Study Of Older Persons Research Articles

Trends in Restricting Symptoms at the End of Life from 1998 to 2019: A Cohort Study of Older Persons.

To describe changes in the occurrence of restricting symptoms at the end of life from 1998 to 2019 and compare these changes according to the condition leading to death. Prospective longitudinal study. Greater New Haven, CT. A total of 665 decedents from a cohort of 754 community-living persons, 70 years or older. The occurrence of 16 restricting symptoms was ascertained during monthly interviews. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed every 18-months. For each restricting symptom, adjusted rates (per 100 person-months) were calculated separately for six multiyear time intervals. From 1998 to 2019, rates decreased for five (31.3%) restricting symptoms (difficulty sleeping; chest pain or tightness; shortness of breath; cold or flu symptoms; and nausea, vomiting, or diarrhea), increased for three (18.8%: arm or leg weakness; urinary incontinence; and memory or thinking problem), and changed little for the other eight (50.0%: poor eyesight; anxiety; depression; musculoskeletal pain; fatigue; dizziness or unsteadiness; frequent or painful urination; and swelling in feet or ankles). The decrease in rates was most pronounced for shortness of breath, with a reduction from 15.0 (95% credible interval = 11.7-18.6) in 1998 to 2001 to 8.2 (95% credible interval = 5.9-10.5) in 2014 to 2019, yielding a rate ratio (95% credible interval) of 0.92 (0.86-0.98). When evaluated according to the condition leading to death, the results were similar, with 10 of the 13 statistically significant rate ratios representing decreases in rates over time and only 3 representing increases. The occurrence of most restricting symptoms at the end of life has been decreasing or stable over the past two decades. These results suggest that end-of-life care has been improving, although additional efforts will be needed to further reduce symptom burden at the end of life.

Reversion from prediabetes to normoglycaemia after weight change in older persons: The KORA F4/FF4 study

Background and aimsIn a non-interventional study of older persons, we assessed the impact of changes in BMI and waist circumference (WC) on reversion from glucose- and HbA1c-defined prediabetes to normoglycaemia (in short: reversion) and on persistence of normoglycaemia. Moreover, we studied whether reversion reduced cardiovascular risk. Methods and resultsFrom the population-based KORA S4/F4/FF4 cohort study conducted in Southern Germany, we utilized data from the second and third visit to the study center (median follow-up 6.5 years). We used two overlapping data sets, one with 563 persons with HbA1c<6.5% (mean age 69 years, 51.5% men), one with 510 persons with glucose-based prediabetes or normal glucose tolerance. We calculated proportions of reversion, and estimated adjusted relative risks for the association between initial BMI/WC and change of BMI/WC, respectively, and reversion (and persistence of normoglycaemia, respectively). We estimated 10-year cardiovascular risks using the Framingham 2008 score.Overall, 27.3% of persons with HbA1c-defined prediabetes and 9.2% of persons with glucose-based prediabetes returned to normoglycaemia during follow-up. Lower initial BMI/WC and reduction of BMI/WC were associated with larger probabilities of returning to normoglycaemia (e.g., for HbA1c 5.7–6.4%, RR = 1.24 (95% CI: 1.09–1.41) per 1 kg/m2 decline of BMI). Moreover, reduction of BMI/WC increased probabilities of maintaining normoglycaemia (e.g., for glucose-based prediabetes, RR = 1.09 (1.02–1.16) per 1 kg/m2 decline of BMI). 10-year cardiovascular risk was 5.6 (1.7–9.6) percentage points lower after reversion from glucose-based prediabetes to normoglycaemia. ConclusionIn older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia.

Effects of local forearm skin heating on skin properties

This study investigated impacts of local skin heating on skin properties and tested whether skin changes depended on heat-induced hyperaemia. It was reasoned that heat-induced vasodilation impacts accompanying interstitial fluid changes. Forearm skin was locally heated from a baseline of 35°C to 40-42°C in 30 young adults (15 females, 15 males, 24.9±2.1years) and non-heated in 10 others (5 females, 5 males, 25.2±1.3years. Skin blood flow (SBF) was continuously measured using a laser Doppler method and skin tissue dielectric constant (TDC), stratum corneum capacitance (SCC) and transepidermal water loss (TEWL) were measured before and after maintained heat for 12min. TDC values were determined to effective measurement depths of 1.5mm (TDC15) and 2.5mm (TDC25). Results showed a large heat-induced hyperaemia, with SBF increasing on average 8.8-fold from its baseline of 35°C. Heating also caused significant increases in TDC, SCC and TEWL that, compared to preheating, increased approximately 1.1-fold, 3.1-fold and 4.5-fold. None of these skin changes correlated with the magnitude of the SBF hyperaemic response. Absence of this correlation may indicate that in young healthy adults, increased capillary filtration due to heat-induced arteriolar vasodilation is rapidly accommodated by postcapillary reabsorption, enhanced lymphatic activity and TEWL processes. An alternate explanation is that heating caused increased red cell oscillations that were detected as part of the laser Doppler increase without representing increased capillary flux. The major determinant of the Increases in TDC, SCC and TEWL is likely a consequence of heat-induced eccrine gland activation. Studies of older persons or those with depressed function are warranted.

Performance of risk prediction scores for cardiovascular mortality in older persons: External validation of the SCORE OP and appraisal.

BackgroundEuropean guidelines recommend the use of the Systematic COronary Risk Evaluation (SCORE) to assess 10-year risk of fatal cardiovascular events in people aged 40 to 65. The SCORE Older Persons (SCORE OP, 5-year and 10-year versions) was recently developed for people aged 65 or older. We assessed the performance of these risk scores in predicting fatal cardiovascular events in older persons in Berlin.Methods and findingsData from the Berlin Initiative Study (BIS), a prospective, population-based study of older persons recruited from a German public health insurance company database were used. 1,657 participants aged 70 or older without reported previous myocardial infarction were included. We assessed calibration by comparing predicted risks to observed (for 5-year versions, 5y) or projected (for 10-year versions) probabilities. During follow-up (median: 4.8 years), 118 cardiovascular deaths occurred. The calibration assessment of the SCORE OP-H 5y and SCORE OP-L 5y equations revealed 2.1- and 1.5-fold overestimation. Comparing 10-year versions, the SCORE OP showed better discrimination ability compared to the SCORE (C-indices of around 0.80 compared to 0.72) and the SCORE for high-risk regions showed the best calibration (chi-square = 29.68). The SCORE OP overestimated the true risk; 519 and 677 events were predicted using the low-risk and high-risk region SCORE OP equations compared to 397 to 399 events projected based on BIS follow-up data (predicted/actual ratios of 1.3 and 1.7).ConclusionsGiven the low transportability of the SCORE OP observed in our population, we caution against its use in routine clinical practice until further information is available to avoid possible overtreatment among older persons in Berlin.

Disease Contour and Household Decision Making: A Gender Comparative Study of Older Persons

Aging is a global demographic phenomenon. The Aging in Pakistan is a grave matter of concern which is neglected not only at state level but in research field too. This study focused to explore the relationship between disease profile and participation of older persons (OPs) in household decision making. A sample of 384 OPs was selected from Rawalpindi for data collection. Data were entered and analyzed in SPSS. Male participation was 70% and 30% of females. The findings of the research indicate 8.1% of cases of hypertension among older persons, heart problems were reported in 12.8% cases and 15.1% of the sample suffering from Diabetes. Cross-tabulation of data shows that the Pearson value is 32.552 and the calculated p-value is .000 [p&lt;.05], this shows that a significant association prevails among household decision making of older persons and their disease profile with special reference to gender group. This also helps to conclude that active yet age bound involvement in household matters in old age is healthy for older persons.

Social Isolation In The COVID-19 Pandemic – Is Maintaining Social Connections Online A Viable Option For All Older Persons: Insights From Singapore

Objectives: At the time of COVID-19 and the control measures emphasizing physical distancing and staying at home, social isolation of older persons is of concern. A possible approach to address this is through the use of technology by older persons, in particular internet-based communication methods, to maintain social connections. In order to help inform such approaches, we explore pre-COVID-19 differences in the risk of social isolation, regular use of devices that enable internet access and use of technology for social connections across subgroups of older persons in Singapore. Methods: We analyze data from Transitions in Health, Employment, Social Engagement and Intergenerational Transfers in Singapore Study, a national study of older persons, collected in 2019. Results: Older persons at higher ages, those with lower levels of education, in worse health and financially worse off are at a higher risk of social isolation as well as have lower proportions of regular use of devices and technology for social connections. We also find that older persons at risk of social isolation are substantially less likely to use devices and technology for social connections. Discussion: The disparity in the risk of social isolation and the use of devices and technology for social connections among older persons implies older person subgroups whose social connectedness may be disproportionately affected in the COVID-19 pandemic. We highlight that concerted, patient, and repeated efforts by the government, family, and older persons themselves may help bridge the disparity in technology use among older persons and make specific recommendations.

Sleep disruption in cognitive decline

Neuroscience Dementia affects nearly 36 million people worldwide, a number that is expected to double within the next two decades. Sleep disruption is thought to underlie some aspects of cognitive decline and neurodegeneration. Kaneshwaran et al. assessed sleep disruption in two cohort studies of older persons—the Rush Memory and Aging Project and the Religious Orders Study. In the subjects, greater sleep fragmentation was associated with higher neocortical expression of genes characteristic of microglial aging and activation. This valuable human data may provide therapeutic pointers for the treatment of neurodegenerative disorders. Sci. Adv. 10.1126/sciadv.aax7331 (2019).

ASPREE SUB-STUDIES

To maximize opportunities provided by a large-scale clinical trial, we established sub-studies during the ASPREE trial to investigate specific areas of interest to the health of older persons. A biobank now stores multiple aliquots of blood, urine or saliva collected from >15,000 healthy ASPREE participants across the US and Australia, most at baseline (pre-randomization) and/or after 3 years post- randomization. Other sub-studies included ALSOP (ASPREE Longitudinal Study of Older Persons; sets of questionnaires administered every 2 years focused on medical or social issues) and neuroimaging projects with brain MRI and retinal vascular imaging to investigate anatomical changes linked with cognitive or cerebrovascular outcomes. Further sub-studies addressed the impact of aspirin on cerebral microhemorrhages, age-related macular degeneration, age-related hearing loss, severe sepsis, and falls and fractures. Biomarker analyses underway include plasma androgens in older women and DNA sequencing of the cohort to investigate contributions of genomics to aging health and disease.

Association Between High School Personality Phenotype and Dementia 54 Years Later in Results From a National US Sample

Personality phenotype has been associated with subsequent dementia in studies of older adults. However, neuropathologic changes often precede cognitive symptoms by many years and may affect personality itself. Therefore, it is unclear whether supposed dementia-prone personality profiles (high neuroticism and low conscientiousness) are true risk factors or merely reflections of preexisting disease. To examine whether personality during adolescence-a time when preclinical dementia pathology is unlikely to be present-confers risk of dementia in later life and to test whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status (SES). Cohort study in the United States. Participants were members of Project Talent, a national sample of high school students in 1960. Individuals were identified who received a dementia-associated International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code during any year between 2011 and 2013. The dates of our analysis were March 2018 to May 2019. Ten personality traits were measured by the 150-item Project Talent Personality Inventory. Socioeconomic status was measured by a composite based on parental educational level, income, occupation, and property ownership. Participants were also surveyed on demographic factors and height and weight. Medicare records were collected, with dementia diagnoses in the period of 2011 to 2013 classified according to the US Centers for Medicare & Medicaid Services ICD-9-based algorithm. Cox proportional hazards regression models estimated the relative risk of dementia based on the 10 personality traits, testing interactions with SES and adjusting for demographic confounders. The sample of 82 232 participants was 50.1% female, with a mean (SD) age of 15.8 (1.7) years at baseline and 69.5 (1.2) years at follow-up. Lower risk of dementia was associated with higher levels of vigor (hazard ratio for 1 SD, 0.93; 95% CI, 0.90-0.97; P < .001). Calm and maturity showed protective associations with later dementia that increased with SES. At 1 SD of SES, calm showed a hazard ratio of 0.89 (95% CI, 0.84-0.95; P < .001 for the interaction) and maturity showed a hazard ratio of 0.90 (95% CI, 0.85-0.96; P = .001 for the interaction). This study's findings suggest that the adolescent personality traits associated with later-life dementia are similar to those observed in studies of older persons. Moreover, the reduction in dementia risk associated with a calm and mature adolescent phenotype may be greater at higher levels of SES. Personality phenotype may be a true independent risk factor for dementia by age 70 years, preceding it by almost 5 decades and interacting with adolescent socioeconomic conditions.

An exploratory study of older persons’ perceptions of engaging in line dancing classes

ABSTRACT With the population of older adults expected to continue growing, understanding the benefits of leisure occupations will be vital in facilitating their active engagement. Line dancing is one such leisure occupation. A small, qualitative study was undertaken to identify the perceived benefits of engaging in line dancing. Semi structured interviews were conducted with four female participants aged 65-87 years. A deductive approach to content analysis was employed using the framework of the Canadian Model of Occupational Performance and Engagement. The participants reported that line dancing offered an opportunity for meaningful occupation in retirement and had positive outcomes for their physical health, mood, cognition, and spirituality. These findings corroborate existing evidence supporting engagement in active leisure occupations as key to promoting the mental health and well-being of older adults.

Widowhood and depression: a longitudinal study of older persons in rural China

Using six waves of longitudinal data (2001–2015) collected in Anhui, China (N = 2,131) and generalized estimating equations (GEE) models, this study fulfilled several objectives. First, the study compared the widowed to the married to examine if the transition to and duration of widowhood contributes to changes in depression. Second, the study examined if the bereavement-depression relationship is a process that precedes widowhood or is an abrupt change following the death of a spouse. Third, the study examined if social resources influence the bereavement-depression relationship. The study found that there is pre-widowhood effect on depression and that the widowhood event also contributes to increases in depression. Levels of post-widowhood depressive symptoms peak during the first six months bereavement and taper off within 25 months. Controlling for social support, contact with children, and living arrangements does not change the bereavement-depression relationship. The findings support Attachment Theory, which suggests that the loss of a spouse leads to emotional isolation that cannot be overcome with kin-based social support and social integration.

Seasonal plasticity of cognition and related biological measures in adults with and without Alzheimer disease: Analysis of multiple cohorts.

BackgroundThere are few data concerning the association between season and cognition and its neurobiological correlates in older persons—effects with important translational and therapeutic implications for the diagnosis and treatment of Alzheimer disease (AD). We aimed to measure these effects.Methods and findingsWe analyzed data from 3,353 participants from 3 observational community-based cohort studies of older persons (the Rush Memory and Aging Project [MAP], the Religious Orders Study [ROS], and the Minority Aging Research Study [MARS]) and 2 observational memory-clinic-based cohort studies (Centre de Neurologie Cognitive [CNC] study at Lariboisière Hospital and the Sunnybrook Dementia Study [SDS]). We performed neuropsychological testing and, in subsets of participants, evaluated cerebrospinal fluid AD biomarkers, standardized structured autopsy measures, and/or prefrontal cortex gene expression by RNA sequencing. We examined the association between season and these variables using nested multiple linear and logistic regression models. There was a robust association between season and cognition that was replicated in multiple cohorts (amplitude = 0.14 SD [a measure of the magnitude of seasonal variation relative to overall variability; 95% CI 0.07–0.23], p = 0.007, in the combined MAP, ROS, and MARS cohorts; amplitude = 0.50 SD [95% CI 0.07–0.66], p = 0.017, in the SDS cohort). Average composite global cognitive function was higher in the summer and fall compared to winter and spring, with the difference equivalent in cognitive effect to 4.8 years’ difference in age (95% CI 2.1–8.4, p = 0.002). Further, the odds of meeting criteria for mild cognitive impairment or dementia were higher in the winter and spring (odds ratio 1.31 [95% CI 1.10–1.57], p = 0.003). These results were robust against multiple potential confounders including depressive symptoms, sleep, physical activity, and thyroid status and persisted in cases with AD pathology. Moreover, season had a marked effect on cerebrospinal fluid Aβ 42 level (amplitude 0.30 SD [95% CI 0.10–0.64], p = 0.003), which peaked in the summer, and on the brain expression of 4 cognition-associated modules of co-expressed genes (m6: amplitude = 0.44 SD [95% CI 0.21–0.65], p = 0.0021; m13: amplitude = 0.46 SD [95% CI 0.27–0.76], p = 0.0009; m109: amplitude = 0.43 SD [95% CI 0.24–0.67], p = 0.0021; and m122: amplitude 0.46 SD [95% CI 0.20–0.71], p = 0.0012), which were in phase or anti-phase to the rhythms of cognition and which were in turn associated with binding sites for several seasonally rhythmic transcription factors including BCL11A, CTCF, EGR1, MEF2C, and THAP1. Limitations include the evaluation of each participant or sample once per annual cycle, reliance on self-report for measurement of environmental and behavioral factors, and potentially limited generalizability to individuals in equatorial regions or in the southern hemisphere.ConclusionsSeason has a clinically significant association with cognition and its neurobiological correlates in older adults with and without AD pathology. There may be value in increasing dementia-related clinical resources in the winter and early spring, when symptoms are likely to be most pronounced. Moreover, the persistence of robust seasonal plasticity in cognition and its neurobiological correlates, even in the context of concomitant AD pathology, suggests that targeting environmental or behavioral drivers of seasonal cognitive plasticity, or the key transcription factors and genes identified in this study as potentially mediating these effects, may allow us to substantially improve cognition in adults with and without AD.

Physical Activity Is Associated With Lower Odds of Cognitive Impairment in Women but Not Men Living With Human Immunodeficiency Virus Infection.

Cardiovascular comorbidities are risk factors for human immunodeficiency virus (HIV)-associated cognitive impairment. Given differences in cardiometabolic risk profiles between women and men with HIV, we investigated whether associations between cardiometabolic risk factors and prevalent cognitive impairment differ by sex. Separate logistic regression models were constructed for women and men at entry into a prospective study of older persons with HIV (PWH) to assess the association of cardiometabolic and other risk factors with cognitive impairment. Of 988 participants, 20% were women. Women had higher total cholesterol (194 vs 186 mg/dL; P = .027), hemoglobin A1c (5.9% vs 5.7%; P = .003), and body mass index (30.8 vs 27.4 kg/m2; P < .001) compared with men, and were less physically active (43% vs 55%; P = .005). In a multivariable model, physical activity was associated with lower odds of cognitive impairment in women (odds ratio, 0.35 [95% confidence interval, .15-.80]; P = .013) but not men. Physical activity may have a greater positive impact on cognitive health in women than in men with HIV. This finding should be confirmed in studies examining the longitudinal association between physical activity and incident cognitive impairment in PWH and the effect of interventions that increase physical activity on cognitive impairment in women with HIV.

Associations of plasma clusterin and Alzheimer's disease-related MRI markers in adults at mid-life: The CARDIA Brain MRI sub-study.

BackgroundClinical and epidemiological studies of older persons have implicated clusterin in Alzheimer's disease (AD) pathogenesis. In the context of identifying early biomarkers of risk, we examined associations of plasma clusterin and characteristics of AD in middle-aged individuals from the community.Materials and methodsSubjects were 639 cognitively normal individuals (mean age 50 ± 3.5) from the Coronary Artery Risk Development in Young Adults (CARDIA) Brain MRI sub-study. Clusterin was quantified using ELISA (mean 255± 31 ng/ml). Associations were assessed between clusterin and volumes of brain regions known to atrophy in early AD, including entorhinal cortex (ECV), hippocampus (HV), and medial temporal lobe (MTLV) volumes (cm3). Total brain volume (TBV) and volumes of structures affected in later AD were examined for comparison.ResultsIn multivariable models, higher clusterin had a negative non-linear association with ECV (combined left and right hemispheres), and this association was influenced by the highest clusterin levels. Compared to mean clusterin, 1 and 2 standard deviation (SD) level increases in clusterin were associated with -2.1% (95% CI: -3.3,-0.9) and -7.3% (95% CI: -11.3,-3.3) lower ECV, respectively. Similar relationships were observed between clusterin and HV, although the relationship was stronger for left-side HV than the right-side. However, the association was not significant after adjusting for covariates. Negative non-linear associations between clusterin and MTLV were strongest for the left side: compared to mean clusterin, 1 and 2 SD level increases in clusterin were associated with -0.9% (95% CI: -1.9, 0.1) and -3.7% (95% CI: -7.1, -0.3) lower MTLV. There were no significant associations between clusterin and brain structures affected in later AD.ConclusionsIn middle-aged adults unselected for AD, plasma clusterin was associated with lower volume of the entorhinal cortex, an area that atrophies early in AD. Clusterin could be informative as part of a multi-component preclinical marker for AD.

Problems of dual vulnerability in nutrition: A qualitative study of older persons caring for under 5-year-olds in post-disaster Haiti.

Malnutrition plays a significant role in under-five mortality rates following disasters. Older people play an important role in childcare in non-Western societies, which often increases in displacement contexts. Until now, policy, in general, and nutrition programmes, in particular, have focused on the mother-child dyad. To gather information on possible barriers to older carers accessing nutritional services for the children they care for and explore ways to overcome these obstacles. A qualitative approach was taken to explore the experiences of the carers themselves. Focus group discussions provided data, which were analysed using grounded theory. Data collected showed older people have similar needs to other caregivers in emergency settings, needs that are often amplified by age. Moreover, many barriers to accessing services were elicited, including targeting and advertising of nutritional programmes, alongside physical and psychosocial barriers to assessing existing support. Participants generated potential solutions to each identified barrier. As older people in Haiti were often the sole carers of under-fives, there is a need to recognise their importance in this role and support them within. More generally, in any emergency setting, organisations need take into account all stakeholders in child nutrition when planning and implementing programmes.

Depressive symptoms prior to and after incident cardiovascular disease and long-term survival. A population-based study of older persons.

Depression after a cardiovascular disease event (post-CVD) is associated with increased mortality. However, little is known about how pre-existing depression affects survival after CVD incidence. To evaluate whether depressive symptoms preceding first incident CVD (pre-CVD) affects survival. From the Rotterdam Study, 6,932 persons aged 55+ and free of dementia and CVD completed the Center for Epidemiological Studies Depression (CES-D) scale every 4 to 5 years from 1993. CES-D subdomains were positive affect, negative affect, somatic symptoms, and interpersonal affect. Persons were followed for mortality and CVD. During 15-year follow-up, 22% of participants suffered their first incident CVD. Pre-CVD depressive symptoms was not associated with mortality after adjustment for smoking status and physical function (HR per 10-point score: 1.05, 95%CI: 0.99-1.10). After first incident CVD, depressive symptoms increased. Higher post-CVD depressive symptoms was associated with increased mortality (HR: 1.13, 95%CI: 1.06, 1.22). The relation between post-CVD depressive symptoms and mortality was no longer statistically significant after adjustment for pre-CVD depressive symptoms. Pre-CVD and post-CVD measures of somatic symptoms and positive affect were associated with mortality. During 15 years follow-up in community-dwelling older adults, the relation between higher depressive symptoms measured before first incident CVD and mortality was not independent of health status. Whereas, higher depressive symptoms measured after CVD was associated with increased mortality, was not independent of pre-CVD depressive symptoms. Given the associations observed between positive affect and mortality, positive affect may be the reason we observed a relation between depressive symptoms and mortality.

Correlates of sleep disturbances in depressed older persons: the Netherlands study of depression in older persons (NESDO)

ABSTRACTObjectives: Sleep disturbances are common among depressed older persons. To gain insight into sleep disturbances in late-life depression, their occurrence and correlates were assessed. Methods: Baseline data of 294 depressed older persons of the Netherlands Study of Depression in Older persons study were used. A diagnosis of current depression according to the diagnostic and statistical manual of mental disorders-IV (DSM-IV) was assessed with the Composite International Diagnostic Interview. Sleep disturbances were measured with the five-item Women's Health Initiative Insomnia Rating Scale, and considered present with a score of ≥10 points. Results: Sleep disturbances were present in 59.9% of the depressed older persons. Bivariate linear regression analyses showed that presence of sleep disturbances was associated with fewer years of education, use of alcohol, the number of chronic diseases, higher pain intensity scores, use of more benzodiazepines, more anxiety and severity of depressive symptoms. In multivariate analyses, severity of depression appeared to be the only independent correlate.Conclusions: Sleep disturbances are highly prevalent in patients with late-life depression and independently correlated with the severity of depression. Treatment of depression may result in improvement of sleep disturbances, although cognitive behavioral interventions that focus on both depression and sleep disturbances may also be effective.

Illness cognitions in later life: Development and validation of the Extended Illness Cognition Questionnaire (ICQ-Plus).

Illness cognitions are mediators between illness and well-being in patients with physical symptoms. The Illness Cognitions Questionnaire (ICQ) explores these illness cognitions but has not been validated in older persons. This study aimed to validate the ICQ in adults aged 60 years and above and to develop an extended version (ICQ-Plus) suitable for older persons. Qualitative interviews were conducted to explore illness cognitions in 21 older persons suffering physical symptoms. The items in the original ICQ and items of these interviews that potentially reflect dimensions not covered by the original ICQ were combined in the ICQ-Plus. Then the ICQ-Plus was completed by 220 older patients with physical symptoms, and its factor structure was explored by maximum-likelihood factor analyses. Analysis of covariance was performed to assess differences in illness cognitions between older persons suffering from medically explained symptoms (MES) and medically unexplained symptoms (MUS). The interviews generated 26 new items. Factor analysis confirmed the 3-factor structure of the original ICQ, including factors covering helplessness, disease benefits, and acceptance. In addition, exploratory factor analysis on the ICQ-Plus items revealed 4 additional factors, including cognitions referring to perseverance, illness anxiety, avoidance, and catastrophizing. Patients with MUS scored significantly lower than did patients with MES on acceptance and disease benefits and higher on helplessness and illness anxiety. We concluded that older patients with physical symptoms express illness cognitions that are relevant for treatment but are not covered by the ICQ and recommend that the extended ICQ-Plus be used in studies of older persons. (PsycINFO Database Record

Understanding pain among older persons: Part 1 – The development of novel pain profiles and their association with disability and quality of life

Background While a range of variables are related to the impact of pain, most population studies of older persons have simply examined the presence or intensity of pain. Objective To develop novel pain profiles based on a range of pain variables, and compare demographic and health variables across profiles. Methods Baseline data from The Irish LongituDinal study on Ageing (TILDA), a population-representative cohort study involving 8,171 community living people resident in Ireland aged 50 or over, was used. Two-step cluster analysis was performed on those who reported being often troubled by pain using all self-reported pain variables. Nine demographic and health variables were compared across pain profiles and the no-pain profile. Results Of the cohort, 65% reported not often being troubled by pain. Of those troubled by pain, four profiles emerged ranging from the profile whose pain did not have impact on daily activities (12% of cohort) to the profile with everyone taking medication to control the pain (9% of cohort). All demographic and health variables differed significantly across the profiles (all P < 0.05) with pain profiles reporting significantly greater disability and poorer quality of life than the no-pain profile (P < 0.05). Conclusions Four pain profiles, based on a range of pain variables, as well as a no-pain profile were identifiable in a large sample of older adults. Identifying those (i) with multi-site pain, (ii) who take pain medications and/or (iii) whose pain affects daily activities clearly identifies those with the highest levels of disability and poorest quality of life.

An Empirical Method of Detecting Time-Dependent Confounding: An Observational Study of Next Day Delirium in a Medical ICU.

Longitudinal research on older persons in the medical intensive care unit (MICU) is often complicated by the time-dependent confounding of concurrently administered interventions such as medications and intubation. Such temporal confounding can bias the respective longitudinal associations between concurrently administered treatments and a longitudinal outcome such as delirium. Although marginal structural models address time-dependent confounding, their application is non-trivial and preferably justified by empirical evidence. Using data from a longitudinal study of older persons in the MICU, we constructed a plausibility score from 0 – 10 where higher values indicate higher plausibility of time-dependent confounding of the association between a time-varying explanatory variable and an outcome. Based on longitudinal plots, measures of correlation, and longitudinal regression, the plausibility scores were compared to the differences in estimates obtained with non-weighted and marginal structural models of next day delirium. The plausibility scores of the three possible pairings of daily doses of fentanyl, haloperidol, and intubation indicated the following: low plausibility for haloperidol and intubation, moderate plausibility for fentanyl and haloperidol, and high plausibility for fentanyl and intubation. Comparing multivariable models of next day delirium with and without adjustment for time-dependent confounding, only intubation’s association changed substantively. In our observational study of older persons in the MICU, the plausibility scores were generally reflective of the observed differences between coefficients estimated from non-weighted and marginal structural models.