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That's Inappropriate! Social Norms in an Older Population-based Cohort.

ABSTRACT: BACKGROUND:Social cognition is not routinely assessed in older adults. We report population-based normative data on the Social Norms Questionnaire (SNQ22) which asks individuals about the appropriateness of specific behaviors in hypothetical scenarios, errors being related either to breaking with norms or to over-adhering to perceived norms. Total SNQ scores represent the number of correct responses while subscale scores are error totals. METHODS:We administered the SNQ22 to 744 adults aged 65+ within a population-based study, and examined the distribution of scores by demographics, other cognitive measures, and Clinical Dementia Rating (CDR). RESULTS:Most participants performed well with few errors. Women and young-old individuals performed significantly better than men and older individuals on total score and over-adherence; women had fewer break-norms errors than men. No race or education effects were observed. Worse (higher) total scores and (lower) over-adherence errors were inversely associated with literacy, CDR, Mini-Mental State Examination, attention, memory, language, executive, and visuospatial domains. Break-norms errors were rare and not associated with any of the above. CONCLUSIONS:In population-based normative data on the SNQ22. age and sex influenced total score and over-adherence errors, which showed the expected associations with CDR and other cognitive domains. Social norms screening may be useful in the cognitive assessment of older adults.

SUBMITTER: Ganguli M

PROVIDER: S-EPMC5951726 | biostudies-literature | 2018 Apr-Jun

REPOSITORIES: biostudies-literature

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That's Inappropriate! Social Norms in an Older Population-based Cohort.

Ganguli Mary M Sun Zhaowen Z McDade Eric E Snitz Beth B Hughes Tiffany T Jacobsen Erin E Chang Chung-Chou H CH

Alzheimer disease and associated disorders 20180401 2

<h4>Background</h4>Social cognition is not routinely assessed in older adults. We report population-based normative data on the Social Norms Questionnaire (SNQ22) which asks individuals about the appropriateness of specific behaviors in hypothetical scenarios, errors being related either to breaking with norms or to over-adhering to perceived norms. Total SNQ scores represent the number of correct responses while subscale scores are error totals.<h4>Methods</h4>We administered the SNQ22 to 744 a ...[more]

PMID: 29140857

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Project description:BackgroundA multimodal general practitioner-focused intervention in the Local Health Authority (LHA) of Parma, Italy, substantially reduced the prevalence of potentially inappropriate medication (PIM) use among older adults. Our objective was to estimate changes in hospitalization rates associated with the Parma LHA quality improvement initiative that reduced PIM use.MethodsThis population-based longitudinal cohort study was conducted among older residents (> 65 years) using the Parma LHA administrative healthcare database. Crude and adjusted unplanned hospitalization rates were estimated in 3 periods (pre-intervention: 2005-2008, intervention: 2009-2010, post-intervention: 2011-2014). Multivariable negative binomial models estimated trends in quarterly hospitalization rates among individuals at risk during each period using a piecewise linear spline for time, adjusted for time-dependent and time-fixed covariates.ResultsThe pre-intervention, intervention, and post-intervention periods included 117,061, 107,347, and 121,871 older adults and had crude hospitalization rates of 146.2 (95% CI: 142.2-150.3), 146.8 (95% CI: 143.6-150.0), and 140.8 (95% CI: 136.9-144.7) per 1000 persons per year, respectively. The adjusted pre-intervention hospitalization rate was declining by 0.7% per quarter (IRR = 0.993; 95% CI: 0.991-0.995). The hospitalization rate declined more than twice as fast during the intervention period (1.8% per quarter, IRR = 0.982; 95% CI: 0.979-0.985) and was nearly constant post-intervention (IRR: 0.999; 95% CI: 0.997-1.001). Contrasting model predictions for the intervention period (Q1 2009 to Q4 2010), the intervention was associated with 1481 avoided hospitalizations.ConclusionIn a large population of older adults, a multimodal general practitioner-focused intervention to decrease PIM use was associated with a decline in the unplanned hospitalization rate. Such interventions to reduce high risk medication use among older adults warrant consideration by health systems seeking to improve health outcomes and reduce high-cost acute care utilization.

Project description:BackgroundConcurrent use of 2 nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, loop diuretics, angiotensin-converting enzyme inhibitors, or anticoagulants is considered potentially inappropriate by Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment criteria.ObjectiveThe objective was to examine drug duplication in a cohort of older adults with dementia.MethodsCohort entry for Nova Scotia Seniors' Pharmacare Program beneficiaries was the date an International Classification of Diseases ninth edition or 10th edition code for dementia was recorded in accessed databases between March 1, 2005, and March 31, 2015. Medication dispensation and sociodemographic data were captured from the Nova Scotia Seniors' Pharmacare Program database between April 1, 2010, and March 31, 2015. Duplication was considered when 2 drugs from the same class were dispensed such that the supply in the patient's possession could overlap for more than 30 days. We reported number of cases of duplication and duration of overlap. Sex differences in drug duplication were assessed with bivariate logistic regression.ResultsIn the cohort of 28,953 Nova Scotia Seniors' Pharmacare Program beneficiaries with dementia, we documented concurrent use in 101 (1.7%) nonsteroidal anti-inflammatory drugs users (mean duration = 75.6 days), 95 (1.0%) selective serotonin reuptake inhibitors users (mean duration = 146.6 days), 5 (0.07%) loop diuretic users (mean duration = 530.6 days), 183 (2.0%) angiotensin-converting enzyme inhibitor users (mean duration = 123.9 days), and 160 (3.5%) anticoagulant users (mean duration = 63.6 days). Nonsteroidal anti-inflammatory drug pairs were most commonly celecoxib with naproxen or diclofenac. Selective serotonin reuptake inhibitors duplication was most commonly sertraline with citalopram. No sex differences in risk for drug duplication were identified.ConclusionsDrug duplication was identified in a cohort of older adults with dementia and is a feasible target for intervention. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).

Project description:INTRODUCTION:Adverse drug events (ADEs) are common in older people and contribute significantly to emergency department (ED) visits, unplanned hospitalisations, healthcare costs, morbidity and mortality. Many ADEs are avoidable if attention is directed towards identifying and preventing inappropriate drug use and undesirable drug combinations. Tools exist to identify potentially inappropriate prescribing (PIP) in clinical settings, but they are underused. Applying PIP assessment tools to population-wide health administrative data could provide an opportunity to assess the impact of PIP on individual patients as well as on the healthcare system. This would open new possibilities for interventions to monitor and optimise medication management on a broader, population-level scale. METHODS AND ANALYSIS:The aim of this study is to describe the occurrence of PIP in Ontario's older population (aged 65?years and older), and to assess the health outcomes and health system costs associated with PIP-more specifically, the association between PIP and the occurrence of ED visits, hospitalisations and death, and their related costs. This will be done within the framework of a population-based retrospective cohort study using Ontario's large health administrative and population databases. Eligible patients aged 66?years and older who were issued at least 1 prescription between 1 April 2003 and 31 March 2014 (approximately 2 million patients) will be included. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Ottawa Health Services Network Ethical Review Board and from the Bruyère Research Institute Ethics Review Board. Dissemination will occur via publication, presentation at national and international conferences, and ongoing exchanges with regional, provincial and national stakeholders, including the Ontario Drug Policy Research Network and the Ontario Ministry of Health and Long-Term Care. TRIAL REGISTRATION NUMBER:Registered with clinicaltrials.gov (registration number: NCT02555891).

Dataset Information

That's Inappropriate! Social Norms in an Older Population-based Cohort.

Publications

That's Inappropriate! Social Norms in an Older Population-based Cohort.

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