 3 months after surgery, 231 patients (75.1%) experienced no cognitive decline, 42 (13.6%) showed only memory decline, 26 (8.4%) showed only executive function decline, and 9 (2.9%) showed decline in both executive and memory domains. Of those with cognitive decline, 36 (46.8%) had mild, 25 (32.5%) had moderate, and 16 (20.8%) had severe decline. The combined group had more severe impairment. Executive function or combined (memory and executive) deficits involved greater levels of functional (i.e., instrumental activities of daily living) impairment. The combined group was less educated than the unimpaired and memory groups. Conclusion Postsurgical cognitive presentation varies with time of testing. At 3 months after surgery, more older adults experienced memory decline, but only those with executive or combined cognitive decline had functional limitations. The findings have relevance for patients and caregivers. Future research should examine how perioperative factors influence neuronal systems.

scholarly journals Self-Efficacy Proxy Predicts Physical Frailty Incidence Over 8 Years in Non-Institutionalized Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 392-392
Author(s):  
Melissa Hladek ◽  
Jiafeng Zhu ◽  
Brian Buta ◽  
Sarah Szanton ◽  
Karen Bandeen-Roche ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Sex Education ◽  
Self Efficacy ◽  
Daily Living ◽  
Functional Decline ◽  
Adverse Outcomes ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Increased Risk

Abstract Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality and other adverse outcomes in response to a stressor. One potential modifiable risk factor of frailty is self-efficacy, which is confidence in one’s ability to perform well at a task or domain in life. Self-efficacy is associated with improved health behavior and decreased chronic disease burden but has not been studied extensively in frailty research. Therefore, the purpose of this study was to evaluate a general self-efficacy proxy measure’s ability to predict frailty in a nationally representative sample of older adults using data from the National Health and Aging Trends Study (NHATS) collected from 2011-2018. 4,835 older adults (65+) were dichotomized into low and high self-efficacy groups using the one-item self-efficacy proxy measure in NHATS. The Physical Frailty Phenotype was used to assess frailty. A discrete time hazard model was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education and income. Model 2 contained Model 1 covariates and activities of daily living and co-morbidities. We found that low self-efficacy predicted a 41% increased risk of developing frailty over 8 years after adjustment for socio-demographics (P&lt;0.0001) and a 27% risk of incident frailty after further adjustment for activities of daily living and co-morbidities (P=0.004). This study provides preliminary evidence that self-efficacy may be a key modifiable element to incorporate into multi-modal frailty interventions.

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