To date, 106 patients have completed behavioral health assessments across three sites: a rural primary care clinic (n = 32), urban federally qualified health center (n = 33), and state-certified residential rehabilitation facility (n = 41). Patients ranged from 18 to 65 years of age (M = 38.6, SD = 11.4). Approximately 51% were female and 75% were non-Hispanic White (followed by 22% African American). Over 60% had a high school degree or less and found it at least somewhat difficult to pay for basic needs. Most patients endorsed substantial (44%) or severe (39%) drug use, with 40% endorsing opioid use. There were no significant differences in substance use by age group. Moderate to severe symptoms of depression (43%) and anxiety (49%) were common. Approximately 70% endorsed adverse childhood experiences, and 44% reported clinically significant post-traumatic stress symptoms. Measures of cognitive functioning and objective health literacy are currently being collected.
While heart failure (HF) accounts for one-fifth of U.S. deaths today, treatments have extended both the life of heart failure (HF) patients and their time spent living at home. Yet, the functional limitations associated with HF can place heavy demands on caregivers. Thus, this study explores social and relational factors that may modify the negative impact of HF patient symptoms on caregiver outcomes. Specifically, we ask: Do social support and patient-caregiver relational mutuality moderate the association between patients’ baseline symptoms and caregiver burden reported one year later? This study uses two waves of data for 99 patient-caregiver dyads (70% female spousal caregivers; 71% White, non-Hispanic; Magecaregiver = 57.22; Magepatient = 66.01) that were part of a 12-month intervention study aimed at improving quality of life for HF patients. We control for caregiver burden at baseline, intervention status, and spousal relationship to the care recipient in analyzing this association. Moderation analyses indicate that higher caregiver-patient mutuality significantly buffers (b = -.24, p =.03) the association between patients’ reports of functional limitations and caregiver reported burden at 12 months. Additionally, higher levels of social support reported by the caregiver weaken (b = -.30, p =.002) the relationship between patient-reported symptom severity and caregiver burden at 12-month follow-up. Longitudinal data and use of multiple reporters in this study advance prior work on caregiving for HF patients. Implications for caregiver interventions are offered.
International discussants Terry Lum, social worker and health services researcher, Bruno Vellas, internist, geriatrician and clinical trial expert, and Desmond O’Neill, geriatrician, humanist and ethicist, will discuss the findings and their implications for future gerontological research, and cross-national as well as cross-disciplinary gerontological research. Along with other presenters, they will serve as panelists for an audience discussion about what kind of common understanding of evidence is necessary or desirable for cross-disciplinary and cross-national gerontological research.
A mobile application has been developed to allow individuals to self-assess the risk of diabetes. A graph shows the risk level in the app. The study aims to (1) estimate the chance for developing diabetes in 2 years after using the app, and (2) investigate the high-risk app users’ lifestyle behavior change after knowing the risk level from the app. This was a 2-year prospective cohort study, using online survey to follow up those app users who provided contacts to the project team. Logistic regression model was used to estimate the chance of developing diabetes. Paired t-tests were used to compare the lifestyle changed over the period after knowing the risk level. A total of 326 app users replied to the invitation emails. After adjusting for sex and educational level, people in the high-risk group had higher chance of developing diabetes (OR 4.59, 95% CI: 1.01 to 20.81, p = 0.048) in two years. High-risk app users improved their habits of vegetables daily intake (Baseline: M = 0.76, SD = 0.43; follow-up: M = 0.93, SD = 0.26; t(81) = -3.77, p <0.001) and doing physical activities (Baseline: M = 0.40, SD = 0.49; follow-up: M = 0.54, SD = 0.50; t(81) = -2.08, p = 0.040). The DRS app has been shown to be a feasible and reliable tool to predict the chance of developing diabetes in two years. The risk level shown in the app has developed impacts on lifestyle modification among the high-risk individuals.
This study aimed to explore multidimensional care needs for non-cancer patients by end of life stage and palliative performance scale (PPS). A retrospective study design was used. Home care nurses were asked to review medical and nursing records and to respond structured questionnaire. 115 participants who were at the ages of 40 or over, continuously received home care nursing throughout stable (between the beginning stage and one week before the death) and near death (one week before to the death) at Seoul St. Mary Hospital in Korea, and died from September 1, 2014 to December 31, 2015 were analyzed. Care needs for ‘coordination among family or relatives’ and ‘support for fundamental needs’ areas were significantly more important in the stable stage than in the near death stage. The ‘Loss, grief care’ area was significantly more important in the near death stage than in the stable stage. As patient’s initial PPS was lower, the level of importance for care needs was higher especially on ‘management of physical symptoms’ and ‘psychological support’ areas in the stable stage and ‘coordination among family or relatives’ area in both stages. Future palliative intervention need to develop based on patients-centered assessment of PPS and care needs to ensure quality of life for non-cancer patients who receive home care. Moreover health care professionals should focus on continuous and holistic tailoring end of life care through advance care planning for non-cancer patients.
Heart disease is the leading cause of deaths worldwide. Systemic arterial hypertension contributes to raising the risk of cardiovascular events. In older women the incidence of hypertension is higher compared to men. The role of exercise in the prevention and treatment of hypertension is undeniable, however, the best mode has not been set. The present study investigated the hemodynamic responses of systolic blood pressure (BP) of 30 elderly hypertensive women under drug therapy, subjected to continuous aerobic exercise (CAE), interval aerobic exercise (IAE), resistance exercise (RE) and control (C) with a minimum interval of 7 days, in random order, with the same intensity. Systolic BP measurements were obtained before and immediately after the sessions by the oscillometric method, and 24-hour ambulatory blood pressure monitoring (24-h ABPM) was performed in 4 groups. The data were analyzed by mixed-effects model. It was observed a decrease in systolic BP in the CAE (123 ± 17 mmHg to 116 ± 19 mmHg, p <0.001), in the IAE (122 ± 16 to 112 ± 16 mmHg, p <0.001), with no immediate change in ER. In the 24-h ABPM was observed lower systolic BP in IAE than in CAE (<0.001). The hypotensive effect of IAE session is larger and longer than CAE session, suggesting that the change in intensity over time of exercise can influence the magnitude of the systolic BP fall in hypertensive older women.
With the aging of the population comes the aging of the workforce. Due to increased costs of living and medical expenses, many older people have to work for a longer lifetime period before they can afford to retire. At the same time, technological innovations are changing the workplace. The objective of our study was to evaluate how older workers experience technology in the workplace and what factors drive a positive or negative experience. As part of the Construction-Wearables-Digitization-Study (ConWearDi), we conducted a survey in three construction companies to assess the experience with technology of young and older workers. In addition, we assessed subjectively perceived demands at work, cognitive functioning, and symptoms of depression and burnout. On the conference, we present the comparison of the experience of technology at work between young and older workers. In addition, we show findings from structural equation models evaluating to what extent the experience of technology is dependent on the level of demand associated with its use, the level of cognitive functioning of the individual worker, and symptoms of depression or burnout. Our findings suggest that a positive experience of technology in the workplace by older workers is dependent on factors associated with usability. The benefit from technological innovations at work may be much greater, if new technologies would adapt their usability according to the physical and cognitive abilities of older workers.
Objective: To evaluate if patients with Parkinson s disease and elderly people can improve on their postural control (PC) and cognition after virtual reality training.
Methods: Sample size was composed by ten subjects, 5 idiopathic PD (PDG) [68.2 ± 6.01 years; Hoehn & Yahr scale = 1:2 subject; 1.5:2 subject and 3:1 subject], and 5 elders subjects (ESG) [68.2 ± 6.3 years]. Fourteen sessions of Kinect Adventures games were carried out [1 hour, 2x/week for 7 weeks, during on period of dopaminergic replacement]. PC and cognition were assessed by Mini-Balance Evaluation Systems Test (MBT) and Montreal Cognitive Assessment (MoCA). Assessments were performed before, after and 1 month after the end of training (follow-up). Descriptive analysis was performed (mean, standard deviation and confidence interval of 95%). Results: Regarding PC, MBT scores in PDG were at baseline: 26.0 ± 3.6 [21.52 – 30.47]; after training: 26.2 ± 3.42 [21.95 – 30.44] and follow-up: 27.6 ± 2.6 [24.36 – 30.83]. MBT scores in ESG were at baseline: 27.4 ± 2.7 [24.04 – 30.75], after training: 29.2 ± 2.77 [25.75 – 32.64] and follow-up: 28.4 ± 1.81 [26.14 – 30.65]. MoCA scores in PDG were 24.0 ± 1.87 [21.67 – 26.32] at baseline 23.6 ± 3.2 [19.61 – 27.58] after training and 23.6 ± 2.7 [20.24 – 26.95] at follow up. MoCA scores in ESG were 21.0 ± 3.08 [17.17 – 24.82] at baseline, 27.2 ± 2.16 [24.50 – 29.89] after training and 26.2 ± 2.48 [23.10 – 29.29] at follow up. Conclusion: Scores of groups in both scales at baseline indicated that patients were next to ceiling of scales. Nevertheless, CG showed improvement on PC and cognition after training. However, future studies with larger sample are needed in order to generalize the results.
The biological processes that constitute ageing and lead to age-related disease risks are poorly understood. Improved knowledge of biomarkers that are indicators of ageing could highlight biological pathways where research should be focused, in order to identify modifiable risk factors and reduce risks currently attributed to chronological age. Previous studies have been limited in scale. Among 0.5 million participants aged 40–70 recruited into the UK Biobank between 2006–2010, we considered measurements for over 50 biomarkers describing physical and biochemical function, collected using touchscreen questionnaires, physical measurement devices, blood tests and urine tests. Linkage to electronic health records provided information on prior disease, and incidence of hospital-related outcomes and mortality for a median follow up duration of 6.0 years. The Klemera-Doubal method (recommended by previous studies) was used to derive a biological age by combining biomarkers strongly related to age, and was applied separately within each sex and by level of prior disease. In our ongoing research, worse lung function, lower fat-free body mass and lower bio-impedance metabolic rate emerge as strong risk factors of greater biological age. The effects of pre-preparation of biomarker measurements, such as adjusting for height or taking principle components, will be explored. We will discuss the predictive power of biological age for all-cause mortality and discharge to care homes, and the extent to which the predictive power of chronological age is captured by biological age and varies by prior disease.
Neurodegenerative conditions, including Alzheimer’s disease and related dementias (ADRD), have an outsized impact on disability and loss of independence in older adults. As such, there is a growing need to identify modifiable risk factors for ADRD at the population level. We conducted a nationwide administrative-register study to investigate mental disorders as a potential preventable risk factor for later-life ADRD. Data were drawn from the New Zealand Integrated Data Infrastructure, a collection of whole-of-population administrative data sources linked at the individual level by a common spine. We identified all individuals born in New Zealand between 1928-1967 and followed them for three decades (N = 1,711,386; observation period = 1988-2018; age at baseline = 21-60 years). Diagnoses of mental disorders were ascertained from public-hospital records. Diagnoses of ADRD were ascertained from public-hospital records, mortality records, and pharmaceutical records. Individuals with a mental disorder were at elevated risk for developing Alzheimer’s disease and related dementias relative to those without a mental disorder. This prospective association was evident in both men and women, across age, and after accounting for pre-existing physical diseases. If associations are causal, ameliorating mental disorders could extend population healthspan and reduce the societal burden of neurodegenerative diseases.
Age-related changes in functional ability, particularly among people aging with long-term disabilities, can impact safe performance of toilet and bathtub transfers and severely limit their ability to successfully age-in-place. The SmartBathroom is a state-of-the-art bathroom laboratory that features mechanically adjustable features and an array of sensors that can measure walking performance, location of feet and hands, and forces applied to the bathroom surfaces and fixtures. To complement the SmartToilet system, TechSAge recently developed the SmartBathing Transfer Testbed prototype that will enable us to study how different bathing environment configurations can impact transfer performance. The testbed consists of a height adjustable tub wall and three-wall, height and angle adjustable grab bars with integrated sensors to measure hand location and grip and load forces. This session will describe the SmartBathing Testbed and present results of studies with individuals both with and without ambulatory impairments performing simulated transfers within the testbed.
The hypothalamic pituitary adrenal axis (HPA axis) is a major neuroendocrine system for stress response and for regulating the immune system. Aged rats as well as older humans demonstrate progressive loss of control of the HPA axis, resulting in impaired diurnal rhythm and hypersecretion of glucocorticoids during times of stress. Higher levels and a blunted diurnal rhythm of cortisol have been observed in frail compared to more robust older adults. Understanding the factors underlying disturbed glucocorticoid secretion that precede age-related diseases and frailty are of considerable importance to prevent vulnerability and disability in late life. In order to study this system in vivo, we utilized a mouse model of chronic inflammation and as frailty and measured changes in plasma corticosterone and pro-inflammatory levels after acute cold stress. The plasma corticosterone level was determined 2 weeks before cold stimulation in 10 young (3 months), 10 old (21 months) C57BL/6J mice, and 10 young IL-10 tm/tm (3 months). 5 mice from each group were exposed to cold stress, the remainder served as controls and were not exposed to cold. The treatment groups were exposed to four degrees Celsius for 5 hours and the controls were kept in room temperature conditions at twenty five degrees Celsius. The results showed higher basal plasma corticosterone (P<0.01) and normal IL-6 and TNFR-1 levels in young IL-10tm/tm, compared to young and old C57BL/6J mice. However, there were unchanged corticosterone level and higher IL-6 and TNFR-1 levels (P=0.04, 0.02, respectively) in young IL-10tm/tm mice after acute cold stress compared to young wild type mice. Lower GRa mRNA expression in hippocampus was also observed in control and treated young IL-10tm/tm (P<0.01), compared the age-matched wild type mice. These findings provide initial evidence for the hypothesis that HPA axis dysfunction is through whole life of frail subjects and even earlier than changes in immune system.
Previous studies used the composite measure of leisure activities to examine the relationship between leisure activities and cognitive function in later life. The aim of this study was to investigate differential effects of cognitively stimulating leisure activities (CSLAs) on cognitive decline in the elderly population using four waves data (1996, 1999, 2003 and 2007) from the Taiwan Longitudinal Study on Aging (TLSA). 2,532 Taiwanese community-dwelling elders aged 67 and older were included in analysis. In each wave, leisure activities and cognitive performance of participants were assessed using questionnaire-based instruments. Four CSLAs including watching TV, radio listening, reading and gambling were assessed in terms of weekly frequencies. The number of error responses from a 9-item Short Portable Mental Status Questionnaire (SPMSQ) was used to measure cognitive performance. Generalized estimating equation models with negative binomial distribution were employed to examine associations between 4 CSLAs and error numbers of SPMSQ. After adjusting for covariates including age, sex, education, marital status, financial status and physical function, the lowest frequency (< once a week) in all four CSLAs were associated with increased error numbers of SPMSQ comparing to their counterparts who were in the highest frequency (almost everyday) in up to 11-year follow-up. Among 4 CSLAs, the greatest effect on cognitive performance was found in reading activity, followed by watching TV and listening radio. We conclude that daily activities in these 4 CSLAs were protective of cognitive function in later life.
This study assessed age-graded change in positive and negative affect over decades of the lifespan. We conducted a coordinated integrative data analysis (IDA) using data from 11 longitudinal samples, comprising a total of 74076 respondents, spanning the ages of 11 to 106. Positive and negative affect were measured using the CES-D in 8 studies, the PANAS in 3 studies, and the MIDI scale in the MIDUS with three to eleven measurement occasions across studies. To assess and compare the extent and nature of change in affect over time across studies, analyses were coordinated, deploying identical multi-level growth models on each dataset. The curvilinear models suggested PA was best characterized by an inverted U-shaped trajectory, peaking in the mid-to-late 50s, while change in NA was best described by a U-shaped curve, bottoming out in the late 60s. We also found measure-related differences in the proportion of variance in affect attributable to within- or between person differences; The majority of the variability in CES-D-assessed affect was attributable to within-person differences over time, while the variability in PANAS-assessed affect was predominantly attributable to between-person differences. Overall, the results did not support steady improvement of emotional experience over the entire life-course as previous studies have suggested, but show promise for midlife when PA peaks and NA bottoms out. This study demonstrates the value of coordinated conceptual replications, resolving some of the mixed findings in the literature regarding age-graded change in affect and enhancing the current understanding of the longitudinal affect phenomenon.
The population of older people with intellectual disabilities (ID) is growing. People with ID are known to have more diseases and are believed to start aging earlier than the general population, but knowledge about their healthcare use is limited. This study aimed to explore somatic healthcare utilization patterns among people with ID in Sweden, compared to the general population 2002–2012. The sample consisted of people with ID, aged 55 years and older in 2012 (n=7936), and an equal-sized birth- and sex matched general population sample (n=7936). The sample was divided into 5-year intervals age groups. In- and outpatient data were collected from the Swedish National Patient Register. The result revealed that in younger age groups, the ID group had higher utilization compared with the general population sample, with higher risks for planned and unplanned in- and outpatient care, particularly for unplanned inpatient registrations. Decreasing patterns were seen with age; with lower risks in the ID group for the oldest age groups. This was most evident in planned in- and outpatient care. In those with at least one registration the ID group had, compared with the general population sample, fewer planned outpatient visits, and in the younger age groups longer unplanned length of stay. In conclusion this study shows that in younger people with ID utilize more healthcare than the general population, that utilization decreases with age and fewer people with ID use healthcare in old age. The barriers for older people with ID to accessing planned healthcare need more investigation.
Research has documented that religiosity is associated with filial responsibility directly and indirectly through familism. However, we know little about whether these associations produce different outcomes between biological and step-adult children. Therefore, we examined the association between religiosity and filial responsibility and the mediating role of familism on the abovementioned association for biological and step-adult children using the Longitudinal Study of Generations (LSOG). We selected 527 biological adult children and 83 step-adult children from the fourth generation (G4) in Wave 8 (2005). Models include controls for participants’ age, race, gender, and education. Results of multiple group analysis show that religiosity was positively associated with filial responsibility among biological adult children and that familism fully mediated this association. Among step-adult children, although religiosity was positively associated with familism, neither religiosity nor familism was associated with filial responsibility. Heterogeneous and homogeneous characteristics of biological and step-adult children’s religious contexts are discussed.
Post-traumatic stress disorder (PTSD) and abnormal spirometry are highly prevalent mental and health conditions in World Trade Center (WTC) responders. We tested the hypothesis that PTSD symptomatology and abnormal spirometry are conjointly and synergistically associated with poorer cognitive performance. A total of 1,326 responders (mean age = 53.1, SD = 8.1, 92% males) from the WTC Health Program took part in the study. PTSD symptomatology was assessed using the PCL-IV, and we calculated the FEV1/FVC ratio to measure pulmonary function. Cogstate assessments measured cognitive performance. Linear regressions were employed to evaluate PTSD and pulmonary function on cognitive performance while adjusting for age, sex, education, smoking status, and comorbidity. Higher PTSD symptomatology and lower pulmonary function were independently and conjointly negatively associated with cognitive performance. Further, a significant synergistic effect was present in that higher severity of PTSD symptomatology in the presence of lower pulmonary function was associated with poorer cognitive performance (estimate = -0.096, SE = 0.03, p <0.001). Results suggested that chronic stress and lung damage might share underlying biological mechanisms, including inflammatory and oxidative stress pathways, which may also be affecting the brain. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied.
Background and Objectives
Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults.
Research Design and Methods
This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007–2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations.
Three distinct joint trajectories were identified: no joint progression (34.4%), moderate joint progression (47.0%), and rapid joint progression (18.6%). During a median follow-up of 8.3 years, the rapid joint progression group, compared to the no joint progression, had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99–3.81]), cardiovascular (CVD) mortality (3.21 [2.08–4.96]) and non-CVD mortality (2.99 [2.28–3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (C-statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65–110) before death.
Discussion and Implications
Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty.
Much is known about the mental health of combat Vietnam Veterans, but less is known about Persian Gulf and post-9/11 veterans and how they compare to those from earlier eras. Using data from an online survey of Oregon veterans, we examine how PTSD symptoms differ by combat exposure across these three cohorts. The sample (N=167, Mage=57.86, SD=12.09), was largely composed of White (88%), male (69%) Veterans. Most served in the Persian Gulf (41%), followed by Vietnam (36%) and post-9/11 (23%) eras. ANCOVAs showed significant cohort differences in PTSD, after controlling for severity of combat exposure and demographics (age, gender, education, income) (F(2, 157) = 4.24, p < .05). Post-9/11 veterans had significantly lower PTSD symptom severity than Vietnam-era veterans but were comparable to Persian Gulf. There were no cohort differences for noncombat veterans. Future research should investigate why Vietnam veterans continue to have worse mental health than younger veteran cohorts. Part of a symposium sponsored by the Aging Veterans: Effects of Military Service across the Life Course Interest Group.
Cardiovascular (CV) and neuro-psychiatric (NP) diseases are the most prevalent chronic conditions in the elderly and frequently co-occur. Which is the prognostic value of their different combinations is not known. We aim to investigate the prognostic role, in terms of hospitalization and mortality, of CV and NP multimorbidity in older adults.
Population-based study involving 3353 60+ year-old participants from the Swedish National Study of Aging and Care (SNAC-K). Multimorbidity was defined as the presence of 2+ diseases. Hazard ratios (HRs) for 11 years overall survival and proportional sub-distribution hazard ratios (sHRs) were calculated for the first hospitalization and competing risk mortality according to different combinations of CV and NP diseases.
Among the study participants (mean age 75 years; 65% females), 70% experienced at least 1 hospitalization and 38% died during the follow-up time. Participants with CV multimorbidity (sHR 1.52 95% CI 1.27–1.82) had higher risk of hospitalization, which increased (sHR 1.64 95%CI 1.32–2.03) if they had also NP diseases, as compared with those without CV and NP diseases. Similarly, the highest mortality rate was detected among participants with mixed (CV+NP) multimorbidity (HR 2.21 95%CI 1.74–2.81). Consistent results were obtained when a composite outcome of hospitalization plus death was considered.
In conclusion, CV and mixed multimorbidity are associated with the highest risk of hospitalization and death in the elderly.
Evidence produced by studies using ICD-9 codes to identify dementia suggests that mild traumatic brain injury (mTBI) can accelerate age-related neurodegeneration and dementia risk. However, ICD-9 codes are unreliable in identifying early onset dementia (<65 years; EOD) in civilian (positive predictive value [PPV]=58%) and VA (PPV=28%). From 1,724 Veterans <65years of age with 2 or more dementia diagnoses based on ICD-9 codes recommended by VA Dementia Steering Committee, we validated dementia diagnoses in 153 randomly selected cases using medical chart abstractions and reviews by a neuropsychologist panel. We matched valid cases based on age, sex, race/ethnicity, year of entry to VA care, and branch of service to 2490 controls with no indicators of dementia or cognitive impairment. TBI severity was defined using multiple DoD and VA data sources. We also identified diagnoses for mental (e.g., depression, post-traumatic stress disorder, substance use disorders) and other medical conditions (e.g., stroke) associated with dementia. We used conditional logistic regression to examine the association of TBI severity with EOD controlling for comorbidity. After controlling for mental health and other comorbid conditions mild TBI (mTBI) was significantly associated with validated EOD [aOR( 95%CI): mTBI-4.5(2.4-8.9), moderate/severe TBI-21.3(8.4-54.3)]. Stroke, depression, PTSD, and headache were also associated with higher odds of EOD. These findings suggest that Veterans with mTBI are at risk for dementia, and clinicians should consider brief screening for cognitive dysfunction to ensure that they receive timely treatment to mitigate and address the impact of dementia on the individual, caregiver, family, and health care system
In 1999 the Australian Government introduced health assessments for people aged 75 years and older, allowing family doctors to evaluate older patients’ health. This study evaluates the uptake of assessments over time by a large cohort of older women, and the impact of the assessments on survival and physical functioning.
Data are for 11,726 women from the 1921–26 birth cohort of Australian Longitudinal Study on Women’s Health, who have completed three-yearly postal surveys since 1996, and allowed linkage to universal national administrative data on health care use (Medicare Benefits Scheme), residential aged care, and the National Death Index. The women were aged between 73–78 years when assessments were introduced in 1999, with follow-up to to 2013 when surviving women were aged 87–92. Time to event models were used to evaluate uptake of assessments, with death included as a competing event. Time-period and propensity score matching was applied to provide balanced groups of women who did and did not have assessments for comparison of survival and physical function scores.
By December 2013, 61.8% of women had at least one health assessment, with widowed, socioeconomically advantaged women, and those with more doctor visits, being more likely to have assessments and to have them earlier. After propensity-matching, women who had assessments had an advantage for survival, and for survival with higher physical functioning scores.
Our data suggest that health assessments afford benefits in terms of survival and physical functioning.
Social networks are critical for end-of-life decision-making and hands on support and may also impact end-of-life outcomes including location of death. Yet we fail to consider these factors in the context of cultural values and variation in healthcare system financing and resources, e.g., availability of palliative care. Using SHARE, we examined the following factors for 6,391 decedents across 13 countries interviewed in the last year of life: family size, living alone, and size and characteristics of social networks. We compared these characteristics cross-nationally for persons dying at home as opposed to in hospital and other formal settings. While individuals with larger social networks are more likely to die at home, we find a cross-national gradient of higher unmet healthcare needs resulting in overall more home-based deaths. Our findings suggest that individual factors such as family availability must be considered in the context of country-level factors when examining quality end-of-life indicators.
The aim of this study is to evaluated the role of Vulnerable Elders Survey (VES-13) as a predictor of functional capacity decline and death in elderly people of low socioeconomic status. This is a cohort study was developed between 2013–2015 and was included aged ≥ 60 years who lived in two assisted areas by Primary Health Care Services, Rio de Janeiro, Brazil. There were interviewed 958 elderlies and was followed for six months. The independent variable (vulnerability) was measurement by VES-13, validated in Brazil. The outcomes analyzed were death and functional capacity decline-evaluated by Lawton and Katz instruments. Logistic regression was performed considering the 5% significance level. In the baseline, 958 elderlies were evaluated and a complete follow-up was obtained for 635. Of these, the mean age of 70.3 years (± 8.27), 65.1% were women and 35.9% were classified as vulnerable. The functional capacity decline to perform ADL was observed in 5.7% of participants and 25.8% for IADL. Deaths were observed in 3%. In assessing the VES-13 as a predictor of these factors, logistic regression indicated that among vulnerable there was a greater chance of functional capacity decline in performing ADL(OR=7.36; CI95% 3.27–16.58) and IADL(OR=1.95; CI95% 1.49–2.54). For death, there was a increase risk with borderline interval(OR=2.44; CI95% 0.99–5.99). The results Indicated que the VES-13 works as a tool that predict outcomes of functional capacity decline and death of the elderly in Brazil, being an important instrument in primary care for screening and monitoring of the elderly.
Achieving meaningful progress on Alzheimer’s disease and other dementias requires a full-fledged public health response. For 13 years, Alzheimer’s Association, Centers for Disease Control and Prevention (CDC), and other partners have collaborated on the Healthy Brain Initiative (HBI) to advance public health awareness of, and action on Alzheimer’s. Molly French (chair) will provide an overview of HBI Road Maps (RMs), which provide the public health sector with actions to mitigate the growing burden of Alzheimer’s and other dementias, especially in populations with disadvantages. The second RM (2013–2018) stimulated an expanding public health response to dementia. John Shean (presenter) will explain the processes to build on this foundation for the new third RM (2018–2023), which calls for eliminating disparities and changing health systems. Lisa McGuire (presenter) will orient participants to the new RM’s set of 25 actions for state/local public health agencies to advance cognitive health and address cognitive impairment; she’ll highlight new robust actions on supporting caregivers for people living with dementia. Updated RM actions for reducing risk for cognitive decline will be discussed by David Marquez (presenter), along with translating science into policies and practice. Michael Splaine (presenter) will feature the first-ever HBI RM for Indian Country to provide American Indian, Tribal, and Native health leaders with promising practices to respond as a growing group of elders and caregivers journey with dementia. Finally, Katie Maslow (discussant) will reflect on the importance of mobilizing the public health sector and opportunities for partnerships with the aging network and researchers.