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Teng S, Xu S, Liang M, Li J, Shen D, Cheng Y, Tang X. An analysis of the factors influencing the demand for care in the community for older adults with mild dementia in China: a cross-sectional study. BMC Nurs 2025; 24:549. [PMID: 40380155 PMCID: PMC12082974 DOI: 10.1186/s12912-025-03212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 05/13/2025] [Indexed: 05/19/2025] Open
Abstract
INTRODUCTION The care needs of older adults with mild dementia have not been studied in depth. In this study, we investigated the impairment status of patients with mild dementia and analyzed the care needs of patients with different levels of impairment in terms of activities of daily living, medical services, environmental care, psychological comfort and social participation, and the factors influencing them. METHODS This study used a cross-sectional research method to investigate mildly demented older adults aged 60 years and above in the Chinese community. A self-administered questionnaire was used to assess the care needs of mildly demented older adults in terms of daily living, medical services, psychological comfort, home environment and social participation, and the ability level of mildly demented older adults was assessed using the official Chinese Norms for Assessing the Ability of the Elderly (GB/T42195-2022). Independent samples t-test and one-way ANOVA were used to compare the differences between demographic characteristics, impairment levels and care needs. Multiple linear regression analysis was used to analyze the independent factors influencing care needs. RESULTS A total of 267 participants were included in this study and participated in the analyses. The results showed that there were differences in the scores of care needs between different ability levels: mildly impaired (58.74 ± 9.008), moderately impaired (78.45 ± 8.951) and severely impaired (99.67 ± 6.480), and that health care services were the main care needs of older adults with mild dementia, and older adults with mild dementia of different ability levels had high needs for health care services. For activities of daily living and psychological comfort, needs increased significantly with the severity of impairment and decreased with worsening impairment in environmental care and social participation. Comprehensive ability level for older adults: Moderately impaired (β = 0.136, P = 0.012), Severely impaired (β = 0.306, P < 0.001), Age:70-79 years (β = 0.136, P = 0.010), 80 years and above (β = 0.354, P < 0.001), Living with children (β = 0.267, P < 0.001), Living with spouse (β = 0.232, P = 0.003) and participation in sports and exercise (β = 0.162, P = 0.001)) had significant positive effects on community care service needs, drinking alcohol (β = -0.118, P = 0.007), and with other chronic diseases ((β = -0.130, P = 0.004) had significant negative effects on community care service needs. DISCUSSION Factors influencing the community care needs of older people with mild dementia who participated in this study included: comprehensive older adults' abilities, age, whether accompanied by other chronic diseases, history of alcohol consumption, presence of physical activity. PRACTICAL IMPLICATIONS Taking into account the different care needs of older adults with mild dementia at different stages of impairment, a comprehensive care program for older adults with mild dementia has been improved in a number of aspects, including daily living, medical services, home environment, psychological well-being and social participation.
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Affiliation(s)
- Shuang Teng
- Xuzhou Medical University, Xuzhou, Jinagsu, China
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuxin Xu
- Xuzhou Medical University, Xuzhou, Jinagsu, China
| | - Mengmeng Liang
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jingjie Li
- Xuzhou Medical University, Xuzhou, Jinagsu, China
| | - Dongdong Shen
- Xuzhou Medical University, Xuzhou, Jinagsu, China
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yan Cheng
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China.
| | - Xianping Tang
- Xuzhou Medical University, Xuzhou, Jinagsu, China.
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Guo Y, Zhang Z, Jiang Q. Spousal Caregiving Types and Cognitive Trajectories Among Middle-Aged and Older Adults in China. Res Aging 2025; 47:308-320. [PMID: 39895081 DOI: 10.1177/01640275251317544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Objectives: This study investigates the longitudinal association between spousal caregiving types and cognitive trajectories among middle-aged and older Chinese adults, with a focus on gender differences. Method: Data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018) were analyzed, covering 4568 couples aged 45 and above. Caregiving types were Activities of Daily Living (ADLs) caregiving, Instrumental Activities of Daily Living (IADLs) caregiving, and both ADLs/IADLs caregiving. Cognitive function was assessed using tests of memory, orientation, numeric ability, and visuospatial ability. Latent growth curve modeling was used to examine associations between caregiving types and cognitive trajectories. Results: Spouses who only provided IADLs caregiving had slower cognitive decline compared to those who did not provide caregiving, regardless of gender. However, those who provided ADLs caregiving had faster cognitive decline compared to non-caregivers, especially in women. Discussion: These findings highlight the importance of caregiving types as well as the gendered effects of caregiving on cognitive trajectories.
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Affiliation(s)
- Yu Guo
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Zhenmei Zhang
- Department of Sociology, Michigan State University, East Lansing, MI, USA
| | - Quanbao Jiang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
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Cai C, Wang J, Liu D, Liu J, Zhou J, Liu X, Song D, Li S, Cui Y, Nie Q, Hu F, Xie X, Cheng G, Zeng Y. Marital Status-Specific Associations Between Multidomain Leisure Activities and Cognitive Reserve in Clinically Unimpaired Older Adults: Based on a National Chinese Cohort. Brain Sci 2025; 15:371. [PMID: 40309859 PMCID: PMC12025604 DOI: 10.3390/brainsci15040371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/06/2025] [Accepted: 03/12/2025] [Indexed: 05/02/2025] Open
Abstract
Background: It is unclear how marital status moderates the association between multidomain leisure activities and the progression of cognitive decline in community-dwelling older adults. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey with up to 10 years of follow-up were used. The study included participants aged ≥65 years without cognitive impairment at baseline. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Linear mixed-effect models were used to evaluate the modifying effect of marriage on leisure activities (multiple types, frequency, and single type) and cognitive decline. Results: A total of 5286 participants (aged 79.01 ± 9.54 years, 50.0% women, and 61.4% rural residents) were enrolled. The results indicated that marital status moderates the relationship between leisure activities and cognitive decline. In the unmarried group, multi-type and high-frequency leisure activities were more strongly associated with slower cognitive decline. Specific activities such as gardening, reading, performing household chores, and playing cards were found to significantly contribute to cognitive protection exclusively within the unmarried group, with no such effect observed in the married group. Conclusions: Marital status affects the relationship between participation in multiple leisure activities and cognitive decline in cognitively intact elderly people. For unmarried older adults, regular participation in leisure activities may be an effective intervention.
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Affiliation(s)
- Cheng Cai
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Junyi Wang
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Dan Liu
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jing Liu
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Juan Zhou
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Xiaochang Liu
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Dan Song
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Shiyue Li
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yuyang Cui
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Qianqian Nie
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Feifei Hu
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Xinyan Xie
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Guirong Cheng
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yan Zeng
- Hubei Provincial Clinical Research Center for Alzheimer’s Disease, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan University of Science and Technology, Wuhan 430065, China; (C.C.); (J.W.); (D.L.); (J.L.); (J.Z.); (X.L.); (D.S.); (S.L.); (Y.C.); (Q.N.); (F.H.); (X.X.); (G.C.)
- Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China
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Henderson A, Weiss S, Harris K, Maza VI, Carney OL, Wickline S, Widjaja T, Garrett B, Beach K, LeRoy AS. Recruiting Spousal Caregivers of People Living With Alzheimer's or a Related Dementia for Caregiver Intervention Research: Lessons Learned From a Feasibility Study. J Appl Gerontol 2025:7334648251326621. [PMID: 40177819 DOI: 10.1177/07334648251326621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Improving caregivers' quality of life begins with conducting research that aims to understand caregiver's needs. However, caregivers may be reluctant to participate in research studies, adding to the importance of developing, tracking, and evaluating recruitment strategies. Here, we review the nationwide community outreach practices we implemented as our lab embarked on a program of research to develop an online intervention tailored for those caring for a spouse with Alzheimer's Disease or a Related Dementia (ADRD). We made hundreds of "cold" calls and e-mails to organizations across the US who may have access to caregivers, but whom we had no prior relationship with. It took 36.5 contact attempts to possible recruitment sites for every 1 enrolled caregiver. While time consuming, this low-cost recruitment method may offer a route for research teams to recruit caregivers into research studies without access to a medical center or collaborating physician(s).
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Affiliation(s)
| | | | | | | | - Olivia L Carney
- Lincoln Memorial University-Debusk College of Osteopathic Medicine, Knoxville, TN, USA
| | | | | | | | | | - Angie S LeRoy
- Rice University, Houston, TX, USA
- University of North Florida, Jacksonville, FL, USA
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Kåreholt I, Nilsen C, Kivipelto M, Finkel D, Sindi S. Midlife financial stress and cognitive and physical impairments in older age: The role of potentially modifying factors. Soc Sci Med 2025; 371:117724. [PMID: 40073519 DOI: 10.1016/j.socscimed.2025.117724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 12/28/2024] [Accepted: 01/17/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. The goal of this study was to investigate whether financial stress is associated with cognitive and physical impairment and their combination, the role of potential modifiable factors and potential sex differences. METHODS The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n = 1497) (baseline data collected 1972-1987, mean age 50 years). Two late-life re-examinations (mean total follow-up 21 years). Midlife financial stress was measured using two questions on financial situation. Cognitive functioning was based on six cognitive domains. Physical impairment was self-reported, including activities of daily living and mobility. Potential mediation factors investigated were smoking, alcohol, physical activity, cohabitant status, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation. RESULTS Midlife financial stress was associated with worse cognitive functioning, physical impairment and their combination. Smoking and sleep disturbances mediated the associations between financial stress, physical impairment, and combined impairments. For men: Among smokers financial stress was associated with worse cognitive functioning; alcohol interacted with financial stress on combined impairments; cohabitation and non-manual work mediated associations to worse cognitive functioning. Among women, sleep disturbances moderated the association to worse cognitive functioning. CONCLUSIONS Midlife financial stress is associated with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.
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Affiliation(s)
- Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden; Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet/Stockholm University, Stockholm, Sweden.
| | - Charlotta Nilsen
- Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden; Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet/Stockholm University, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Deborah Finkel
- Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Vargese SS, Jylhä M, Raitanen J, Forma L, Aaltonen M. Hospitalizations of the older adults with and without dementia during the last two years of life: the impact of comorbidity and changes from 2002 to 2017. Aging Clin Exp Res 2025; 37:25. [PMID: 39833621 PMCID: PMC11753344 DOI: 10.1007/s40520-024-02918-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 12/23/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Multimorbidity creates challenges for care and increases health care utilization and costs. People with dementia often have multiple comorbidities, but little is known about the role of these comorbidities in hospitalizations. AIMS This study examines the frequency of hospitalizations during the last two years of life in older adults with and without dementia, the impact of comorbidities on hospitalizations, and their time trends. METHODS The data came from national registers and covered all persons 70 and above who died in Finland in 2002-2017. The effect of dementia and comorbidities on hospitalizations in the last two years of life was determined using binary logistic regression and negative binomial regression. RESULTS At all levels of comorbidity, people with dementia were less likely to be hospitalized and had a lower number of hospitalizations than people at the same level of comorbidity but no dementia. Hospitalizations were strongly associated with multimorbidity. During the study period, the overall hospitalization rates from home and LTC have declined. DISCUSSION The declining trend of hospitalization during the 15-year study period should be interpreted in the context of the health and long-term care system. CONCLUSION Among people with dementia, comorbidities were the main driver for hospitalizations. Regardless of the number of comorbidities, people with dementia were hospitalized less often than people without dementia in last two years of life. It remains unclear whether the lower hospitalization rate is due to the improved ability to care for people with dementia outside the hospital or to the lack of sufficient medical care for them.
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Affiliation(s)
- Saritha Susan Vargese
- Faculty of Social Sciences (Health Sciences, Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.
- Believers Church Medical College Hospital, Pathanamthitta, Kerala, India.
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences, Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences, Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences (Health Sciences, Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences, Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Ma L, Pang J, Liu Q, Li P, Huang J, Xu Y, Xie H. A study on cognitive trajectory changes and predictive factors in middle-aged and older adults individuals with dual sensory impairment based on the health social determinants model. Front Public Health 2024; 12:1489429. [PMID: 39741941 PMCID: PMC11685189 DOI: 10.3389/fpubh.2024.1489429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 12/04/2024] [Indexed: 01/03/2025] Open
Abstract
Aim This study aims to explore the cognitive trajectory changes in middle-aged and older adults individuals with dual sensory impairment (simultaneous visual and hearing impairment) and to identify the predictors of different trajectory changes. Methods Based on the longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, data from 2,369 middle-aged and older adults individuals with dual sensory impairment were selected. A latent variable growth mixture model was constructed to analyze the cognitive function development trajectories in this population and to identify their predictive factors. Results The cognitive function development trajectories in the middle-aged and older adults population can be categorized into three types: high cognitive level stable group, low cognitive level slowly declining group, and moderate cognitive level rapidly declining group. Logistic regression analysis showed that age (OR 30.544; 95% CI 9.35-99.754; p < 0.001), sleep duration (OR 0.559; 95% CI 0.343-0.909; p < 0.005), education (OR 0.009; 95% CI 0.003-0.025; p < 0.001), marital status (OR 2.122; 95% CI 1.457-3.090; p < 0.001), social participation (OR 0.499; 95% CI 0.379-0.658; p < 0.001), place of residence (OR 1.471; 95% CI 1.089-1.988; p < 0.001), and medical insurance (OR 0.353; 95% CI 0.169-0.736; p < 0.005) are predictive factors for cognitive function trajectories in this population. Conclusion There is group heterogeneity in the cognitive function development trajectories among middle-aged and older adults individuals with dual sensory impairment. Factors such as less than 4 h of nighttime sleep, low social participation, alcohol consumption, and lack of medical insurance are modifiable risk factors for cognitive decline in this population. Preventive strategies should be formulated accordingly, especially for vulnerable groups, including older rural residents and those with lower educational attainment, to prevent cognitive function deterioration in middle-aged and older adults individuals with dual sensory impairment.
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Affiliation(s)
| | | | | | | | | | | | - Hui Xie
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, China
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Pang J, Xu Y, Liu Q, Huang J, Li P, Ma L, Zeng C, Ma X, Xie H. Trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults. Front Public Health 2024; 12:1436722. [PMID: 39314790 PMCID: PMC11416970 DOI: 10.3389/fpubh.2024.1436722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
Objective To explore the trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults. Methods Utilizing data from 983 disabled middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, latent growth mixture models were constructed to analyze the categories of cognitive function development trajectories and their predictive factors. Results The cognitive function trajectories of the disabled middle-aged and older adults were classified into three categories: rapid decline (32.6%), Slow decline (36.1%), and Stable (31.2%). Multinomial logistic regression analysis identified age, gender, residence, education, marital status, household income, sleep duration, depression, hearing ability, and social participation as predictors of these trajectories. Conclusion There is heterogeneity in the cognitive function development trajectories among disabled middle-aged and older adults. Healthcare professionals can implement targeted health management based on the characteristics of different groups to prevent the deterioration of cognitive function in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hui Xie
- College of Nursing, Bengbu Medical University, Bengbu, Anhui, China
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Wu YC, Shen SF, Chen LK, Tung HH. A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial. J Med Internet Res 2024; 26:e53450. [PMID: 39052335 PMCID: PMC11310648 DOI: 10.2196/53450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/27/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults' independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. OBJECTIVE This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program's strengths and limitations. METHODS A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. RESULTS A web-based participatory program enhancing 3 skills-coping, control belief, and manageability for resilience-was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=-4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI -10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI -24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI -2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. CONCLUSIONS This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491.
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Affiliation(s)
- Yi-Chen Wu
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Shu-Fen Shen
- Department of Nursing, Mackay Medical College, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Heng-Hsin Tung
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing,National Yang Ming Chiao Tung University, Taipei, Taiwan
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10
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Seemiller LR, Flores-Cuadra J, Griffith KR, Smith GC, Crowley NA. Alcohol and stress exposure across the lifespan are key risk factors for Alzheimer's Disease and cognitive decline. Neurobiol Stress 2024; 29:100605. [PMID: 38268931 PMCID: PMC10806346 DOI: 10.1016/j.ynstr.2024.100605] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
Alzheimer's Disease and related dementias (ADRD) are an increasing threat to global health initiatives. Efforts to prevent the development of ADRD require understanding behaviors that increase and decrease risk of neurodegeneration and cognitive decline, in addition to uncovering the underlying biological mechanisms behind these effects. Stress exposure and alcohol consumption have both been associated with increased risk for ADRD in human populations. However, our ability to understand causal mechanisms of ADRD requires substantial preclinical research. In this review, we summarize existing human and animal research investigating the connections between lifetime stress and alcohol exposures and ADRD.
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Affiliation(s)
- Laurel R. Seemiller
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Julio Flores-Cuadra
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Neuroscience Graduate Program, Huck Institute of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Keith R. Griffith
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Grace C. Smith
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Nicole A. Crowley
- Department of Biology, The Pennsylvania State University, University Park, PA, 16802, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
- Neuroscience Graduate Program, Huck Institute of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
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11
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Boerner K, Stokes J, Jansen T. Widowhood and bereavement in late life. Curr Opin Psychol 2024; 55:101748. [PMID: 38071788 DOI: 10.1016/j.copsyc.2023.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 01/28/2024]
Abstract
Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.
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Affiliation(s)
- Kathrin Boerner
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 140, 26129 Oldenburg, Germany; Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA.
| | - Jeffrey Stokes
- Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA
| | - Taylor Jansen
- Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, USA
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12
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Joshi P, Hendrie K, Jester DJ, Dasarathy D, Lavretsky H, Ku BS, Leutwyler H, Torous J, Jeste DV, Tampi RR. Social connections as determinants of cognitive health and as targets for social interventions in persons with or at risk of Alzheimer's disease and related disorders: a scoping review. Int Psychogeriatr 2024; 36:92-118. [PMID: 37994532 PMCID: PMC11058077 DOI: 10.1017/s1041610223000923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social connections have a significant impact on health across age groups, including older adults. Loneliness and social isolation are known risk factors for Alzheimer's disease and related dementias (ADRD). Yet, we did not find a review focused on meta-analyses and systematic reviews of studies that had examined associations of social connections with cognitive decline and trials of technology-based and other social interventions to enhance social connections in people with ADRD. STUDY DESIGN We conducted a scoping review of 11 meta-analyses and systematic reviews of social connections as possible determinants of cognitive decline in older adults with or at risk of developing ADRD. We also examined eight systematic reviews of technology-based and other social interventions in persons with ADRD. STUDY RESULTS The strongest evidence for an association of social connections with lower risk of cognitive decline was related to social engagement and social activities. There was also evidence linking social network size to cognitive function or cognitive decline, but it was not consistently significant. A number of, though not all, studies reported a significant association of marital status with risk of ADRD. Surprisingly, evidence showing that social support reduces the risk of ADRD was weak. To varying degrees, technology-based and other social interventions designed to reduce loneliness in people with ADRD improved social connections and activities as well as quality of life but had no significant impact on cognition. We discuss strengths and limitations of the studies included. CONCLUSIONS Social engagement and social activities seem to be the most consistent components of social connections for improving cognitive health among individuals with or at risk for ADRD. Socially focused technology-based and other social interventions aid in improving social activities and connections and deserve more research.
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Affiliation(s)
- Pallavi Joshi
- Psychiatry Department, Banner University Medical Center, and University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Kyle Hendrie
- Psychiatry Department, Banner University Medical Center, and University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Dylan J. Jester
- Women’s Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Benson S. Ku
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess medical Center and Harvard Medical School, Boston, MA, USA
| | - Dilip V. Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics, La Jolla, CA, USA
| | - Rajesh R. Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
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13
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Liang HJ, Xiong Q, Remawi BN, Preston N. Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis. BMC Palliat Care 2024; 23:14. [PMID: 38212776 PMCID: PMC10782629 DOI: 10.1186/s12904-024-01344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death. METHODS MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child. RESULTS Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals. CONCLUSION Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.
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Affiliation(s)
- Hui-Ju Liang
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK.
| | - Qian Xiong
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
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14
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Meng H, Lv X, Zhang R, Feng Y, Wang J, Liu J, Zhang J. Occurrence and Risk Factors for Cognitive Decline Shared by Couples: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2024; 100:29-40. [PMID: 38848191 DOI: 10.3233/jad-240325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background To date, the magnitude of association and the quality of evidence for cognitive decline (mild cognitive impairment, Alzheimer's disease, and dementia) in couples and risk factors for outcomes have not been reviewed and analyzed systematically. Objective The aim of this study was to investigate the concordance of cognitive impairment in unrelated spouses and to qualitatively describe potential risk factors. Methods Eight databases were searched from inception to October 20, 2023. Eligible studies were independently screened and assessed for quality. Statistical analysis was conducted using Stata 15.1 software. The study was preregistered with PROSPERO (CRD42023488024). Results Eleven studies involving couples were included, with moderate to high evidence quality. Compared to controls, spouses of individuals with cognitive impairment had lower cognitive scores (Cohen's d: 0.18-0.62) and higher risk of cognitive decline (OR = 1.42, 95% CI: 1.15-1.76). The consistency of cognitive impairment between spouses was attributed to three theories: 1) the impact of caregiving stress experienced by the spouse; 2) assortative mating, which suggests that individuals select partners with similar characteristics; and 3) the influence of shared living environments and lifestyles. Conclusions The cognitive status of one spouse can affect the cognitive function of the other spouse. It is important to consider shared lifestyle, environmental, and psychobehavioral factors, as they may contribute to the risk of cognitive decline by couples. Identifying these factors can inform the development of targeted recommendations for interventions and preventive measures.
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Affiliation(s)
- Hongyan Meng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiangru Lv
- Gansu Health Vocational College, Lanzhou, Gansu, China
| | - Rong Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yuping Feng
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jing Wang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jiarui Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, Gansu, China
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15
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Montine KS, Berson E, Phongpreecha T, Huang Z, Aghaeepour N, Zou JY, MacCoss MJ, Montine TJ. Understanding the molecular basis of resilience to Alzheimer's disease. Front Neurosci 2023; 17:1311157. [PMID: 38192507 PMCID: PMC10773681 DOI: 10.3389/fnins.2023.1311157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
The cellular and molecular distinction between brain aging and neurodegenerative disease begins to blur in the oldest old. Approximately 15-25% of observations in humans do not fit predicted clinical manifestations, likely the result of suppressed damage despite usually adequate stressors and of resilience, the suppression of neurological dysfunction despite usually adequate degeneration. Factors during life may predict the clinico-pathologic state of resilience: cardiovascular health and mental health, more so than educational attainment, are predictive of a continuous measure of resilience to Alzheimer's disease (AD) and AD-related dementias (ADRDs). In resilience to AD alone (RAD), core features include synaptic and axonal processes, especially in the hippocampus. Future focus on larger and more diverse cohorts and additional regions offer emerging opportunities to understand this counterforce to neurodegeneration. The focus of this review is the molecular basis of resilience to AD.
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Affiliation(s)
| | - Eloïse Berson
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
| | - Thanaphong Phongpreecha
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
| | - Zhi Huang
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Nima Aghaeepour
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - James Y. Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Michael J. MacCoss
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Thomas J. Montine
- Department of Pathology, Stanford University, Stanford, CA, United States
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16
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Christian LM, Wilson SJ, Madison AA, Prakash RS, Burd CE, Rosko AE, Kiecolt-Glaser JK. Understanding the health effects of caregiving stress: New directions in molecular aging. Ageing Res Rev 2023; 92:102096. [PMID: 37898293 PMCID: PMC10824392 DOI: 10.1016/j.arr.2023.102096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Dementia caregiving has been linked to multiple health risks, including infectious illness, depression, anxiety, immune dysregulation, weakened vaccine responses, slow wound healing, hypertension, cardiovascular disease, metabolic syndrome, diabetes, frailty, cognitive decline, and reduced structural and functional integrity of the brain. The sustained overproduction of proinflammatory cytokines is a key pathway behind many of these risks. However, contrasting findings suggest that some forms of caregiving may have beneficial effects, such as maintaining caregivers' health and providing a sense of meaning and purpose which, in turn, may contribute to lower rates of functional decline and mortality. The current review synthesizes these disparate literatures, identifies methodological sources of discrepancy, and integrates caregiver research with work on aging biomarkers to propose a research agenda that traces the mechanistic pathways of caregivers' health trajectories with a focus on the unique stressors facing spousal caregivers as compared to other informal caregivers. Combined with a focus on psychosocial moderators and mechanisms, studies using state-of-the-art molecular aging biomarkers such as telomere length, p16INK4a, and epigenetic age could help to reconcile mixed literature on caregiving's sequelae by determining whether and under what conditions caregiving-related experiences contribute to faster aging, in part through inflammatory biology. The biomarkers predict morbidity and mortality, and each contributes non-redundant information about age-related molecular changes -together painting a more complete picture of biological aging. Indeed, assessing changes in these biopsychosocial mechanisms over time would help to clarify the dynamic relationships between caregiving experiences, psychological states, immune function, and aging.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Stephanie J Wilson
- Department of Psychology, Southern Methodist University, University Park, TX, USA
| | - Annelise A Madison
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Ruchika S Prakash
- Department of Psychology, The Ohio State University, Columbus, OH, USA; Center for Cognitive and Behavioral Brain Imaging, Ohio State University, Columbus, OH, USA
| | - Christin E Burd
- Departments of Molecular Genetics, Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Ashley E Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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17
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Su F, Chao J, Zhang B, Zhang N, Luo Z, Han J. Couples' Cognition, Intimacy, and Activity Engagement: An Actor-Partner Interdependence Model Analysis. Clin Gerontol 2023:1-13. [PMID: 37888884 DOI: 10.1080/07317115.2023.2274524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES This study examines the actor and partner effects of cognition on activity engagement and the potential mediating role of intimate relationship in older couple dyadic context. METHODS Data for this study were obtained from heterosexual couples who participated in the 2020 wave of the Health and Retirement Study. Constructing a dyadic model of couples' cognitions, activity engagement, and intimacy using structural equation modeling to analyze the relationship between variables and mediating effects. RESULTS At the actor level, cognition was positively correlated with their activity participation. At the partner level, wives' cognition and husbands' activity engagement were positively correlated. Husband's cognitive score affect wife's subjective feelings about intimacy. The mediation effect of Wife's intimacy on the relationship between husband's cognition and wife's activity engagement was significant. CONCLUSIONS In older couples, cognition influences activity engagement at a binary level, and this association is influenced by the level of intimacy. Improving intimacy can help increase activity engagement in older couples, which in turn promotes health. Clinical Implications Maintaining cognition helps older people enjoy good marriage and participation in activities. For women, the closer the partnership, the higher the frequency of participating in various activities.
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Affiliation(s)
- Fan Su
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Jianqian Chao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Bowen Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Na Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Zongyu Luo
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Jiaying Han
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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18
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Lee M, Demmer RT, Kucharska-Newton A, Windham BG, Palta P, Shippee T, Lutsey PL. Spousal Cognitive Status and Risk for Declining Cognitive Function and Dementia: The Atherosclerosis Risk in Communities Study. J Aging Health 2023; 35:688-698. [PMID: 36751693 PMCID: PMC10404645 DOI: 10.1177/08982643231155997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Objectives: We investigated the relationship between the cognitive status of participants' spouses and participants' own cognitive outcomes, controlling for mid-life factors. Methods: Participants (n = 1845; baseline age 66-90 years) from the prospective Atherosclerosis Risk in Communities Study were followed from 2011 to 2019. We used linear regression and Cox proportional hazard models to estimate whether spouses of people with MCI/dementia had lower cognitive functioning and elevated risk of incident dementia. Results: Having a spouse with MCI/dementia was associated with a deficit in cognitive function (b = -0.09 standard deviations; 95% CI = -0.18, 0.00). Adjustment for mid-life risk factors attenuated this association (b = -0.02 standard deviations; 95% CI = -0.10, 0.06). We observed no significant relationship between spousal MCI/dementia status and incident dementia (hazard ratio = 0.97; 95% CI = 0.69, 1.38). Discussion: Spousal cognitive status is not associated with poor cognitive outcomes independent of mid-life factors.
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Affiliation(s)
- Mark Lee
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - B. Gwen Windham
- Department of Medicine, School of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Priya Palta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tetyana Shippee
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Wang J, Liu W, Yu S, Li X, Ma Y, Zhao Q, Lü Y, Xiao M. Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study. J Am Med Dir Assoc 2023; 24:1374-1380.e1. [PMID: 37236264 DOI: 10.1016/j.jamda.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China. METHODS Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables. RESULTS Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003). CONCLUSIONS AND IMPLICATIONS Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.
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Affiliation(s)
- Jun Wang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiqi Yu
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingzhuo Ma
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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20
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Shively CA, Frye BM, Negrey JD, Johnson CSC, Sutphen CL, Molina AJA, Yadav H, Snyder-Mackler N, Register TC. The interactive effects of psychosocial stress and diet composition on health in primates. Neurosci Biobehav Rev 2023; 152:105320. [PMID: 37453725 PMCID: PMC10424262 DOI: 10.1016/j.neubiorev.2023.105320] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Social disadvantage and diet composition independently impact myriad dimensions of health. They are closely entwined, as social disadvantage often yields poor diet quality, and may interact to fuel differential health outcomes. This paper reviews effects of psychosocial stress and diet composition on health in nonhuman primates and their implications for aging and human health. We examined the effects of social subordination stress and Mediterranean versus Western diet on multiple systems. We report that psychosocial stress and Western diet have independent and additive adverse effects on hypothalamic-pituitary-adrenal and autonomic nervous system reactivity to psychological stressors, brain structure, and ovarian function. Compared to the Mediterranean diet, the Western diet resulted in accelerated aging, nonalcoholic fatty liver disease, insulin resistance, gut microbial changes associated with increased disease risk, neuroinflammation, neuroanatomical perturbations, anxiety, and social isolation. This comprehensive, multisystem investigation lays the foundation for future investigations of the mechanistic underpinnings of psychosocial stress and diet effects on health, and advances the promise of the Mediterranean diet as a therapeutic intervention on psychosocial stress.
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Affiliation(s)
- Carol A Shively
- Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Brett M Frye
- Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Biology, Emory and Henry College, Emory, VA, USA
| | - Jacob D Negrey
- Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Courtney L Sutphen
- Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Hariom Yadav
- Center for Microbiome Research, Microbiomes Institute, University of South Florida, Tampa, FL, USA
| | - Noah Snyder-Mackler
- Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA; School of Life Sciences, Arizona State University, Tempe, AZ, USA; School for Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Thomas C Register
- Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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21
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Llaurador-Coll M, Rios S, García-Gavilán JF, Babio N, Vilella E, Salas-Salvadó J. Plasma levels of neurology-related proteins are associated with cognitive performance in an older population with overweight/obesity and metabolic syndrome. GeroScience 2023; 45:2457-2470. [PMID: 36964401 PMCID: PMC10651568 DOI: 10.1007/s11357-023-00764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/17/2023] [Indexed: 03/26/2023] Open
Abstract
Cognitive impairment is present in a broad spectrum of medical conditions and in aging. Here, we aimed to identify plasma proteins related to cognitive function in a sample of older adults with overweight/obesity and metabolic syndrome. A total of 129 subjects (mean age 64.7 years; 36% females) were grouped according to low (l-GCF, N=65) or high (h-GCF, N=64) global cognitive function and matched according to education, sex, age, and body mass index. Cognitive performance was assessed using neuropsychological tests. Plasma levels of 92 neurology-related proteins were assessed using a proximity extension assay. An elastic net regression analysis was used to identify proteins more associated with cognitive performance. Additionally, the protein expression levels were compared between the two groups by means of a t-test with false discovery rate correction. Pearson correlations were used to assess associations between the protein levels and scores from the neurocognitive tests. Six proteins (alpha-2-MRAP, HAGH, Siglec-9, MDGA1, IL12, and EDA2R) were identified as potential contributors to cognitive performance, remaining significantly increased in l-GCF compared to h-GCF participants after correction for multiple testing. Negative correlations (r= -0.23 to -0.18, i.e., lower protein levels, higher cognitive function) were found between global cognitive function and Siglec-9, NMNAT1, HAGH, LXN, gal-8, alpha-2-MRAP, IL12, PDGF-R-alpha, NAAA, EDA2R, CLEC1B, and LAT. Mini-mental state examination z scores showed the strongest correlations with protein levels, specifically negative correlations with CLEC1b, LXN, LAT, PLXNB3, NMNAT1, gal-8, HAGH, NAAA, CTSS, EZR, KYNU, MANF (r=-0.38 to -0.26) and a positive correlation with ADAM23 (r= 0.26). In summary, we identified several plasma proteins that were significantly associated with cognitive performance in older adults with obesity and metabolic syndrome, although further research is needed to replicate the results in larger samples and to include a predictive perspective.
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Affiliation(s)
- Martí Llaurador-Coll
- Universitat Rovira i Virgili, Departament de Medicina i Cirurgia, Reus, Spain
- Hospital Universitari Institut Pere Mata, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
| | - Santiago Rios
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesus F García-Gavilán
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Nancy Babio
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Vilella
- Universitat Rovira i Virgili, Departament de Medicina i Cirurgia, Reus, Spain.
- Hospital Universitari Institut Pere Mata, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Salas-Salvadó
- Institut d'Investigació Sanitària Pere Virgili-CERCA, Reus, Spain.
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
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Sex-Specific Neurocognitive Impairment. Neurol Clin 2023; 41:359-369. [PMID: 37030963 DOI: 10.1016/j.ncl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This article explores sex-specific neurocognitive impairment. It first defines relevant terms such as gender and sex. Next, it describes the nature of the problem including under-representation of women and other gender and sexual minorities in neuroscience research, including cognitive studies. A biopsychosocial framework is employed to account for structural and social determinants of health in sex/gender-specific neurocognitive impairment. Issues in assessment including the use of gender/sex-specific normative data are also discussed. Lastly, the article covers the current state of research as it relates to sex/gender-specific neurocognitive impairment across a range of medical conditions including neurodegenerative diseases and coronavirus disease-2019.
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Jennings EA, Farrell MT, Liu Y, Montana L. Associations between cognitive function and marital status in the United States, South Africa, Mexico, and China. SSM Popul Health 2022; 20:101288. [PMID: 36444339 PMCID: PMC9700314 DOI: 10.1016/j.ssmph.2022.101288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
We investigate the associations between marital status and cognitive well-being among adults aged 50 and older across four settings: the United States, rural South Africa, Mexico, and China. Using a standardized measure of immediate word recall, we assess whether people in each non-married status have worse cognitive function than their married counterparts, and the extent to which these associations vary across settings. We theorize that the practices around marriage in each setting, as well as the social stigma attached to marital dissolution, will reveal differing associations between marital status and cognition. Results suggest that, among women, being in a widowed marital status is associated with lower cognitive function in each setting except Mexico (after accounting for education and employment), while being separated/divorced or never married is associated with lower cognitive function only among women in the U.S. and Mexico. Among men, being widowed is associated with lower cognitive function relative to being married in each setting except South Africa (after accounting for education and employment), and being never married is associated with lower cognitive function in the U.S. and China (but not in South Africa or Mexico, after accounting for education and employment). Men also face relatively lower cognitive function if separated/divorced in the U.S. and South Africa. We discuss possible reasons for these associations across settings.
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Affiliation(s)
| | | | - Yuning Liu
- Harvard Graduate School of Arts and Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Livia Montana
- The Demographic and Health Surveys (DHS) Program, USA
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24
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Zhu Z, Wang Z, Wu Y, Chen X, Liu H, Zhang J, Liu M, Liu Y. The Widowhood Effect on Mortality in Older Patients with Hip Fracture. Int J Gen Med 2022; 15:7693-7700. [PMID: 36238540 PMCID: PMC9552787 DOI: 10.2147/ijgm.s384862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture. Methods Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted. Results Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054–1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female. Conclusion Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.
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Affiliation(s)
- Zhonglun Zhu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Zhicong Wang
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China,Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuxuan Wu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Xi Chen
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Hailong Liu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Jianjun Zhang
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China
| | - Mozhen Liu
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuehong Liu
- Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China,Correspondence: Yuehong Liu, Department of Orthopedics, People’s Hospital of Deyang City, Deyang, People’s Republic of China, Email
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