Drug Burden Index and change in cognition over time in community-dwelling older men: the CHAMP study

Objective: Anticholinergic and sedative medications are associated with acute cognitive impairment, but the long-term impact on change in cognition is unclear. This study investigated the effect of anticholinergic and sedative medications, quantified using the Drug Burden Index (DBI), on change in cognition over time in community-dwelling older men.

Methods: This was a prospective cohort study of men aged ≥70 years in Sydney, Australia. DBI was assessed at baseline, 2, and 5 years. Cognitive performance was assessed using the Mini-Mental State Exam (MMSE) at each wave. Logistic quantile mixed-effects modelling was used to assess the adjusted effect of DBI on the median MMSE-time profile. Analyses were restricted to men with English-speaking backgrounds (n?=?1059, 862, and 611 at baseline, 2, and 5 years).

Results: Overall, 292 (27.7%), 258 (29.9%), and 189 (31.3%) men used anticholinergic or sedative medications at baseline, 2, and 5 years. There was a concave relationship between MMSE and time, where higher DBI corresponded to lower MMSE scores (coefficient: ?0.161; 95% CI: ?0.250 to ?0.071) but not acceleration of declining MMSE over time.

Conclusions: Exposure to anticholinergic and sedative medications is associated with a small impairment in cognitive performance but not decline in cognition over time.

• KEY MESSAGES

• Exposure to anticholinergic and sedative medications, quantified using the Drug Burden Index, is associated with small cross-sectional impairments in cognitive performance.

• There was no evidence that exposure to anticholinergic and sedative medications is associated with accelerating decline in cognitive performance over a 5-year follow-up.

• Older people taking anticholinergic and sedative medications may derive immediate but small benefits in cognitive performance from clinical medication reviews to minimize or cease prescribing of these medications.

     

Preferences for end-of-life care and decision-making among Chinese community-dwelling older adults: A comparative cross-sectional study in Hong Kong and Wuhan in China

This study aimed to describe and compare end-of-life care and decision-making preferences among Chinese community-dwelling older adults between Wuhan and Hong Kong in China. The study adopted a cross-sectional correlation design and recruited a convenience sample of 259 older adults, aged ≥65 years old from five community centers in Wuhan and Hong Kong. Participants completed a validated structured questionnaire that measured their end-of-life care and decision-making preferences. Multivariate logistic regression analyses were conducted. Results showed that Wuhan participants were significantly more likely to view “trying every means to extend the life span” as very important/important; and they perceived “support from religious personnel” as unimportant/very unimportant. Different from those older adults in Hong Kong, the Wuhan participants significantly chose their home as the preferred place for end-of-life care and death. They also tended to prefer family members to enact the decision-maker role in end-of-life decision situations. The study suggests older adults in Hong Kong and Wuhan have some differences in preferences for end-of-life care and decision-making, which provides the basis for future development of culturally relevant community-based end-of-life care.     

Sedative load and functional outcomes in community‐dwelling older Australian men: the CHAMP study

The aim of this cross‐sectional study was to investigate the association between sedative load and functional outcomes in community‐dwelling older Australian men. A total of 1696 males aged ≥ 70 years, enrolled in the Concord Health and Ageing in Men Project, were studied. Participants underwent assessments during 2005–2007. Sedative load was computed using a published model. Outcomes included activities of daily living (ADL), instrumental activities of daily living (IADL), physical performance measures and a clinical diagnosis of cognitive impairment. Of the participants, 15.3% took medications with sedative properties. After adjusting for age, education, depressive symptoms and comorbidities, participants who took one medication with sedation as a prominent side effect (sedative load = 1) had odds ratio (OR) of 2.15 (95% confidence interval, CI: 1.20–3.85) for ADL disability, compared with participants with sedative load = 0. Participants who took at least one primary sedative or two medications with sedation as a prominent side effect (sedative load ≥ 2) had an OR of 1.55 (95% CI: 1.02–2.35) for IADL disability, compared with participants with sedative load = 0. The mean 6‐m walking speed (P = 0.001) and grip strength (P = 0.003) were significantly different between sedative load groups in unadjusted models only. No association between sedative load and poorer performance on balance and chair stands tests or cognitive impairment was observed. Participants with sedative load of one were more likely to report ADL disability, whereas participants with sedative load of ≥2 were more likely to report IADL disability. Higher sedative load was not associated with poorer physical performance or cognitive impairment in older Australian men.     

ICF participation restriction is common in frail, community-dwelling older people: an observational cross-sectional study

Objectives

To determine the extent of participation restriction in a sample of frail older people, and to identify the domains of participation that are most restricted. A secondary aim was to determine which health and demographic factors were associated with participation restriction.

Design

An observational cross-sectional study.

Setting

Adults recently discharged from an aged care and rehabilitation service in Australia who were enrolled in a clinical trial.

Participants

One hundred and eighty-one community-dwelling adults aged over 70 years (mean age 84, standard deviation 5.7) who met the Cardiovascular Health Study criteria for frailty, had a Mini Mental State Examination score over 18 and a predicted life expectancy exceeding 12 months.

Main outcome measures

Participation restriction was evaluated using the Reintegration to Normal Living Index.

Results

Eighty percent of subjects reported participation restriction in at least one aspect of their life. Restricted participation was most prevalent in the areas of work in the home or community (114/181, 63%) and community mobility (92/181, 51%), and least common with regard to interpersonal relationships (9/181, 5%). Multivariate regression analysis showed that grip strength, mood, number of medical conditions and mobility were independently and significantly (P < 0.05) associated with participation restriction, and explained 29% of the variance in participation restriction. Cognition and living alone were not significantly associated with participation restriction.

Conclusions

Participation restriction was common in this sample of frail, community-dwelling older people. It was associated with factors from multiple levels of the International Classification of Functioning, Disability and Health. Further research is suggested to investigate the causes and treatment of participation restriction.     

Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging

Background

Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea.

Objectives

To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults.

Methods

A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Results

The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty.

Conclusions

Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults.

Implications for practice

The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.     

A day in the life of older people in a rehabilitation setting: an observational study

Abstract

Purpose: Nurses' contribution during inpatient rehabilitation is well documented. However, despite being the largest professional group in this setting, the specialty of rehabilitation nursing is poorly recognised. This article reports on the first of a four-phase study that aimed to clarify and develop the nursing contribution to inpatient rehabilitation for older persons. The aim of this study was to identify activity patterns and time use during daytime and evenings of older adult patients undergoing inpatient rehabilitation. Methods: Direct observation using behavioural modelling was undertaken of a convenience sample of 37 older people undergoing inpatient rehabilitation in a specialist unit of a large tertiary hospital in New Zealand. The primary outcome was the observation of meaningful activity. Binomial logistic regression was used to study the association between relevant variables. Findings: Meaningful activity was most likely to involve walking without assistance and to occur 08:00 to 14:00?h and 16:00 to 21:00?h during weekdays. Patients were more likely to receive treatment during the weekend. Irrespective of time, registered nurses were the health professionals most often present with patients. Conclusions: There is likely to be unrealised opportunities for registered nurses to support improved rehabilitation outcomes. Registered nurses' involvement in rehabilitation needs to be actively optimised.

• Implications for Rehabilitation

• Nurses' engagement with older adults in rehabilitation settings is likely to be substantial, placing them as key members of the rehabilitation team.

• Nurses make a pivotal contribution to inpatient rehabilitation based on specialised knowledge and skills but this contribution is not well understood.

• Opportunities are likely, at times when allied health professionals are less often present, e.g. evenings and weekends, for registered nurses to more intentionally overlap rehabilitation activities with other care requirements.

     

Differences in health status of older people aged 65 and above after total hip replacement compared with the normal population: a cross-sectional study

Aim. The aim of the study was to describe the health status of older patients with osteoarthrosis following total hip replacement and to compare their health status with population norms in order to analyse the need for a rehabilitation programme after total hip replacement. Background. Total hip replacement is a very efficient operation in terms of pain relief and improvement of walking ability. However, after the operation some patients still report low health status. Method. A cross‐sectional study including 287 older patients aged 65–74 and 75+ years who had had total hip replacement within the previous 12 months was performed. Patients from five Danish counties received a mailed questionnaire requesting information about their health status and demographic data. The Short‐Form 36 measures eight domains of importance of health. The scores related to each dimension are transformed to an interval scale ranging from 0 (worst score) to 100 (best score). Danish population norm data were used as reference point. Results. In total, 287 (91.4%) patients responded. The patients completed the questionnaire 207 (114) days after surgery within a range of 10–360 days. In all eight health domains patients reported significantly lower scores than the age specific norm population. Conclusion. Our results indicate that health status is scored lower for patients after total hip replacement. This implies that there might be a need for further postoperative rehabilitation based on the identification of problems experienced by patients in the postoperative period. Relevance to clinical practice. Patients health status is a predictor for well‐being, quality of life and survival. Older people need rehabilitation after surgery to reduce dysfunction and improve perception of health. Our results demonstrate a need for further studies examining problems experienced by patients in the postoperative period. Intervention research is needed before such a programme can be implemented.     

Factors associated with acid-fast bacillus isolation in patients with noncystic fibrosis bronchiectasis: A cross-sectional study

IntroductionAcid-fast bacillus (AFB) is a major pathogen that causes noncystic fibrosis bronchiectasis requiring multidrug chemotherapy. Bronchoscopic bronchial wash is performed to determine the causative pathogens of bronchiectasis; but, predictive factors for AFB isolation have not been fully elucidated. This study aimed to determine the factors associated with AFB isolation from bronchial wash samples.MethodsThis was a single-center, cross-sectional study. Patients undergoing bronchoscopic bronchial wash for bronchiectasis were included, whereas those who did not undergo high-resolution computed tomography (HRCT); had acute pneumonia, interstitial lung disease, and a positive polymerase chain reaction result but a negative culture result for AFB; or in whom a guide sheath was used for suspected lung cancer were excluded. Binomial logistic regression was used to analyze the factors associated with a positive culture for AFB.ResultsOf the 96 included cases, AFB isolation was observed in the bronchial wash fluid of 26 patients (27%). No smoking history, a positive result for antiglycopeptidolipid (GPL)-core IgA antibody, and the presence of tree-in-bud appearance, multiple granular and nodular images on HRCT were more commonly observed in patients with AFB isolation than in those without. In the multivariate analysis, the tree-in-bud appearance (odds ratio, 4.223; 95% CI, 1.046–17.052) and anti-GPL core IgA antibody (odds ratio, 9.443; 95% CI, 2.206–40.421) were significantly associated with AFB isolation.ConclusionsThe tree-in-bud appearance on HRCT is likely to predict AFB isolation independent of anti-GPL core IgA antibody results. Bronchoscopic bronchial wash should be recommended for bronchiectasis with multiple granulomas on HRCT.     

Association of the Geriatric Nutritional Risk Index with incident hypertension in the older Chinese population: a 6-year cohort study

BackgroundWe examined the association of the Geriatric Nutritional Risk Index (GNRI) with the incidence of hypertension.MethodsWe used data of the China Health and Nutrition Survey in this study. Participants aged ≥60 years were eligible. The GNRI was defined as follows: GNRI = [1.489 × albumin (ALB; g/L)] + [41.7 × (actual weight/ideal weight)]. Participants with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication were defined as having hypertension.ResultsThis study included 4853 participants, comprising 3612 control participants and 1241 participants with hypertension. The GNRI, ALB, and body mass index (BMI) were significantly associated with higher incidence of hypertension (HR: 1.030, 1.026, and 1.088; 95% CI: 1.020–1.041, 1.008–1.044, and 1.069–1.107, respectively). The GNRI, ALB, and BMI were associated with an earlier age of hypertension onset (β = −0.403, −0.613, and −0.321; 95% CI: −0.493 to −0.314, −0.767 to −0.459, and −0.484 to −0.159, respectively).ConclusionsA higher GNRI was associated with increased incidence of hypertension. An elevated GNRI was associated with earlier age of hypertension onset.     

Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: An exploratory cross-sectional study

BackgroundNurses caring for older people with delirium encounter moral challenges in hospitals which could trouble their conscience, if they perceive limitations that prevent them from fulfilling their duties. Little is known about the stress associated with troubled conscience, that is stress of conscience, beyond nursing homes.AimTo explore factors associated with stress of conscience among nurses caring for older people with delirium in a hospital setting.MethodAn exploratory cross-sectional study was conducted. A total of 223 nurses completed the questionnaire at a tertiary hospital in Australia.FindingsThe stress of conscience mean sample score, comparable to previous studies, was 63.6. Younger age, more years of nursing experience, lower levels of perceived person centeredness were associated with higher stress of conscience (p < 0.001). The regression model explained 24% of the total variation in Stress of Conscience (R² = 0.24: F = 13.874: p < 0.001).DiscussionThe levels of stress of conscience (mean score of 63.6) in this study were comparable to studies of nurses caring for older people with cognitive impairment in nursing homes. Younger age and longer working experience correlated with higher levels of stress of conscience, consistent with previous research. The novel contribution was that higher perceived levels of person centeredness could mitigate nurses stress of conscience.ConclusionHigher levels of person-centredness which positively correlated with less stress of conscience in the hospital setting, provide a foundation to explore barriers and facilitators to support quality care and staff health. Further studies would be valuable as the regression model accounted for 24% of the total variance in stress of conscience.