Journal of the American Geriatrics Society
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The Impact of Insomnia on Cognitive Functioning in Older Adults OBJECTIVES: To examine whether self‐reported symptoms of insomnia independently increase risk of cognitive decline in older adults. DESIGN: Longitudinal cohort study. SETTING: The four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: Six thousand four hundred forty‐four community‐dwelling men and women age 65 and older who had no more than one error on the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and an in‐person interview at the third annual follow‐up (FU3). MEASUREMENTS: Insomnia was defined as report of trouble falling asleep or waking up too early most of the time. Cognitive decline was defined as two or more errors on the SPMSQ at FU3. Logistic regression was used to determine risk of cognitive decline associated with insomnia, controlling for demographic, behavioral, and health‐related factors. Analyses were stratified by sex and depressed mood. RESULTS: Among nondepressed men, those reporting symptoms of insomnia at both baseline and FU3 had an adjusted odds ratio (OR) of 1.49 (95% CI = 1.03–2.14) for cognitive decline, relative to those with no insomnia at FU3. Men with insomnia at FU3 only were not at increased risk (OR = 1.16, 95% CI = 0.82–1.65). These relationships were not found in women. Men and women with depressive symptoms at FU3 were at increased risk for cognitive decline independent of insomnia. CONCLUSION: Chronic insomnia independently predicts incident cognitive decline in older men. More sensitive measures of cognitive performance may identify more subtle declines and may confirm whether insomnia is associated with cognitive decline in women. J Am Geriatr Soc 49:1185–1189, 2001.
Journal of the American Geriatrics Society - Tập 49 Số 9 - Trang 1185-1189 - 2001
Fall Frequency and Characteristics and the Risk of Hip Fractures OBJECTIVES : The 2 objectives of this study were to investigate the association between history of falls and risk of hip fracture and to identify characteristics of falls that determine whether or not a hip fracture will occur.DESIGN : Population‐based case‐control study.SETTING : Subjects were selected from the community and from nursing homes in Sydney, Australia.PATIENTS : There were 412 subjects (205 cases, 207 controls) in the part of the study concerned with falls frequency and risk of hip fracture (age range 65–100 years). Differences between hip fracture‐related falls and other falls were studied in 209 cognitively intact subjects: 84 controls who had fallen at least once in the previous 3 years and 125 cases.MEASUREMENTS : Data were collected with an interviewer‐administered questionnaire.MAIN RESULTS : There was a strong relationship between reported number of falls in the past year and risk of hip fracture. This relationship was stronger among men than among women. There was only 1 statistically significant fall characteristic associated with risk of hip fracture; falling while turning was much more likely to lead to a hip fracture than falling when walking in one direction (age‐ and sex‐adjusted odds ratio: 7.9, 95% confidence interval: 1.4–43.0).CONCLUSIONS : (1) Taking a simple falls history is a useful way of identifying elderly people, particularly men, at increased risk of hip fracture; (2) The direction of a fall is an important determinant of hip fracture occurrence.
Journal of the American Geriatrics Society - Tập 42 Số 7 - Trang 774-778 - 1994
Enhancing Caregiver Health: Findings from the Resources for Enhancing Alzheimer's Caregiver Health II Intervention OBJECTIVES: To examine the relationships between changes from baseline to post‐Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self‐reported health, burden, and bother.DESIGN: Randomized, multisite clinical trial.SETTING: CG and care recipient (CR) homes in five U.S. cities.PARTICIPANTS: Four hundred ninety‐five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls.INTERVENTION: CGs were assigned to the REACH intervention or a no‐treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in‐home and three telephone sessions over 6 months. Control subjects received two brief “check‐in” telephone calls during this 6‐month period.MEASUREMENTS: The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention.RESULTS: After the intervention, CGs reported better self‐rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG‐rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow‐up, although differences between baseline and posttest did not vary according to race.CONCLUSION: A structured, multicomponent skills training intervention that targeted CG self‐care behaviors as one of five target areas, improved self‐reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.
Journal of the American Geriatrics Society - Tập 58 Số 1 - Trang 30-37 - 2010
Comparative Effectiveness of 2 Interventions for Hispanic Caregivers of Persons with Dementia Objectives To compare the effectiveness of 2 caregiver interventions with known efficacy: the Resources for Enhancing Caregiver Health‐Offering Useful Treatment (REACH‐OUT) and the New York University Caregiver Intervention (NYUCI). Design 1:1 randomized pragmatic trial. Setting New York City. Participants Informal Hispanic caregivers of persons with dementia (N=221; mean age 58.2, 82.8% female, 63.3% adult children, 31.7% spouses). Intervention Participants were randomized to 6 months of NYUCI (n=110) or REACH‐OUT (n=111), balanced on characteristics at baseline. All participants were referred for social supportive services. Measurements The primary outcomes were changes between baseline and 6 months in depressive symptoms, measured using the Geriatric Depression Scale (GDS), and caregiver burden, measured using the Zarit Caregiver Burden Scale (ZCBS). Results There were no differences in outcomes between NYUCI and REACH‐OUT. Both interventions showed a reduction in burden (REACH‐OUT: 5.2 points, 95% confidence interval (CI)=2.2–8.1, p<.001; NYUCI: 4.6‐points, 95% CI=1.7–7.5, p=.002). There were no significant changes on the GDS. Effects for the ZCBS were significant only for spouses and older caregivers. Conclusion Although there were no significant intervention group differences, both interventions resulted in significantly reduced burden for Hispanic caregivers at 6 months, particularly for spouses and older caregivers.
Journal of the American Geriatrics Society - Tập 66 Số 9 - Trang 1708-1715 - 2018
The MDS Cognition Scale: A Valid Instrument for Identifying and Staging Nursing Home Residents with Dementia Using the Minimum Data Set OBJECTIVE : We report the development and validation of an MDS‐based cognitive index, the MDS Cognition Scale (MDS‐COGS), by evaluating it against two popular dementia rating scales, the Global Deterioration Scale (GDS) and the Mini‐Mental State Examination (MMSE).DESIGN : A Cross‐sectional study.PARTICIPANTS : Two hundred nursing home residents.MEASUREMENTS : Each study participant was assessed on the GDS and the MMSE by trained medical students. At the same time, but independent of the medical students, a geriatric nurse completed the Minimum Data Set (MDS) instrument on each participant.MAIN RESULTS : The Cognitive Performance Scale (CPS), a categorical measure of cognition that uses MDS items, was compared with the GDS in 133 subjects, using a split‐sample technique. The GDS was found to be more appropriate as a 4‐stage than a 7‐stage scale, with GDS stages 1–4 acting as a single stage. The CPS showed very poor percent agreement with GDS stages 5 and 7 (50% or less) and, therefore, was revised by adding other MDS predictors. The new instrument, designated MDS‐COGS, is a 0–10 point scale generated from eight MDS cognitive items. The MDS‐COGS was then validated against the 4‐stage GDS and MMSE in the remaining 67 nursing home residents. Chance‐corrected agreement (kappa) between the MDS‐COGS and GDS in the 67 subjects was 0.80 (95% CI = 0.70, 0.88), and percent agreement with GDS stages 5 and 7 was 60% and 85%, respectively. The MDS‐COGS was also demonstrated to be a valid measure of cognitive impairment as defined by the MMSE, with sensitivity, specificity, chance‐corrected agreement (kappa), and area under the ROC curve, all above 0.80.CONCLUSIONS : The MDS Cognition Scale, the MDS‐COGS, provides a valid measure of the presence and severity of cognitive impairment in nursing home residents using items from the Minimum Data Set.
Journal of the American Geriatrics Society - Tập 42 Số 11 - Trang 1173-1179 - 1994
Environmental Correlates of Resident Agitation in Alzheimer's Disease Special Care Units OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment.DESIGN: A cross‐sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status.SETTING: Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota.PARTICIPANTS: All residents and staff of the participating units.MAIN OUTCOME MEASURES: Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk‐throughs in each of the study facilities.RESULTS: The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non‐loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions.CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.
Journal of the American Geriatrics Society - Tập 46 Số 7 - Trang 862-869 - 1998
Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life BACKGROUND/OBJECTIVES Frailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality. DESIGN Prospective cohort study. SETTING The Longitudinal Aging Study Amsterdam. PARTICIPANTS Community‐dwelling older adults aged 65 and older (n = 1,427). MEASUREMENTS Frailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995–2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking. RESULTS Frailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40–1.48; P < .01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HRFL = 1.83; 95% confidence interval [CI] = 1.42–2.37; HRFS = 1.77; 95% CI = 1.36–2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings. CONCLUSION Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well‐being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.
Journal of the American Geriatrics Society - Tập 68 Số 11 - Trang 2587-2593 - 2020
Predictive Validity of Measures of Comorbidity in Older Community Dwellers: The Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study OBJECTIVES: To compare the ability of five measures of comorbidity to predict mortality and incident disability in basic activities of daily living (BADLs) in unselected older persons.DESIGN: An assessment of the data obtained from the Insufficienza Cardiaca negli Anziani Residenti a Dicomano (ICARe Dicomano) Study, a longitudinal epidemiological survey on heart failure in older people.SETTING: Dicomano, a small, rural town near Florence, Italy.PARTICIPANTS: The entire population aged 65 and older living in Dicomano, Italy, was enrolled in the ICARe Dicomano Study.MEASUREMENTS: At baseline (1995), comorbidity was quantified in 688 participants, based on clinical diagnoses, using disease count (DC), Charlson Comorbidity Index (CCI), Index of Co‐Existent Diseases (ICED), and Geriatric Index of Comorbidity (GIC), or on drug use, using Chronic Disease Score (CDS). Incident ADL disability was assessed in 1999 and vital status in 2004.RESULTS: Mortality increased with the severity of comorbidity, with hazard ratios around 2 when comparing the highest and the lowest quartiles of DC, CCI, and ICED in Cox regressions adjusted for age, sex, and physical and cognitive performance. Prediction of mortality with GIC and CDS was only borderline significant. All measures predicted incident ADL disability; the strongest risk gradient (hazard ratio=8.2 between the highest and lowest quartiles) was observed with ICED. Physical and, to a minor extent, cognitive performance added significantly to predicting mortality and incident BADL disability.CONCLUSION: All the measures of comorbidity predicted death and BADL disability in older community dwellers. DC, CCI, and ICED performed better than GIC and CDS. Physical performance measures are strong, independent contributors to the prediction of these outcomes.
Journal of the American Geriatrics Society - Tập 54 Số 2 - Trang 210-216 - 2006
A Manual of Guidelines to Score the Modified Cumulative Illness Rating Scale and Its Validation in Acute Hospitalized Elderly Patients OBJECTIVES: To update previous guidelines to score the Cumulative Illness Rating Scale (CIRS) and test their usefulness in hospitalized elderly patients.DESIGN: The CIRS was scored retrospectively in a cohort of elderly patients followed for 18 months.SETTING: An acute internal medicine ward in an academic tertiary care hospital.PARTICIPANTS: Three hundred eighty‐seven patients aged 65 and older.MEASUREMENTS: The CIRS was retrospectively scored for the enrolled patients. Intrarater and interrater reliability were calculated. Two illness severity indices (total score (TSC) and severity (SV)) and one comorbidity index (CM) were obtained. Clinical features and comprehensive geriatric assessment (CGA) variables were also used. All patients underwent an 18‐month follow‐up for mortality and rehospitalization.RESULTS: Intrarater and interrater reliability of the CIRS scored following the guidelines was good (intraclass correlation coefficients of 0.83 and 0.81, respectively). The TSC, SV, and CM correlated with clinical features (laboratory values, medication usage, and length of in‐hospital stay) and CGA variables (cognitive impairment, depression and disability). All three indices were able to predict 18‐month mortality and rehospitalization rates.CONCLUSION: This study confirmed the validity of the CIRS as an indicator of health status and demonstrated its ability to predict 18‐month mortality and rehospitalization in hospitalized elderly patients. The availability of detailed guidelines for scoring the CIRS can improve its usefulness and facilitate more‐widespread use for research and clinical aims.
Journal of the American Geriatrics Society - Tập 56 Số 10 - Trang 1926-1931 - 2008
Dementia with Lewy Bodies
Journal of the American Geriatrics Society - Tập 46 Số 11 - Trang 1449-1458 - 1998
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