Hypertension and Cognitive Health Among Older Adults in India.
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ABSTRACT: Objectives
To assess the prevalence of diagnosed and undiagnosed hypertension and their relationship to cognitive function in older adults in India.Design
Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD), an in-depth national study of late-life cognition and dementia.Setting
Geriatric hospitals and respondents' homes across 14 states in India.Participants
N = 2,874 individuals aged 60 years and older from LASI-DAD.Measurements
Hypertension was identified by self-report of physician diagnosis or measured blood pressure (BP) of 140/90 mmHg or higher. Undiagnosed hypertension was defined as hypertensive BP measurements, but no physician diagnosis. Controlled hypertension was defined as BP lower than 140/90 mmHg among those with a physician diagnosis. Total hypertension included both diagnosed and undiagnosed hypertension. A summary cognition score, derived from the sum of 18 cognitive tests administered in the LASI-DAD (range = 0-360) was used to assess cognitive function.Results
Total hypertension prevalence was 63.2% (41.5% diagnosed and 21.6% undiagnosed). Among those with hypertension, 34.5% were undiagnosed, 34.2% were diagnosed but uncontrolled, and 31.3% were diagnosed and controlled. Neither diagnosed nor undiagnosed hypertension was related to cognitive function in fully adjusted models. Older age, female sex, less education, being widowed, rural residence, residing in the north or central regions, being in a scheduled caste or tribe, low consumption, being underweight, and history of stroke were all independently associated with worse cognitive test performance.Conclusion
Two-thirds of older Indian adults had hypertension, with the majority being undiagnosed or diagnosed but not adequately controlled. Hypertension was not independently associated with cognitive function, whereas sociodemographic factors were independently related to cognitive function. J Am Geriatr Soc 68:S29-S35, 2020.
SUBMITTER: Farron MR
PROVIDER: S-EPMC7523549 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:ObjectivesTo document sex differences in late-life cognitive function and identify their early-life determinants among older Indian adults.DesignHarmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI-DAD).SettingIndividual cognitive testing in hospital or household setting across 14 states of India.ParticipantsIndividuals aged 60 years and older from LASI-DAD (2017-2019) (N = 2,704; 53.5% female).MeasurementsGiven the low levels of literacy and numeracy among older Indian adults, we consider two composite cognitive scores as outcome variables. Score I is based on tests that do not require literacy or numeracy, whereas score II is based on tests that require such skills. Ordinary least squares is used to estimate models featuring a progressively increasing number of covariates. We add to the baseline specification, including a sex dummy, age, and state indicators, measures of early-life socioeconomic status (SES), early-life nutrition, as proxied by knee height, and education.ResultsAcross most cognitive domains, women perform significantly worse than for men: -0.4 standard deviations (SD) for score I and -0.8 SD for score II. Early-life SES, health, and education explain 90% of the gap for score I and 55% for score II. Results are similar across hospital-based and home testing.ConclusionIn India, lower levels of early-life human capital investments in nutrition and education among women compared with men are associated with a female disadvantage in late-life cognitive health. This has important implications for public health policy, aiming at reducing the risk of cognitive decline and dementia-a nascent concern in India. J Am Geriatr Soc 68:S20-S28, 2020.
| S-EPMC7521343 | biostudies-literature
Project description:Objective We aimed to investigate the relationship between blood pressure and cognitive function among older adults in India. Methods In this study, we analyzed cross-sectional data of systolic and diastolic blood pressure (SBP and DBP, respectively) and cognitive testing from 3690 adults aged 60 years and older participating in the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia from 14 states in India. Results After controlling for key sociodemographic, health, and geographic factors, higher SBP and lower DBP were each independently associated with worse cognitive function. Older age, female sex, lower education level, being widowed, residing in a rural area, being a member of a Scheduled Caste or Scheduled Tribe, having a low level of economic consumption, being underweight, and a history of stroke were all independently associated with worse cognitive function scores. Conclusions Both SBP and DBP were independently associated with cognitive function among older adults in India in diverging directions. Clinical interventions targeting high SBP and low DBP may benefit both cognitive health and cardiovascular health.
| S-EPMC8733366 | biostudies-literature
Project description:As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20-40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.
| S-EPMC10724991 | biostudies-literature
Project description:Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017-18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64-21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.
| S-EPMC9329336 | biostudies-literature
Project description:ObjectiveTo investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.Data sources/study settingHealth Literacy and Cognition in Older Adults ("LitCog," prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.Study designStudy participants completed structured, in-person interviews administered by trained research assistants.Data collectionHealth literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.Principal findingsAll health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.ConclusionsCognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.
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Project description:The association between raised blood pressure and increased risk of subsequent cognitive decline is well known. Left ventricular hypertrophy (LVH), as a marker of hypertensive target organ damage, may help identify those at risk of cognitive decline. We assessed whether LVH was associated with subsequent cognitive decline or dementia in hypertensive participants aged ≥80 years in the randomized, placebo-controlled Hypertension in the Very Elderly Trial. LVH was assessed using 12-lead electrocardiography (ECG) based on the Cornell Product (CP-LVH), Sokolow-Lyon (SL-LVH), and Cornell Voltage (CV-LVH) criteria. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to <24 or an annual fall of >3 points were defined as cognitive decline and triggered dementia screening (Diagnostic Statistical Manual IV). Death was defined as a competing event. Fine-Gray regression models were used to examine the relationship between baseline LVH and cognitive outcomes. There were 2645 in the analytical sample, including 201 (7.6%) with CP-LVH, 225 (8.5%) SL-LVH and 251 (9.5%) CV-LVH. CP-LVH was associated with increased risk of cognitive decline, subdistribution hazard ratio (sHR)1.3 (95% confidence interval (CI) 1.01-1.67) in multivariate analyses. SL-LVH and CV-LVH were not associated with cognitive decline (sHR1.06 (95% CI 0.82-1.37) and sHR1.13 (95% CI 0.89-1.43), respectively). LVH was not associated with dementia. LVH may be related to subsequent cognitive decline, but evidence was inconsistent depending on ECG criterion and there were no associations with incident dementia. Additional work is needed to understand the relationships between blood pressure, LVH assessment and cognition.
| S-EPMC10063439 | biostudies-literature
Project description:Objectives: The current study set out to examine the links between contact frequency with one's social network and cognitive health in later life. It assessed both direct and indirect pathways and the possible role of ethnicity in the effect of the social network on cognitive function. Method: We used data from adults aged 50 and above, which was collected in Israel as part of the Survey of Ageing, Retirement and Health (SHARE). A moderated mediation analysis was conducted to test the direct and indirect associations between contact frequency and cognitive function, as well as the moderation of these associations by population group. Three population groups were examined - veteran-Jews, Arabs and immigrants from the former Soviet Union. Results: Contact frequency with the close social milieu was found to be directly positively related to cognitive function. The association was also mediated by depressive symptoms, such that frequent contacts were linked to cognitive health via reduced depressive symptoms. This indirect link differed, however, among the three population groups. Conclusion: Contact frequency is important for cognitive health in the second half of life, and it operates both directly and by decreasing depressive symptoms. However, these links are not found among all ethnic groups and may, therefore, depend on the culture and social norms of each group and the meaning attributed to social ties.
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Project description:We hypothesized that the sleep complaints of insomnia predict incident hypertension, particularly in African Americans. The purpose of this study was to analyze insomnia complaints as predictors of incident hypertension in the Cardiovascular Health Study (CHS), stratifying by gender and allowing for race and sleep variable interaction.This is a prospective cohort study over a 6-year period of follow-up.This is a community-based study of participants in Forsyth County, North Carolina; Pittsburgh, Pennsylvania; Sacramento County, California; and Washington County, Maryland.The study analyzed data from 1419 older individuals (baseline mean age 73.4 +/- 4.4 years) from the Cardiovascular Health Study who were not hypertensive at baseline.none.We constructed relative risks of incident hypertension over a 6-year period for insomnia complaints singly and in combination.Difficulty falling asleep, singly or in combination with other sleep complaints, predicted a statistically significant reduction of risk for incident hypertension for non-African American men in 6 years of follow-up. Insomnia complaints did not predict incident hypertension in 6 years of follow-up in women or in African Americans, although there may not have been enough power to show a significant association for African Americans.Insomnia did not predict hypertension in this older cohort which was free of hypertension at baseline. Difficulty falling asleep was associated with reduced risk of hypertension in non-African American men.
| S-EPMC2625325 | biostudies-other
Project description:Purpose of reviewThe population of older adults 60-79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease.Recent findingsWomen live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60-79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60-79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets.
| S-EPMC10904451 | biostudies-literature
Project description:ObjectivesThis study aimed to determine the predictors of health-promoting behaviour among older adults with hypertension in Bengkulu City, Bengkulu, Indonesia.MethodsA cross-sectional study was conducted in 333 older adults with hypertension, who were selected using multistage sampling method. Data were obtained by face-to-face interview with structured questionnaires. The questionnaires used in this study included the Health-Promoting Lifestyle Profile II (HPLP II), Hypertension Knowledge-Level Scale (HK-LS), Self-Rated Abilities for Health Practices Scale (SRAHP), Barriers to Health-promoting Behaviour Scales (BAS), Benefits to Health-Promoting Behaviour Scales (BES), Multidimensional Scale of Perceived Social Support (MSPSS) and Situational Influences Questionnaire (SIQ). Data were analysed by using multiple linear regressions.ResultsThe mean and standard deviation (Mean?±?SD) of each questionnaire were as follows: HPLP II, 2.55?±?0.19; HK-LS, 11.83?±?3.00; SRAHP, 2.00?±?5.87; BAS, 27.89?±?2.70; BES, 34.29?±?2.29; MSPSS, 60.35?±?8.12; and SIQ, 47.71?±?6.66. According to the multiple linear regression model, 36.9% of the variation in health-promoting behaviour among older adults with hypertension can be explained by six variables, namely, education, knowledge, self-efficacy, perceived barriers, social support and situational influences (adjusted R 2?=?0.369).ConclusionsHigh and good-quality education will increase the level of health-promoting behaviour, whereas barriers, such as expense and time requirement, can decrease it. Situational influences and support from family and friends can also influence the older adult's attempts to change their health behaviour. Increased self-efficacy will clearly result in improved health-promoting behaviour of older adults with hypertension.
| S-EPMC6626242 | biostudies-literature