Dataset Information

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

ABSTRACT: It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program "Help at Home" in Heraklion Crete, Greece. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment questionnaire and the SHARE-f index, respectively. Barthel-Activities of Daily Living and the Charlson Comorbidity Index were also used for the identification of disability and comorbidity, respectively. The mean age of the 192 participants (66% female) was 78.04 ± 8.01 years old. In depth-analysis using multiple linear regression, revealed that frailty was not significantly associated with cognitive decline (frail vs. non-frail (B'=-2.39, p=0.246) even after adjusting for depression and multi-comorbidity. Importantly, as protective factors for cognitive decline progression and thus dementia development, was scientifically correlated with annual individual income >4500 (B'=2.31, p=0.005) -poverty threshold-compared to those with <4500 and, higher education level as compared to Uneducated (B'=2.94, p=0.019). However, depression was associated with cognitive decline regardless of socioeconomic variables. In conclusion, our results suggest that health professionals caring for frail people with cognitive impairment, must focus on early recognition and management of depression.

SUBMITTER: Kleisiaris C

PROVIDER: S-EPMC6581500 | biostudies-literature | 2019 Jan-Jun

REPOSITORIES: biostudies-literature

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Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

Kleisiaris C C Kaffatou E M EM Papathanasiou I V IV Androulakis E E Panagiotakis S S Alvino S S Tziraki C C

Translational medicine @ UniSa 20190106

It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program "Help at Home" in Heraklion Crete, Gree ...[more]

PMID: 31360664

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Project description:PurposeTo identify the effect of frailty and geriatric syndromes on the quality of life (QoL), of older adults receiving home care, taking into consideration their socioeconomic and homebound status, including multi-comorbidities.Patients and methodsThis cross-sectional study enrolled elders aged (≥65) years old, registered members of "Help at Home" programs in the Reference Region of Crete, from March to May 2019. Participants were screened using the WHOQOL-BREF for Quality of Life, geriatric syndromes such as frailty using the SHARE-Frailty Index (SHARE-Fi), the Montreal Cognitive Assessment (MoCA), for cognitive function and the Geriatric Depression Scale (GDS), for the assessment of depression.ResultsThe mean age of the 301 participants was 78.45 (±7.87) years old. The prevalence of frailty was 38.5%, severe depression 13.6%, cognitive dysfunction 87.8% and severe comorbidity 70.6%. Intriguingly, none of the participants (0%) was identified as free of comorbidity (CCI = 0-1). The overall QoL (ranging from 4-20) of the study participants was 13.24 (±4.09). The bivariate analysis showed that overall QoL significantly differed among older adults with frailty (15.91 vs. 11.56, p < 0.001), cognitive dysfunction (15.42 vs. 12.90, p < 0.001), depression (14.90 vs. 9.31, p < 0.001), and disability in Activities of Daily Living (13.67 vs. 10.67, p = 0.002), compared to non-frail, normal cognition and depression, and independent elders, respectively. Multiple linear regression models revealed that frail and depressive elders reported significantly lower QoL (β = -2.65, p < 0.001 and (β = -5.71, p < 0.001), compared to non-frail and older adults with no depressive symptoms, respectively, despite the fact that this association was not significant for older adults with dementia (β = -2.25, p = 0.159), even after adjusting for potential confounding effects (age, gender, comorbidity, homebound status, etc.).Conclusionfrailty and geriatric syndromes including comorbidities are important risk factors for "poor" QoL among older adults receiving home-based healthcare.

Project description:BackgroundHigher maximal- and explosive strength is associated with better physical function among older adults. Although the relationship between isometric maximal strength and physical function has been examined, few studies have included measures of isometric rate of force development (RFD) as a measure of explosive strength. Furthermore, little is known about the oldest old (>80 years), especially individuals who receive home care and use mobility devices. Therefore, the aim of this study was to examine the association between maximal- and explosive muscle strength with physical function in community-dwelling older adults receiving home care.MethodsAn exploratory cross-sectional analysis including 107 (63 females and 43 males) community-dwelling older adults [median age 86 (interquartile range 80-90) years] receiving home care was conducted. Physical function was measured with five times sit-to-stand (5TSTS), timed 8-feet-up-and-go (TUG-8ft), preferred-, and maximal gait speed. Maximal strength was assessed as maximal isometric voluntary contraction (MVC) and explosive strength as RFD of the knee extensors. We used linear regression to examine the associations, with physical function as dependent variables and muscle strength (MVC and RFD) as independent variables.ResultsMVC was significantly associated with 5TSST [standardized regression coefficient β = -0.26 95% CI (-0.45, -0.06)], TUG-8ft [-0.6 (-0.54, -0.17)], preferred gait speed [0.39 (0.22, 0.57)], and maximal gait speed [0.45 (0.27, 0.62)]. RFD was significantly associated with 5TSST [-0.35 (-0.54, -0.17)], TUG-8ft [-0.43 (-0.60, -0.27)], preferred gait speed [0.40 (0.22, 0.57)], and maximal gait speed [0.48 (0.31, 0.66)].ConclusionsHigher maximal- and explosive muscle strength was associated with better physical function in older adults receiving home care. Thus, maintaining and/or improving muscle strength is important for perseverance of physical function into old age and should be a priority.

Project description:BackgroundOlder adults see multiple outpatient providers and increasingly use home health care (HHC) services. Previous studies attempting to draw inferences about the association between HHC use and patient outcomes have been mixed. Whether HHC is associated with care coordination and how both influence outcomes are unknown. In addition, prior studies have not taken the patient perspective into account. We examined the association between receiving HHC and self-reported gaps in care coordination and separately, preventable adverse outcomes.MethodsThe analysis for this cross-sectional study was conducted between October 2021 and June 2022, using data on 4296 Medicare beneficiaries from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who completed a survey on care coordination from 2017 to 2018. The associations between the receipt of HHC and two outcomes (a gap in care coordination, and separately, a preventable adverse event) were examined with Poisson models with robust standard errors. Potential confounders were accounted for through propensity score-based inverse probability weighting.ResultsAmong 4296 participants, 430 (10%) received HHC and they were older and had more comorbidities and ambulatory visits than those without HHC. HHC was not associated with differences in self-reported gaps in care coordination (33.3% HHC vs. 32.5% no-HHC, p = 0.70). HHC recipients reported more preventable drug-drug interactions (9.1% vs. 4.0%, p < 0.001) but not more preventable ED visits or hospital admissions. In IPW-adjusted models, HHC was not associated with gaps in care coordination (p = 0.60) but was associated with double the risk of a preventable adverse outcome (aRR 2.06; CI: 1.37, 3.10, p < 0.001).ConclusionsHHC recipients were significantly more likely (than those without HHC) to report a potentially preventable adverse event (particularly a drug-drug interaction), suggesting an opportunity to improve patient safety by leveraging the observations of older adults receiving HHC.

Project description:Rationale & objectiveMany older adults receiving hemodialysis have mobility limitations and rely on care partners, yet data are sparse regarding the support provided by care partners. Our aim was to examine how care partners support the mobility of an older adult receiving hemodialysis.Study designQualitative study.Setting & participantsUsing purposive sampling, we recruited persons aged 60 years or more receiving maintenance hemodialysis and care partners aged 18 years or more who were providing support to an older adult receiving hemodialysis. We conducted in-person semi-structured interviews about mobility with each individual.Analytical approachWe conducted descriptive and focused coding of interview transcripts and employed thematic analysis. Our outcome was to describe perceived mobility supports provided by care partners using qualitative themes.ResultsWe enrolled 31 older adults receiving hemodialysis (42% women, 68% Black) with a mean age of 73 ± 8 years and a mean dialysis duration of 4.6 ± 3.5 years. Of these, 87% of patients used assistive devices and 90% had care partners. We enrolled 12 care partners (75% women, 33% Black) with a mean age of 54 ± 16 years. From our patient and care partner interviews, we found three themes: (1) what care partners see, (2) what care partners do, and (3) what care partners feel. Regarding what they see, care partners witness a decline in patient mobility. Regarding what they do, care partners guide and facilitate activities and manage others who also assist. Regarding what they feel, care partners respect the patient's autonomy but experience frustration and worry about the patient's future mobility.LimitationsModest sample size; single geographic area.ConclusionsIn older adults receiving hemodialysis, care partners observe a decline in mobility and provide support for mobility. They respect the patient's autonomy but worry about future mobility losses. Future research should incorporate care partners in interventions that address mobility in older adults receiving hemodialysis.

Dataset Information

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

Publications

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care.

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