Risk Factors for Harm in Cognitively Impaired Seniors Who Live Alone: A Prospective Study
Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada Journal of the American Geriatrics Society
(Impact Factor: 4.57).
10/2004; 52(9):1435-41. DOI: 10.1111/j.0002-8614.2004.52404.x
To identify risk factors for harm due to self-neglect or behaviors related to disorientation in cognitively impaired seniors who live alone that can be used in primary care.
Inception cohort followed prospectively for 18 months.
Participants were referred by their primary care physicians and community service agencies or were patients of several medical units of a large teaching hospital.
One hundred thirty-nine community-residing participants, aged 65 and older who scored less than 131 on the Dementia Rating Scale and lived alone.
Baseline Mini-Mental State Examination (MMSE); a social resources questionnaire; presence of chronic obstructive pulmonary disease (COPD), cerebrovascular disease, diabetes mellitus, Charlson Comorbidity Index, and medication use were examined as predictors of incident harm. Informants and primary care physicians provided information about the nature of any harm at 3-month intervals over an 18-month period. An incident of harm was included if it occurred as the result of self-neglect or behaviors related to disorientation, resulted in physical injury or property loss or damage, and required emergency community interventions.
Based on the consensual agreement of four raters, 21.6% had an incident of harm. The proportional hazards model was highly significant (P<.001) and supported by bootstrapping estimates. Four variables were significantly predictive of time to incident harm: perception of fewer social resources, poorer performance on MMSE, presence of COPD, and presence of cerebrovascular disorders.
Predictors of incident harm can be identified in the primary care setting and provide direction for the early identification of those at highest risk. Validation of findings with a new cohort is necessary.
Available from: Elisabet Londos
- "In elderly medical inpatients this is particularly important, as cognitive impairment is a poor prognostic factor and an independent predictor of mortality [2-4]. Furthermore, cognitive impairment may be associated with undetected medical comorbidities, mental incapacity and risk of accidents at home after discharge [5-8]. In hospitals, patients with cognitive impairment may have communication difficulties when specifying their complaints or in the comprehension of discharge information . "
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Detecting cognitive impairment in medical inpatients is important due to its association with adverse outcomes. Our aim was to study recognition of cognitive impairment and its association with mortality.
200 inpatients aged over 60 years were recruited at the Department of General Internal Medicine at University Hospital MAS in Malmö, Sweden. The MMSE (Mini-Mental State Examination) and the CDT (Clock-Drawing Test) were performed and related to recognition rates by patients, staff physicians, nurses and informants. The impact of abnormal cognitive test results on mortality was studied using a multivariable Cox proportional hazards regression.
55 patients (28%) had no cognitive impairment while 68 patients (34%) had 1 abnormal test result (on MMSE or CDT) and 77 patients (39%) had 2 abnormal test results. Recognition by healthcare professionals was 12% in the group with 1 abnormal test and 44-64% in the group with 2 abnormal test results. In our model, cognitive impairment predicted 12-month mortality with a hazard ratio (95% CI) of 2.86 (1.28-6.39) for the group with 1 abnormal cognitive test and 3.39 (1.54-7.45) for the group with 2 abnormal test results.
Cognitive impairment is frequent in medical inpatients and associated with increased mortality. Recognition rates of cognitive impairment need to be improved in hospitals.
Available from: ncbi.nlm.nih.gov
- "Because older adults often present with chronic disabilities or ailments [15, 16], the developers of the OARS designed an assessment tool that focused primarily on adaptation and the maintenance of personal well-being in five resources: Social Resources, Economic Resources, Mental Health, Physical Health, and self-care capacity or functional health (including both instrumental activities of daily living (IADL) and activities of daily living (ADLs)). This instrument has received widespread use by a diverse group of geriatric practitioners, researchers, and service group providers such as epidemiologists characterizing particular populations, clinicians assessing patient status, resource allocators providing services, and program evaluators investigating the impacts of interventions [12, 17–19]. "
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ABSTRACT: Objectives. Using data from the first two phases of the Georgia Centenarian Study, we proposed a latent factor structure for the Duke OARS domains: Economic Resources, Mental Health, Activities of Daily Living, Physical Health, and Social Resources. Methods. Exploratory and confirmatory factor analyses were conducted on two waves of the Georgia Centenarian Study to test a latent variable measurement model of the five resources; nested model testing was employed to assess the final measurement model for equivalency of factor structure over time. Results. The specified measurement model fit the data well at Time 1. However, at Time 2, Social Resources only had one indicator load significantly and substantively. Supplemental analyses demonstrated that a model without Social Resources adequately fit the data. Factorial invariance over time was confirmed for the remaining four latent variables. Discussion. This study's findings allow researchers and clinicians to reduce the number of OARS questions asked of participants. This has practical implications because increased difficulties with hearing, vision, and fatigue in older adults may require extended time or multiple interviewer sessions to complete the battery of OARS questions.
Available from: rehabnurse.org
- "Self-neglect is associated with functional decline and poor nutrition (Reyes-Ortiz, 2006). Significant predictor variables of self-neglect were found to include perception of fewer social resources, poor performance on the mini-mental state examination (MMSE), and a diagnosis of chronic obstructive pulmonary disease (COPD; Tierney et al., 2004). Self-neglect has been associated with problems of dementia, depression, diabetes, psychiatric illness, cerebrovascular disease, and nutritional deficiency that lead to executive dysfunction and either a lack of capacity for self-care or an impairment in ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs). "
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ABSTRACT: Self-neglect is a serious and growing problem among older adults. A 2004 survey from Adult Protective Services (APS) showed that adults age 60 or older were named in 85,000 reports of self-neglect from 21 states (Naik, Lai, Kunik, & Dyer, 2008; Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006). Although rehabilitation nurses are obligated to uphold the autonomy of older adults and strengthen their independence, dilemmas result when people's poor health behaviors put them or others at risk for negative consequences. When making decisions about nursing actions related to self-neglecting elderly people, the basic principles of autonomy, beneficence, nonmaleficence, and capacity must be considered. The purpose of this article is to discuss major ethical perspectives related to self-neglect among older adults.
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