Factor Structure of Pain Medication Questionnaire in Community‐Dwelling Older Adults with Chronic Pain

Objectives: This study was to develop a version of the Pain Medication Questionnaire (PMQ) specific to the elderly chronic pain population and to identify relevant subscales and items for that population. Exploratory factor analysis (EFA) was conducted to assess the factor structure of the PMQ, to eliminate items that are not appropriate for this population, and to improve ease of administration in the elderly population. Methods: Data were obtained through a survey administered to older adults with chronic pain who consumed opioid medications in a cross‐sectional study at outpatient clinics affiliated with the Baltimore Veterans Affairs Medical Center and the University of Maryland Medical System. EFA was conducted on the PMQ in the geriatric chronic pain population, which was compared with the PMQ studies from the general chronic pain population. Results: A two‐factor solution yielded Factor 1 with four items and Factor 2 with three items; 18 items did not load significantly on either factor, and only seven items loaded significantly on either factor. All of the chosen factor loadings ranged from 0.41 to 0.88. Conclusion: The findings suggest that, although a small number of the items were identified from the overall scale, they adequately explain two relatively unique factors pertaining to pain management among older adults. This preliminary study suggests that the seven‐item PMQ may be useful in assessing opioid medication misuse in community‐dwelling older adults with chronic pain. Future studies are needed to confirm the reliability, validity, and factor structure of this modified PMQ in the geriatric population.     

Validity of Instrumented 360° Turn Test in Older Adults with Cognitive Impairment

Abstract

Aims: To examine concurrent and construct validity of inertial sensor 360° turn measures in relation with motion capture and mobility assessments in cognitively impaired older adults.

Methods: Data was collected in 31 participants, mean age 85.2 (SD 5.2), during clockwise (CW) and counter clockwise (CCW) 360° turns using (1) APDM body-worn inertial sensors and (2) Qualisys 8-camera laboratory-based motion capture.

Results: Absolute agreement between inertial sensor and motion capture measures was excellent for turn duration and turn peak velocity (ICC = 0.96–0.98). Strong to moderate correlations were present between inertial sensor turn measures and performance on the Timed Up and Go, Short Physical Performance Battery and 90-s Balance Test. ROC curve analysis of CCW 360° turn duration and turn peak velocity distinguished higher risk versus lower risk for mobility disability.

Conclusions: Inertial sensor 360° turn measures demonstrated concurrent and construct validity in relation to motion capture and mobility assessments.     

Concurrent Validity of Postural Sway Measures in Older Adults With Cognitive Impairment

Abstract

Aims: To examine concurrent validity of inertial sensor (APDM ISway) versus force plate center of pressure (COP) measures of postural sway in cognitively impaired older adults. Methods: Participants, mean age 85.6 (SD 4.8), were tested in 4 static standing conditions: (1) eyes open/normal base, (2) eyes open/narrow base, (3) eyes closed/normal base, and (4) eyes closed/narrow base. ISway and COP measures were collected. Results: Strong correlations between ISway trunk sway smoothness [ISway JERK, (m²/s⁵)] and COP path length (r?=?0.67–0.85) and COP mean velocity (r?=?0.77–0.87); also ISway total sway acceleration path length/trail duration [ISway PATH, (m²/s²)] and COP path length (r?=?0.77–0.87) and COP mean velocity (r?=?0.77–0.91). Increased sway was detected in narrow versus normal base and eyes closed versus open conditions (P = .001). Conclusions: APDM ISway demonstrated concurrent validity to force-plate COP and changes in postural sway were detected between conditions.     

Benefits and Challenges of Lung Cancer Screening in Older Adults

Purpose

Lung cancer screening with low-dose computed tomography has been shown to significantly reduce lung cancer–related mortality in high-risk patients. However, patients diagnosed with lung cancer are typically older and often have multiple age- and smoking-related comorbidities. As a result, cancer screening in older adults remains a complex decision, requiring careful consideration of patients' risk characteristics and life expectancy to ensure that the benefits outweigh the risks of screening. In this review, we evaluate the evidence regarding lung cancer screening, with a focus on older patients.

Historical and Current Advances That Incorporate Competing Risk for Benefit and Mortality in Older Patients With Cancer

Competing risk occurs when patients have >1 disease or condition that can affect an important outcome, such as mortality. In older adults who develop cancer, the presence of comorbid chronic diseases or functional impairments can change the likelihood that the cancer will lead to an adverse outcome. The recognition and incorporation of competing risk into oncology research started during the experimental development of chemotherapy. A related concept of considering performance status in clinical trials of cancer therapies also occurred in the context of treatment interventions using chemotherapy. Statistical methodologies for competing risk have advanced substantially over time, and a patient's performance measurements remain common in deciding how best to care for older patients with cancer. The historical development of these 2 uses of competing risk, statistical adjustment in research and patient performance measurement, is explained. Furthermore, this article discusses more recent advances in merging these 2 approaches. Particular attention is given to advances in calculating life expectancy that are specific to a patient's condition, status, or setting, and to describing how these estimates might be used to inform decisions about cancer care in older patients. Frameworks for moving beyond mortality as the only considered competing outcome to describe other outcomes, such as functional loss or the need for institutionalization, are also described. Finally, approaches that could more fully leverage the advanced methods for incorporating competing risks into clinical decision making are presented.     

The Relationship between Body Function and Structure Factors and the Activity-Participation of Healthy Community-Dwelling Older Adults

ABSTRACT

Aim: to investigate the relationship between ICF “body functions and structure factors” and the “activity-participation” of community-dwelling older adults. Methods: 41 healthy older adults (age range 65–92 years) from Tasmania, Australia completed the Bruininks Motor Ability Test (BMAT), Leisure Satisfaction Measure, Lawton Instrumental Activities of Daily Living, Keele Assessment of Participation, and the Activity Card Sort (Australian version). Spearman Rho correlation and linear regression analyses were completed to investigate relationships between the dependent and independent variables. Results: Co-ordination, and Balance and Mobility subscale scores on the BMAT had no association with activity-participation while the BMAT Fine Motor Integration and Manual Dexterity subscale scores were predictive of their activity-participation. Conclusions: The findings indicate that body function and structure factors (related to fine motor skills) were associated with and predictive of older adults” activity-participation. Further research is needed to investigate the link between body structure and function factors and older adults” activity-participation levels.     

Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer

ContextOlder adults with advanced cancer face uncertainty related to their disease and treatment.ObjectivesTo evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer.MethodsSecondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy—General), and emotional well-being (Functional Assessment of Cancer Therapy—General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential.ResultsWe included 527 patients (median age 76 years; range 70–96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = ?1.08; SE = 0.11) and emotional well-being (β = ?0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8).ConclusionUncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.     

Responsiveness of the Box and Block Test with Older Adults in Rehabilitation

Aims: Study the responsiveness of the Box and Block Test (BBT) with older adults in rehabilitation. Methods: For a larger study on the responsiveness of several outcome measures, 264 older adults were recruited in rehabilitation units (RU) and day hospitals (DH) and assessed four times during their rehabilitation. For the present study, only the data for participants who had an impairment in at least one upper extremity were used (n = 87). The standardized response mean (SRM) and Guyatt Index (GI) were calculated. Analyses by sub-group were also performed. Results: The BBT's responsiveness coefficients were moderate (SRM: 0.59; GI: 0.60). They were higher for participants treated in a RU (0.80 and 0.69) and participants who had had a stroke (0.67 and 0.83). Conclusion: The BBT can detect changes in dexterity in older adults undergoing rehabilitation, especially those being treated in a RU and those who have had a stroke.     

Exploring Patterns of Health Service Use in Older Emergency Department Patients

Objectives: Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient‐level predictors of group membership. Methods: Subjects were adults ≥ 65 years of age treated and released from an academic medical center ED. Latent cluster analysis (LCA) models were estimated to identify groups with similar numbers of primary care (PC), specialist, and outpatient ED visits and hospital days within 12 months preceding the index ED visit. Results: In this sample (n = 308), five groups with distinct patterns of health service use emerged. Low Users (35%) had fewer visits of all types and fewer hospital days compared to sample means. Low Users were more likely to be female and had fewer chronic health conditions relative to the overall sample (p < 0.05). The ED to Supplement Primary Care Provider (PCP) (23%) group had more PCP visits, but also significantly more ED visits. Specialist Heavy (22%) group members had twice as many specialist visits, but no difference in PCP visits. Members of this class were more likely to be white and male (p < 0.05). High Users (15%) received more care in all categories and had more chronic baseline health conditions (p < 0.05) but no differences in demographic characteristics relative to the whole sample. The ED and Hospital as Substitution Care (6%) group had fewer PC and specialist visits, but more ED visits and hospital days. Conclusions: In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk‐assessment methods. ACADEMIC EMERGENCY MEDICINE 2010; 17:1086–1092 © 2010 by the Society for Academic Emergency Medicine     

Engaging Older Adults with Dementia in Creative Occupations Using Artificially Intelligent Assistive Technology

Engagement in creative occupations has been shown to promote well-being for older adults with dementia. Providing access to such occupations is often difficult, as successful participation requires face-time with a person who is knowledgeable in facilitating engagement as well as access to any required resources, such as an arts studio. In response, a computer-based device, the Engaging Platform for Art Development (ePAD), was created to with the aim of enabling more independent access to art creation. ePAD is a an artificially intelligent touch-screen device that estimates a client's level of engagement and provides prompts to encourage engagement if the client becomes disengaged. ePAD is customizable such that an art therapist can choose themes and tools that they feel reflect their client's needs and preferences. This article presents a mixed-methods study that evaluated ePAD's usability by six older adult (with mild-to-moderate dementia) and art therapist dyads. Usability measures suggest that all participants found ePAD engaging but did not find prompts effective. Future development of ePAD includes improving the prompts, implementing the recommendations made by participants in this research, and long-term testing in more naturalistic art therapy contexts.     

Cardiometabolic Health of Chinese Older Adults With Diabetes Living in Beijing, China

ABSTRACT Objectives: Using the PRECEDE-PROCEED model, this study examined the presence of metabolic syndrome and modifiable cardiovascular disease (CVD) risk factors associated with metabolic syndrome among Chinese adults with diabetes living in Beijing, China.
Design and Sample: The cross-sectional study collected data through face-to-face interviews. The study included 73 Chinese older adults with diabetes. Their mean age was 68 years (±7.66), with a range from 52 to 90 years.
Measurements: Data were collected on demographic characteristics, blood pressure (BP), body mass index (BMI), waist circumference, lipid profile and fasting glucose, physical activity, diet, and health status.
Results: The great majority (85%) had metabolic syndrome; 65% had hypertension; 52% had high levels of low-density lipoproteins, and 80.6% had a high level of fasting glucose. Half of the participants (51.4%) were overweight, 16.7% were obese, and 86.3% had central obesity. Age, gender, BMI, income, insurance, smoking history, physical activity, and diet explained 23% of the variance in the metabolic syndrome component, systolic blood pressure.
Conclusions: The association of predisposing and enabling factors and health behavior with the metabolic syndrome needs to be further explored. Persons with diabetes should have regular health screenings to check for blood pressure, BMI, cholesterol, glucose, and triglycerides in order to decrease the risks associated with metabolic syndrome and CVD.     

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.     

The Effect of Pain on Major Cognitive Impairment in Older Adults

Older adults frequently report pain; cross-sectional studies have shown that pain is associated with worse cognitive function. However, longitudinal studies are lacking. We prospectively studied 441 participants without dementia, including 285 with pain, aged 65 years and older, enrolled in the Central Control of Mobility in Aging study, a prospective cohort study. We analyzed the longitudinal association between pain (measured with the Medical Outcomes Study pain severity scale) and major cognitive impairment (measured with the Repeatable Battery for the Assessment of Neuropsychological Status and the Trail Making Test Delta) using Cox regression analysis adjusted for age, gender, ethnicity, and education. Over a mean follow-up of 2.75 years (standard deviation?=?1.94), there was no difference in the risk of developing cognitive impairment between participants with pain and participants without pain. However, among those with pain, risk for developing major memory impairment was higher among those with high levels of pain than those with low levels of pain (adjusted hazard ratio?=?3.47, 95% confidence interval?=?1.42–8.46). The association with pain and incident impairments in attention or executive function was not significant. We did not find that pain is associated with incident cognitive impairment in general, but among older adults with pain, a high level of pain is associated with increased risk of developing incident memory impairment.

Deciphering the 4 D's: cognitive decline, delirium, depression and dementia--a review

PURPOSE: The purpose of this paper is to assist advanced practice nurses to recognize, identify, and diagnose cognitive change in older adults. BACKGROUND/RATIONALE: Optimal cognitive function is important for continued independence, and yet changes in cognition are frequently unrecognized among older adults. Cognitive change in older adults can be observed due to age-related cognitive decline, the development of acute confusion (delirium), depression, dementia and/or a combination of these. When the aetiological source for alterations in cognitive function is delirium or depression, the potential for reversibility mandates that the reason for the cognitive change be identified with steps taken to remedy the situation. Also, early recognition of dementia is an important factor in obtaining timely and appropriate care. These conditions can exist concurrently and may fluctuate making deciphering the reason for the cognitive change problematic. CONCLUSIONS: It is essential to understand how the 4 'D's' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.