Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study

BackgroundOrthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore.MethodsData was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status.ResultsThe prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26–4.30; p = 0.007) compared to those aged 75–84 years (OR: 1.76; 1.08-2.85; p = 0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56–5.88, p = 0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p = 0.007).ConclusionsOlder age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult’s functional capacity and quality of life to prevent injury.     

Longitudinal associations between cancer history and cognitive functioning among older adults

ObjectivesThis study aimed to examine (1) whether cancer history accelerates older adults’ rates of cognitive decline over time and (2) whether chemotherapy increases older cancer patients’/ survivors’ rates of cognitive decline over time.MethodsThis longitudinal study drew a subsample of 8811 adults aged 65 or older from Wave 6 of the Health and Retirement Study in 2002 and followed biennually until Wave 13 in 2016. Linear mixed-effects models were performed to test whether cancer history and chemotherapy were associated with accelerated rates of cognitive decline over time among older adults in different age groups.ResultsMiddle-old adults (aged 75–84) with a cancer history had significantly reduced rates of cognitive decline over time, including the global measure of cognitive functioning (B = 0.16, p< .01), mental status (B = 0.08, p< .01), and episodic memory (B = 0.09, p< .05) compared to their counterparts without a cancer history. This effect was not significant for the youngest-old (aged 65–74) or oldest-old adults (aged 85 or older). Also, chemotherapy was not significantly associated with older cancer patients’/survivors’ cognitive functioning at baseline or over time in different age groups.ConclusionsThis study finds that cancer history and chemotherapy do not further exacerbate older adults’ cognitive functioning over time. On the contrary, cancer history shows a “protective” effect on middle-old adults’ cognitive functioning. This encouraging finding indicates that older adults can be more actively engaged in the decision-making of treatments and following care plans. Future mediation studies are needed to further investigate underlying mechanisms.     

Dietary Fiber Intake is Associated with Cognitive Function in Older Adults: Data from the National Health and Nutrition Examination Survey

BackgroundAging is a global health challenge that is associated with a decline in cognitive function. In the United States, most older adults (≥50 years) do not meet the recommended daily fiber intake, although preliminary evidence suggests that dietary fiber consumption could elicit clinical benefits on cognitive function. We investigated the associations between dietary fiber intake and cognitive function in older adults.MethodsWe analyzed data from the US National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014, with a study cohort of 1070 older adults (≥60 years). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning Test (WLT), Word Recall Test (WRT) and their Intrusion Word Count Tests (WLT-IC and WRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression and cubic spline analyses were employed to examine the association between dietary fiber intake and cognitive performance on a test-by-test basis, after covariates adjustment (ie, age, sex, race, socioeconomic status, educational level, medical history, body mass index, alcohol, and energy intake).ResultsParticipants had a mean age of 69.2 years and were primarily non-Hispanic white of middle-high socioeconomic status with a college degree at minimum. The mean dietary fiber intake was 17.3 g/d. The analysis showed that dietary fiber intake was positively associated with DSST (P = .031). No associations with CERAD WLT (P = .41), WRT (P = .68), WLT-IC (P = .07), and WRT-IC (P = .28), and AFT (P = .40) scores were observed. A plateau in DSST score was revealed at a dietary fiber intake of 34 g/d.ConclusionsHigher dietary fiber intake is associated with improved specific components of cognitive function in older adults aged 60 years and older. Public health interventions that target a recommended dietary fiber intake may provide a promising strategy to combat cognitive decline in high-risk groups of older adults.     

Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study

BackgroundHearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear.MethodsWe retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks.ResultsWe analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12–2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels.ConclusionHearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.     

Multimorbidity and functional limitation: the role of social relationships

ObjectivesTo examine the relationship between multimorbidity and functional limitation, and how social relationships alter that association.MethodsThis cross-sectional study used data collected by self-reported questionnaires from adults aged 65 years and older living in a rural area in Japan in 2017. This analysis included complete data from 570 residents. Multimorbidity status was defined as having two chronic diseases exist simultaneously in one individual, and the function status was measured by their long-term care needs. Social relationships were assessed by the Index of Social Interaction and divided into high and low levels. Multiple logistic regression analysis was used to examine the association between social relationships and functional limitation and to assess the role of social relationships in this association.ResultsThe logistic regression model indicated that the risk of functional limitation was higher in multimorbidity participants than free-of-multimorbidity participants (OR = 2.55, 95% CI = 1.56–4.16). Compared with participants with no multimorbidity and a high level of social relationships, low level of social relationships increased the risk of functional limitation among participants both with and without multimorbidity, with the OR = 7.71, 95% CI = 3.03–19.69 and OR = 3.28, 95% CI = 1.30–8.27, respectively. However, no significant result was found in participants with multimorbidity and a high level of social relationships (P = 0.365).ConclusionsMultimorbidity was associated with functional limitations. However, this association could be increased by a low level of social relationships and decreased by a high level of social relationships.     

Implementing a screening and diagnosis program for dementia in primary care

BACKGROUND: Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care. METHODS: We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records. RESULTS: Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment—no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record. CONCLUSIONS: Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings. Supported by grant R01 HS10884-01 from the Agency for Healthcare Research and Quality.     

Serum high-density lipoprotein cholesterol concentration and functional state: The Korean Urban Rural Elderly (KURE) Study

BackgroundFunctional state and cholesterol metabolism are important for older adults; however, this association has not been fully investigated among community-dwelling older adults. Thus, we investigated the association of HDL cholesterol with multiple functional state measures in an elderly Korean population.MethodsThis cross-sectional analysis included 3514 participants, aged 65 years or older, who participated in baseline health assessment for the Korean Urban Rural Elderly cohort study from 2012 to 2015. HDL cholesterol concentration was analyzed using both continuous and categorical variables. Functional state was assessed by the mini-mental state examination (MMSE), activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, timed up-and go (TUG) test, and chair-rise test (CRT). Multiple logistic regression models were used to investigate independent association between HDL cholesterol and functional state, after adjusting for sex, age, body mass index, systolic blood pressure, fasting glucose, lipid-lowering drug, history of cancer and cardiovascular disease, and health behaviors.ResultsHDL cholesterol concentration was significantly associated with MMSE, ADL, IADL, TUG, and CRT in the unadjusted model. After adjustment for covariates, the association remained significant for MMSE (standardized β = 0.059, p = 0.001), ADL (standardized β = −0.053, p = 0.004), and CRT (standardized β = −0.037, p = 0.037). In fully-adjusted model, Participants who had a lower HDL concentration (<40 mg/dL) showed significantly increased odds for having MMSE decline (OR 1.451, 95% CI 1.119–1.883) and ADL dependency (OR 2.251, 95% CI 1.119–4.526), compared reference group (≥60 mg/dL).ConclusionsHigher HDL cholesterol concentration was associated with better functional state among Korean older adults.     

Nutritional status is associated with physical function and disability in older adults with chronic heart failure

BackgroundThe association between nutritional status (NS) and physical performance and disability in older adults with chronic heart failure (CHF) is not well established. We aimed at evaluating whether NS, estimated using the Mini Nutritional Assessment (MNA), is associated with gait speed (GS) and disability (ADL/IADL impairment) in this population and to assess whether energy intake (EI) and appendicular skeletal muscle mass index (ASMMI) influence this relationship.MethodsIn this cross-sectional study we enrolled 88 older adults admitted to a cardiology outpatient clinic for CHF. MNA was analyzed both as continuous and categorical variable (risk of malnutrition [RM]/well-nourished [WN]). The association between NS and GS and disability was assessed using linear and logistic regression models, respectively, crude, adjusted firstly for age, sex, ejection fraction, and mood status, and then for EI and ASMMI.ResultsMean age was 77.8 years, 73% were men. MNA score was positively associated with GS: β adjusted = 0.022, P = 0.035; the coefficient was unaffected by adjustment for EI and ASMMI (β = 0.022, P = 0.052). Compared to WN, RM participants had a lower gait speed (0.82 vs 0.99 m/s, P = 0.006); the difference was attenuated after adjustment for potential confounders (β − = 0.138, P = 0.055). MNA score was inversely associated with ADL impairment (Adjusted OR: 0.80, 95%CI 0.64–0.98), but not with IADL impairment (Adjusted OR: 0.94, 95%CI 0.78–1.13).ConclusionReduced MNA score is associated with poorer physical function and ADL impairment in older adults affected by CHF, independently of EI and ASMMI. Routinely evaluation of NS should be performed in this population.     

Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit

BackgroundDelirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF).MethodsWe investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients’ ICU stays.ResultsDelirium occurred in 109 patients (26.7%), and the in-hospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The Guidelines–Heart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium.ConclusionsDevelopment of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.     

The Association between Education and Rehabilitation Outcomes: a Population Retrospective Observational Study

ObjectivesRetrospective observational study aiming at testing whether different education levels in older adults are associated with the rehabilitation outcome.Study designThe study planned to cover all patients of over 65 rehabilitated from 2015 to 2017 at Golgi-Redaelli, a large government-funded rehabilitation Institute in Northern Italy comprising of three centers. Different administrative datasets were linked to investigate the factors associated with the functional outcome. The cohort resulted in 2,486 older adults for whom information on education and rehabilitation outcome was available.Main outcome measuresRehabilitation outcome was measured with the Barthel Index testing the ability in basic activities of daily living and the Tinetti Performance Oriented Mobility Assessment measuring stability and walking. Multiple linear and logistic regression models were run controlling for rehabilitation setting and center of care, age, gender, cognitive functioning and comorbidity.ResultsEducation resulted negatively associated with functional recovery. Patients with at least 8 years of education improved 2.24 point less in Barthel Index (out of100) and 0.70 points less in Tinetti Performance Oriented Mobility Assessment (out of 28) than the less educated patients. Results confirmed the importance of cognitive functioning in predicting rehabilitation outcome in older patients.ConclusionsDifferent mechanisms can explain an unexpected negative association between education and rehabilitation outcome, when possible inequalities in access to care are controlled for by study design (the cohort was admitted to a NHS-funded institute). Additional studies are needed to confirm our results and to test more specific hypotheses about the degree of effectiveness of rehabilitation across socio-economic groups.     

Impact of Early Life Socioeconomic Status on Decision Making in Older Adults Without Dementia

ObjectivesA growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project.Materials and MethodsCross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy.ResultsEarly life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029).ConclusionsFindings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.     

The association between pain and prevalent and incident motoric cognitive risk syndrome in older adults

BackgroundThe Motoric Cognitive Risk Syndrome (MCR) is a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Worse cognitive and motoric function is associated with chronic pain in older adults. Our aim was to study the association between pain and prevalent and incident MCR in adults aged 65 years and older.MethodsWe analyzed the cross-sectional association between severity of pain and prevalent MCR in 3244 older adults participating in the Health and Retirement Study (2008 wave) using logistic regression analysis adjusting for demographic, peripheral, central or biological risk factors. Additionally, we analyzed the longitudinal association between severity of pain and incident MCR in 362 participants in the Central Control of Mobility in Aging Study, using Cox regression analysis.ResultsThe 155 Health and Retirement Study participants with severe pain had an increased risk of prevalent MCR (n = 249), compared to 2245 individuals without pain (adjusted for demographics OR: 2.78, 95 % CI:1.74–4.45).Over a mean follow-up of 3.01 years (SD 1.38), 29 individuals in the Central Control of Mobility in Aging Study developed incident MCR. Older adults with severe pain had over a five times increased risk of developing incident MCR, compared to those without pain even after adjusting for demographic variables (HR: 5.44, 95 % CI: 1.81–16.40).ConclusionOlder adults with severe pain have a higher prevalence and incidence of MCR. These findings should be further explored to establish if pain is a potentially modifiable risk factor to prevent cognitive decline.     

Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis

ObjectivesConsidering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults.MethodsSeven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d).ResultsTwelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported.DiscussionYoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.     

Physical performance across the cognitive spectrum and between dementia subtypes in a population-based sample of older adults: The HUNT study

BackgroundLiterature on physical performance in older adults across the cognitive spectrum remains inconclusive, and knowledge on differences between dementia subtypes is lacking. We aim to identify distinct physical-performance deficits across the cognitive spectrum and between dementia subtypes.Methods11,466 persons were included from the 70-year-and-older cohort in the fourth wave of the Trøndelag Health Study (HUNT4 70+). Physical performance was assessed with the Short Physical Performance Battery (SPPB), 4-meter gait speed, five-times-sit-to-stand (FTSS), grip strength and one-leg-standing (OLS). Clinical experts diagnosed dementia per DSM-5 criteria. Multiple linear and logistic regression were performed to analyze differences between groups. Age, sex, education, somatic comorbidity, physical activity and smoking status were used as covariates.ResultsGait speed declined across the cognitive spectrum, beginning in people with subjective cognitive decline (SCD). Participants with mild cognitive impairment (MCI) additionally showed reduced lower-limb muscle strength, balance and grip strength. Those with dementia scored lowest on all physical-performance measures. Participants with Alzheimer's disease (AD) had a higher SPPB sum score and faster gait speed than participants with vascular dementia (VaD) and Lewy body dementia (LBD); participants with VaD and LBD had lower odds of being able to perform FTSS and OLS than participants with AD.ConclusionsPhysical performance declined across the spectrum from cognitively healthy to SCD to MCI and to dementia. Participants with AD performed better on all assessments except grip strength than participants with VaD and LBD. Stage of cognitive impairment and dementia subtype should guide exercise interventions to prevent mobility decline and dependency.     

Relationships between cognitive function and frailty in older Korean adults: The moderating effect of the number of teeth

BackgroundCognitive function and physical frailty are known to be closely related. Among older adults with dementia, those who wear dentures have a higher mortality rate than those who do not wear them. This suggests the possibility that oral health may affect the cognitive-frailty relationship. This study aims to investigate whether the number of teeth present, acts as a moderating variable in the cognitive function-frailty relationship.MethodsData were obtained from the cross-sectional baseline study of the Korean Frailty Aging Cohort Study (2016–2017). Cognitive function was assessed using the Mini-Mental State Examination. Frailty score was based on the Cardiovascular Health Study Index. Oral condition was evaluated by the number of teeth present and analyzed using categories of 0-9 teeth, 10-19 teeth, and ≥20. The moderation effect was analyzed using the ordinary least squares (OLS) regression.ResultsData on 2,310 older adults (1,110 men; mean age 75.9 ± 3.9 years) was analyzed. Adjusting for age, sex, income, education, alcohol drinking, body mass index, and number of comorbidities, cognitive function and frailty showed a negative association (B=-.030, p = .011). In the 10-19 teeth category, compared to the 0-9 teeth category, a negative association with frailty was found (B=-.152, p = .026). A significant interaction effect between the number of teeth and cognitive function was detected (p = .007).ConclusionThe number of teeth may modify the degree of the association between cognitive function and frailty. For effective frailty management of older persons, cognitive function management and oral management should be considered and performed together.     

Cognitive impairments and functional declines in older adults at high risk for care needs

Aim: Functional status of those who have very mild cognitive impairment have not been sufficiently investigated. In the current study, we analyzed the characteristics of functional awareness in older adults who had cognitive impairment and were at high risk of requiring support/care (termed as specified elderly at high risk for care needs in the long‐term care insurance scheme). Methods: The answers of a health check, which is provided by the local municipal government for those aged 75 years or older who have not been certified as eligible for care services, were analyzed. The differences of the variables between the two groups regarding yes/no answers to each of three cognition‐related questions were analyzed. Then, a multiple logistic analysis was carried out to investigate the association of yes/no answers of the three cognition‐related questions and the awareness of functional decline. Results: The participants who had cognitive impairment had greater awareness of functional declines. Multiple logistic regression analysis showed that subjective memory impairment and disorientation were significantly associated with a wider range of awareness of functional decline. Conclusions: Subjective cognitive impairment was associated with a wide range of awareness of functional decline in older adults at high risk for care need. Geriatr Gerontol Int 2013; 13: 77–82 .     

Association between family caregivers and depressive symptoms among community-dwelling older adults in Japan: A cross-sectional study during the COVID-19 pandemic

ObjectivesNovel coronavirus disease (COVID-19) pandemic could increase the mental health burden of family caregivers of older adults, but related reports are limited. We examined the association between family caregiving and changes in the depressive symptom status during the pandemic.MethodsThis cross-sectional study included 957 (mean age [standard deviation] = 80.8 [4.8] years; 53.5% females) community-dwelling older adults aged ≥ 65 years from a semi-urban area of Japan, who completed a mailed questionnaire. Based on the depressive symptom status assessed with the Two-Question Screen between March and October 2020, participants were classified into four groups: “non-depressive symptoms,” “incidence of depressive symptoms,” “remission from depressive symptoms,” or “persistence of depressive symptoms.” Participants were assessed in October 2020 for the family caregiving status, caregiving role, the severity of care recipients’ needs, and increased caregiver burden during the pandemic, each with the simple question. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) for changes in depressive symptom status.ResultsCompared to non-caregivers, family caregivers were associated with the incidence (OR [95% CI] = 3.17 [1.55–6.51], p < 0.01) and persistence of depressive symptoms (OR [95% CI] = 2.39 [1.30–4.38], p < 0.01). Primary caregivers, caregivers for individuals with severe care needs, and caregivers with increased burden during the pandemic had a high risk of depressive symptoms.ConclusionsFamily caregivers had a high risk of depressive symptoms during the pandemic. Our findings highlight the need for a support system for family caregivers.     

Social networks and cognitive function in older adults receiving home- and community-based aged care

ObjectivesSocial engagement has been linked to preserved cognitive functioning in later life. Yet, little is known about the specific network factors that best predict cognitive function in older adults. This study aimed to (i) characterize the quality and quantity of interpersonal relationships and (ii) explore the relationship between social network types and cognitive function in older adults receiving home- and community-based aged care services.MethodsParticipants (n = 175) receiving aged care services participated in a structured interview regarding their cognitive function (Telephone Interview for Cognitive Status-Modified), social networks (Lubben Social Network Scale-12) and quality of life (European Quality of Life Scale). Socio-demographic and aged care service use factors were obtained from provider electronic management systems. Multiple regression analyses were conducted to examine the relationships between the size and composition of clients’ social networks, aged care service use and cognition.ResultsThe sample had a median age of 81 years (range 61-96) and most were women (65.8%). Over a third (37.6%) had cognitive impairment and reported moderately high social networks. Males had higher social networks, were receiving fewer hours but more types of services, and had significantly better cognitive performance. Age, network size and composition were not associated with cognitive performance.DiscussionMore extensive social networks were associated with maintenance of cognitive health for older adults in community aged care. Whether this is causal or a marker of better cognitive health requires a longitudinal approach, and ideally should be tested with interventions at community levels.     

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study

ObjectivesThis study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia.MethodsOne hundred and seventy-seven older people with dementia (Mini-Mental State Examination 11–23; Addenbrooke’s Cognitive Examination-Revised <83) residing in the community or low level care facility completed baseline neuropsychological, physical and functional assessments. Of these, 134 participants agreed to reassessment of the above measures one year later.ResultsOverall, many neuropsychological, physical and functional performance measures declined significantly over the one year study period. Baseline gait speed was significantly associated with decline in verbal fluency (B(109) = 2.893, p = 0.046), specifically phonemic/letter fluency (B(109) = 2.812, p = 0.004) while controlling for age, education, dementia drug use and baseline cognitive performance. There was also a trend for an association between baseline gait speed and decline in clock drawing performance (B(107) = 0.601, p = 0.071).ConclusionsOlder people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.     

Dehydration in older people: A systematic review of the effects of dehydration on health outcomes,healthcare costs and cognitive performance

ObjectiveTo systematically examine the effect of dehydration on health outcomes, identify associated financial costs and consider impacts on cognitive performance in older adults.DesignA systematic review of English-language articles via OVID using MEDLINE, PsychINFO, EMBASE, and others, to March 2018. Included studies examined the relationship between hydration status and health, care costs or cognitive outcome.SettingCross sectional and cohort data from studies reporting on dehydration in older adults.ParticipantsAdults aged 60 years and older.MeasurementsIndependent quality ratings were assessed for all extracted articles.ResultsOf 1684 articles screened, 18 papers (N = 33,707) met inclusion criteria. Participants were recruited from hospital settings, medical long-term care centres and the community dwelling population. Data were synthesised using a narrative summary. Mortality rates were higher in dehydrated patients. Furthermore, health outcomes, including frailty, bradyarrhythmia, transient ischemic attacks, oral health and surgery recovery are linked to and worsened by dehydration. Length of hospital stay, either as a principal or secondary diagnosis, is greater in those with dehydration, compared to those who are euhydrated. Finally, neurocognitive functioning may be impacted by dehydration. There are issues with study design, inconsistency in hydration status measurement and different measures used for outcome assessment.ConclusionDehydration in older people is associated with increased mortality, poorer course of illness and increased costs for health services. In addition, there is some, but sparse evidence that dehydration in older people is linked to poorer cognitive performance. Intervention studies should test strategies for reducing dehydration in older adults.