Cognitive Overload? An Exploration of the Potential Impact of Cognitive Functioning in Discrete Choice Experiments with Older People in Health Care

ObjectivesThis exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people.MethodsA DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity.ResultsBoth the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE.ConclusionsThis study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people.     

Drug Burden Index associated with function in community-dwelling older people in Finland: A cross-sectional study

Abstract

Background. This cross-sectional study aimed to investigate the relationship between exposure to anticholinergic and sedative medications, measured with the Drug Burden Index (DBI), and functional outcomes in community-dwelling older people living in Finland.

Methods. The study population consisted of community-dwelling older people (n = 700) enrolled in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Outcomes included walking speed, chair stands test, grip strength, timed up and go (TUG) test, instrumental activities of daily living (IADL), and Barthel Index.

Results. Exposure to DBI drugs was identified in 37% of participants: 24% had a DBI range between >0 <1, and 13% DBI ≥1. After adjusting for confounders, exposure to DBI drugs was associated with slower walking speed (P < 0.0001), poorer performance on chair stands (P = 0.0001) and TUG (P < 0.0001), difficulties in IADL (P < 0.0001), and Barthel Index (P < 0.0001). The mean adjusted walking speed, time to complete chair stands and TUG, IADL, and Barthel scores were significantly poorer among participants with higher DBI ranges.

Conclusion. In older adults living in Finland, DBI was associated with impaired function on previously tested and new outcomes. This finding supports the use of the DBI as tool, in combination with other assessments, to identify older people at risk of functional impairment. The findings highlight the need for revision of current guidelines to improve the quality of drug use in older people.     

Rheumatic heart disease and risk of incident heart failure among community-dwelling older adults: A prospective cohort study

Abstract

Background. Little is known about the association of rheumatic heart disease (RHD) with incident heart failure (HF) among older adults.

Design. Cardiovascular Health Study, a prospective cohort study.

Methods. Of the 4,751 community-dwelling adults ≥ 65 years, free of prevalent HF at baseline, 140 had RHD, defined as self-reported physician-diagnosed RHD along with echocardiographic evidence of left-sided valvular disease. Propensity scores for RHD, estimated for each of the 4,751 participants, were used to assemble a cohort of 720, in which 124 and 596 participants with and without RHD, respectively, were balanced on 62 baseline characteristics.

Results. Incident HF developed in 33% and 22% of matched participants with and without RHD, respectively, during 13 years of follow-up (hazard ratio when RHD was compared to no-RHD 1.60; 95% confidence interval 1.13–2.28; P = 0.008). Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for RHD-associated incident heart failure were 2.04 (1.54–2.71; P < 0.001), 1.32 (1.02–1.70; P = 0.034), and 1.55 (1.14–2.11; P = 0.005), respectively. RHD was not associated with all-cause mortality (HR 1.09; 95% CI 0.82–1.45; P = 0.568).

Conclusion. RHD is an independent risk factor for incident HF among community-dwelling older adults free of HF, but has no association with mortality.     

Does Quality of Life Vary with Different Types of Housing Among Older Persons? A Pilot Study

With the increasing number of persons who are elderly, identification of the characteristics of optimal housing that contribute to meeting the various needs of older persons is essential. A pilot study to identify the effects of three different housing environments (personal dwellings, specialized housing and nursing homes) on reported quality of life was conducted, using the Flanagan Quality of Life Scale plus two general health items, among persons over the age of 65 (n = 87). Significant differences were found in several quality of life issues related to relationships and satisfaction with life. Persons in specialized housing consistently reported good quality of life related to socialization. While individuals in each group reported no difference in the importance of each quality of life factor, individuals in the nursing home consistently reported the lowest quality of life. The implication of this study for housing placement, transition, planning, and creating housing contexts that promote quality of life are discussed.     

A Review of “Aging with HIV: Psychological,Social, and Health Issues,by Janice E. Nichols,David C. Speer,Betty J. Watson,Mary R. Watson,Tiffany L. Vergon,Coletter M. Vallee,and Joan M. Meah”

No abstract available for this article.     

Meanings of at‐homeness at end‐of‐life among older people

Maintaining the well‐being of older people who are approaching the end‐of‐life has been recognised as a significant aspect of well‐being in general. However, there are few studies that have explicitly focused on at‐homeness among older people. This study aims to illuminate meanings of at‐homeness among older people with advancing illnesses. Twenty men and women, aged 85 or older, with advancing illnesses and who lived in their own homes, in nursing homes or in short‐term nursing homes in three urban areas of Sweden were strategically sampled in the study. Data were generated in narrative interviews, and the analysis was based on a phenomenological hermeneutical method. After obtaining a naïve understanding and conducting structural analyses, two aspects of the phenomenon were revealed: at‐homeness as being oneself and at‐homeness as being connected. At‐homeness as being oneself meant being able to manage ordinary everyday life as well as being beneficial to one's life. At‐homeness as being connected meant being close to significant others, being in affirming friendships and being in safe dependency. Here, at‐homeness is seen as a twofold phenomenon, where being oneself and being connected are interrelated aspects. Being oneself and being connected are further interpreted by means of the concepts of agency and communion, which have been theorised as two main forces of the human being.     

The personal and social context of planning for end-of-life care

OBJECTIVES: To examine the potential facilitators of or deterrents to end-of-life planning for community-dwelling older adults, including personal (health-related and sociodemographic) and social (physician and family) influences. DESIGN: In-person interviews with older adults, telephone interviews with physicians and family members. SETTING: Cleveland, Ohio. PARTICIPANTS: Two hundred thirty-one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members. MEASUREMENTS: Questions assessing older adults' discussions with others about end-of-life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status. RESULTS: Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end-of-life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians. CONCLUSION: These findings suggest that many physicians are not talking with their patients about their end-of-life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.