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Smith G, Miller A, Marra DE, Wu Y, Bian J, Maraganore DM, Anton S. Evaluation of a Computable Phenotype for Successful Cognitive Aging. Mayo Clin Proc Innov Qual Outcomes 2023; 7:212-221. [PMID: 37304063 PMCID: PMC10250575 DOI: 10.1016/j.mayocpiqo.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Objective To establish, apply, and evaluate a computable phenotype for the recruitment of individuals with successful cognitive aging. Participants and Methods Interviews with 10 aging experts identified electronic health record (EHR)-available variables representing successful aging among individuals aged 85 years and older. On the basis of the identified variables, we developed a rule-based computable phenotype algorithm composed of 17 eligibility criteria. Starting September 1, 2019, we applied the computable phenotype algorithm to all living persons aged 85 years and older at the University of Florida Health, which identified 24,024 individuals. This sample was comprised of 13,841 (58%) women, 13,906 (58%) Whites, and 16,557 (69%) non-Hispanics. A priori permission to be contacted for research had been obtained for 11,898 individuals, of whom 470 responded to study announcements and 333 consented to evaluation. Then, we contacted those who consented to evaluate whether their cognitive and functional status clinically met out successful cognitive aging criteria of a modified Telephone Interview for Cognitive Status score of more than 27 and Geriatric Depression Scale of less than 6. The study was completed on December 31, 2022. Results Of the 45% of living persons aged 85 years and older included in the University of Florida Health EHR database identified by the computable phenotype as successfully aged, approximately 4% of these responded to study announcements and 333 consented, of which 218 (65%) met successful cognitive aging criteria through direct evaluation. Conclusion The study evaluated a computable phenotype algorithm for the recruitment of individuals for a successful aging study using large-scale EHRs. Our study provides proof of concept of using big data and informatics as aids for the recruitment of individuals for prospective cohort studies.
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Affiliation(s)
- Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | - Amber Miller
- Department of Neurology, College of Medicine, University of Florida, Gainesville
| | - David E. Marra
- Department of Psychology, VA Boston Healthcare System, Boston, MA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | | | - Stephen Anton
- Department of Clinical and Health Psychology, University of Florida, Gainesville
- Department of Physiology and Aging, University of Florida, Gainesville
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Korhonen K, Leinonen T, Tarkiainen L, Einiö E, Martikainen P. Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators. Int J Epidemiol 2022; 52:523-535. [PMID: 36343014 PMCID: PMC10114069 DOI: 10.1093/ije/dyac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health.
Methods
We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed.
Results
An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to <4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%).
Conclusions
The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Taina Leinonen
- Finnish Institute of Occupational Health , Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki , Helsinki, Finland
| | - Elina Einiö
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Max Planck Institute for Demographic Research , Rostock, Germany
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
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Houghton JSM, Nickinson ATO, Bridgwood B, Nduwayo S, Pepper CJ, Rayt HS, Gray LJ, Haunton VJ, Sayers RD. Prevalence of Cognitive Impairment in Individuals with Vascular Surgical Pathology: a Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 61:664-674. [PMID: 33573912 DOI: 10.1016/j.ejvs.2020.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE A significant proportion of vascular surgery patients may have undiagnosed cognitive impairment; however, its true prevalence and impact on outcomes are unknown. The aim of this review was to estimate the prevalence of cognitive impairment among individuals with clinically significant vascular surgical pathology and investigate its associations with post-operative outcomes in those undergoing vascular surgery. METHODS MEDLINE, EMBASE, EMCare, CINAHL, PsycINFO, and Scopus were searched for relevant studies. Included studies assessed cognitive function among individuals with either symptomatic vascular surgical pathology, or disease above threshold for intervention, using a validated cognitive assessment tool. The primary outcome measure was prevalence of cognitive impairment. Secondary outcomes included incidence of post-operative delirium (POD). Two reviewers independently extracted relevant study data and assessed risk of bias (ROBINS-E or RoB 2 tool). Prevalence (%) of cognitive impairment was calculated for individual studies and presented with 95% confidence intervals (CI). Prevalence data from comparable studies were pooled using the Mantel-Haenszel method (random effects model) for separate vascular disease types. Certainty of effect estimates was assessed using the GRADE criteria. RESULTS Twenty-four studies (2 564 participants) were included in the systematic review, and nine studies (1 310 participants) were included in the meta-analyses. The prevalence of cognitive impairment was 61% (95% CI 48 - 74; 391 participants; low certainty) in studies including multiple vascular surgical pathologies, 38% (95% CI 32 - 44; 278 participants; very low certainty) in carotid artery disease, and 19% (95% CI 10 - 33; 641 participants; low certainty) in those with intermittent claudication. Lower cognitive assessment scores were associated with POD (five studies; 841 participants), but data were not suitable for pooling. CONCLUSION Screening elective vascular surgery patients for cognitive impairment may be appropriate given its high prevalence, and the association of worse cognition with POD, among individuals with clinically significant vascular surgical pathology.
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Affiliation(s)
- John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK.
| | - Andrew T O Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Bernadeta Bridgwood
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sarah Nduwayo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Coral J Pepper
- Library Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet S Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK; National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
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Scholten N, Ihle P, Pfaff H. [Sustainable Infrastructure for Health Services Research: Development of a Regional SHI Routine Database]. DAS GESUNDHEITSWESEN 2020; 83:463-469. [PMID: 33184806 DOI: 10.1055/a-1205-0751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The scientific use of SHI routine data is increasing, especially in the field of health services research. This also raises new questions with regard to the development of databases, which make it possible to store these data for longitudinal analyses over a longer period of time and by combining data from different SHI companies. On the basis of the experience gained in setting up the CoRe-Net database, we want to show that it is possible to install such a research infrastructure and make it usable in the long term. METHODOLOGY/RESULTS On the basis of the current regulatory framework (e. g. the added specification of § 75 SGB X) and taking into account strict data protection criteria, it is possible to set up a database covering several health insurance funds: In CoRe-Net, a pseudonymisation centre and a trust centre were implemented for this purpose. At the same time, multiple pseudonymisation was carried out using a one-way hash procedure. Data analysis are only possible after approval by the participating health insurance funds and if valid approval has been obtained from relevant ethics committees. CONCLUSION The amendment of § 75 SGB X in 2018 creates a legal framework for the collection and storage of SHI routine data within the framework of a research project for future questions within a defined research area.
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Affiliation(s)
- Nadine Scholten
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR), Universität zu Köln, Köln
| | - Peter Ihle
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln
| | - Holger Pfaff
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR), Universität zu Köln, Köln
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Kelfve S. Underestimated Health Inequalities Among Older People-A Consequence of Excluding the Most Disabled and Disadvantaged. J Gerontol B Psychol Sci Soc Sci 2019; 74:e125-e134. [PMID: 28369563 DOI: 10.1093/geronb/gbx032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The present study analyzed whether estimates of health inequalities in old age are sensitive to the exclusion of people living in institutions and nonuse of proxy interviews. METHOD Pooled data from the 2004 wave (n = 1,180, aged 69-100, primarily interviewed over the phone) and the 2011 wave (n = 931, aged 76-101, primarily interviewed face-to-face) of the Swedish Panel Study of Living Conditions of the Oldest Old were used to compare absolute and relative differences in disability and mortality between people with compulsory education and people with more than compulsory education. RESULTS Both absolute and relative health inequalities would have been underestimated in a survey that excluded institutionalized people and proxy-interviewed community dwellers. The same patterns were found in men and women and regardless of the mode of data collection (telephone or face-to-face interview). The degree of underestimation was lower in those 85 years and older than in those 69 to 84 years. DISCUSSION A survey that only includes people who live in the community and can participate without the help of a proxy might give the impression that those with low levels of education have less extensive health disadvantages than they actually have.
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Affiliation(s)
- Susanne Kelfve
- Aging Research Center (ARC), Karolinska Institutet & Stockholm University, Sweden.,National Institute for the Study of Ageing and Later Life (NISAL), Linköping University, Norrköping, Sweden
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Bartlett R, Milne R, Croucher R. Strategies to improve recruitment of people with dementia to research studies. DEMENTIA 2018; 18:2494-2504. [PMID: 29327604 DOI: 10.1177/1471301217748503] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Low participation in research is one of the key challenges to advancing understanding of dementia, and improving the care and treatment of those who live with this condition. Nurses and nurse researchers play a vital role in recruiting people with dementia to studies, as several countries including the United States and the United Kingdom set national targets and develop initiatives to encourage more people with dementia to take part in research. Aim To highlight the challenges to recruiting people with dementia to studies, and to identify strategies that nurses, and in particular, nurse researchers can use for overcoming them. Our focus is primarily on the role of nurses in recruiting people with dementia to dementia studies, but much of the discussion will apply to other health professionals involved in the recruitment of people with dementia to research more generally. Discussion Challenges discussed include a lack of awareness about research participation opportunities and a suitable study partner. We discuss how the nurses’ role is to ensure that recruitment practices are personalised and responsive to participants’ needs and situation, rather than target driven. The notion of responsible research is used to anchor the discussion. Conclusion Increasing the participation of people with dementia in research is a global priority. Nurses and nurse researchers play an important role in ensuring that people who take part in research have an optimal research experience. Implications for practice: Recruiting people with dementia to research studies is a national priority in many countries. With a greater understanding of the challenges involved and strategies that can be used to overcome them, nurses can have an effective role in the recruitment process and research experience.
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Schulze J, Mazzola R, Hoffmann F. Incidence of Tube Feeding in 7174 Newly Admitted Nursing Home Residents With and Without Dementia. Am J Alzheimers Dis Other Demen 2016; 31:27-33. [PMID: 26082459 PMCID: PMC10852935 DOI: 10.1177/1533317515588180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tube feeding is a common form of long-term nutritional support, especially for nursing home residents, of whom many have dementia. OBJECTIVE Estimating the incidence of feeding tube placement in nursing home residents with and without dementia. METHODS Using claims data, we studied a cohort of newly admitted nursing home residents aged 65 years and older between 2004 and 2009. Analyses were stratified by dementia. We estimated incidence rates and performed multivariate Cox regression analyses. RESULTS The study cohort included 7174 nursing home residents. Over a mean follow-up of 1.3 years, 273 people received a feeding tube. The incidence per 1000 person-years was 28.4, with higher estimates for patients with dementia. When adjusting for age, sex, and level of care as a time-dependent covariate, influence of dementia decreased to a nonsignificant hazard ratio. CONCLUSION It seems that not dementia itself but the overall clinical condition might be a predictor of tube feeding placement.
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Affiliation(s)
- Jana Schulze
- Department of Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany
| | - Rosa Mazzola
- Department of Interdisciplinary Research on Ageing and Nursing, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Heinen I, van den Bussche H, Koller D, Wiese B, Hansen H, Schäfer I, Scherer M, Schön G, Kaduszkiewicz H. [Morbidity differences according to nursing stage and nursing setting in long-term care patients: Results of a claims data based study]. Z Gerontol Geriatr 2016; 48:237-45. [PMID: 24509639 DOI: 10.1007/s00391-013-0556-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany. MATERIALS AND METHODS The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated. RESULTS In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs. CONCLUSION Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.
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Affiliation(s)
- I Heinen
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Palot A, Charpin D. [The feasibility of screening for COPD and asthma in the general population]. Rev Mal Respir 2015; 33:25-31. [PMID: 26228110 DOI: 10.1016/j.rmr.2015.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There are very few surveys devoted to the prevalence of asthma and COPD in the general population. The Motorola Health System has been developed to make such surveys easier. OBJECTIVES The main objective was to assess the acceptability and efficacy of the Motorola Health system in collecting health data at home in the context of an epidemiological study of respiratory health. The secondary objective was to determine whether a home-based survey would lead to a higher participation rate than a hospital-based survey. METHODS Four hundred and eighty-three individuals were selected from the electoral rolls of the 15th district of Marseille and randomly divided into two groups: home-based and hospital-based. The protocol included a questionnaire, several measurements: height, weight, blood pressure, spirometry and pulse oxymetry, and blood sampling. All data were transferred to a portable computer. RESULTS Data acquisition and transfer worked well. Among the 232 subjects from the home-based survey, 62 (26.7%) participated, whereas only 36 (14.3%) of the 251 subjects from the hospital-based group did so (P<0.001). In an additional telephone survey, participants (13.6%) and non-participants (11.0%) had the same (P<0.9) prevalence of asthma. CONCLUSION The Motorola Health System allowed accurate data acquisition and transfer in the context of an epidemiological survey of respiratory health. A home-based survey gave a higher participation rate than a hospital-based one.
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Affiliation(s)
- A Palot
- Clinique des bronches, allergie et sommeil, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - D Charpin
- Clinique des bronches, allergie et sommeil, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France; Aix-Marseille université, 58, boulevard Charles-Livon, 13284 Marseille, France.
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[The epidemiology of chronic diseases and long-term care: results of a claims data-based study]. Z Gerontol Geriatr 2015; 47:403-9. [PMID: 23912127 DOI: 10.1007/s00391-013-0519-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany. MATERIALS AND METHODS The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age ≥ 65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n = 8,678). A comparison group was formed with n = 114,962. We calculated prevalences and relative risks -using nominal regression- to determine influential factors on long-term care. RESULTS A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (> 20%) among long-term care users and at the same time great prevalence differences between users and non-users CONCLUSION These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.
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Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res 2014; 26:555-9. [PMID: 24647931 DOI: 10.1007/s40520-014-0210-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM We compared the prevalence of dementia in nursing home residents and community-dwelling older adults . METHODS Using health insurance claims data for the year 2009, we estimated the prevalence of at least three of four quarters with a diagnosis of dementia in persons aged ≥65 years. RESULTS Of 213,694 persons aged 65+ years, 4,584 (2.2 %) lived in nursing homes. The prevalence of dementia was 51.8 % (95 % CI 50.4-53.3) in nursing home residents and 2.7 % (95 % CI 2.6-2.8) in community-dwelling elderly. Increasing prevalences with age were found in both sexes in community-dwelling elderly. These trends were not seen in nursing home residents where prevalences were already high for the age group 65-69 years (35.7 % in males and 40.9 % in females, respectively). CONCLUSIONS More than half of nursing home residents suffer from dementia, which is about 19-fold higher than the prevalence in insured living in the community.
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Affiliation(s)
- Falk Hoffmann
- Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Postfach 33 04 40, 28334, Bremen, Germany,
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Abstract
BACKGROUND AND PURPOSE Little is known about the characteristics of non-participants in epidemiological studies. We evaluated external validity by comparing fracture and mortality rate in participants and non-participants in a longitudinal study on risk factors for fracture. METHODS 1,604 randomly selected women, 75 years of age, were invited to attend a study on osteoporosis and fracture. 1,044 women attended the study (participants) and 560 women did not participate (non-participants). Fracture data for all were obtained prospectively from radiographic records. Mortality data were obtained through the population register. Mean follow-up was 13 (11-15) years. Cumulative survival was compared with the log-rank test. Fracture incidence rates per 1,000 person-years were compared with Mann-Whitney U-tests. In addition, fracture comparisons were made with the cumulative incidence function and Gray's test. RESULTS 454 participants (44%) died during the follow-up, as compared to 372 of the non-participants (66%) (p < 0.001). The fracture incidence rate for any type of fracture was 43 for participants and 47 for non-participants (p = 1.0). The fracture incidence rate for typical osteoporotic fracture was 36 for participants and 39 for non-participants (p = 0.6). The corresponding values for distal forearm fracture were 11 and 7 (p = 0.002), they were 8 and 9 for proximal humerus fracture (p = 0.9), 13 and 10 for vertebral fracture (p = 0.007), 15 and 18 for hip fracture (p = 0.8), and they were 6 and 5 for pelvic fracture (p = 0.3). The cumulative incidence function confirmed the results. INTERPRETATION Our findings suggest that participants had a lower mortality rate than non-participants. Distal forearm and vertebral fractures were more frequent in participants. However, the external validity for fractures in general appeared to be satisfactory.
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Affiliation(s)
- Axel Wihlborg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm
| | - Kristina Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund University, Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm
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Koller D, Schön G, Schäfer I, Glaeske G, van den Bussche H, Hansen H. Multimorbidity and long-term care dependency--a five-year follow-up. BMC Geriatr 2014; 14:70. [PMID: 24884813 PMCID: PMC4046081 DOI: 10.1186/1471-2318-14-70] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency. METHODS This study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was "time until long-term care dependency". The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan-Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters. RESULTS Mean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78-1.92). The conditions with the highest risks for long-term care dependency are Parkinson's disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern "Neuropsychiatric disorders" have a 79% higher risk of care dependency. CONCLUSIONS The results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.
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Affiliation(s)
- Daniela Koller
- Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Gerd Glaeske
- Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Heike Hansen
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
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Koller D, Schön G, Schäfer I, Glaeske G, van den Bussche H, Hansen H. Multimorbidity and long-term care dependency--a five-year follow-up. BMC Geriatr 2014. [PMID: 24884813 DOI: 10.1186/1471‐2318‐14‐70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency. METHODS This study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was "time until long-term care dependency". The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan-Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters. RESULTS Mean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78-1.92). The conditions with the highest risks for long-term care dependency are Parkinson's disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern "Neuropsychiatric disorders" have a 79% higher risk of care dependency. CONCLUSIONS The results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.
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Affiliation(s)
- Daniela Koller
- Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany.
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Vandeweerd C, Corvin J, Coulter M, Perkins E, Telford R, Yalcin A, Myers J, Yegidis B. A preliminary investigation of risks for adverse outcomes of relationship seeking on social network sites (SNS): a descriptive study of women over 50 seeking relationships on MySpace in Hillsborough County, Florida. J Women Aging 2014; 26:127-45. [PMID: 24713052 DOI: 10.1080/08952841.2014.884897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In contrast to younger populations, little attention has been paid to the increase in seniors using Internet-based venues to find relationships and the potential risk for adverse outcomes this poses. This study examined data collected via an online survey from 45 ethnically diverse women aged 50+ "seeking relationships" on MySpace. The majority of women reported a relationship with someone they met online (85%). They also reported experiencing adverse events including financial exploitation (40%), threats (55%), and physical harm (38%) by someone they met online at levels greater than traditional relationship seeking in the general population. Directions for future research are explored.
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Affiliation(s)
- Carla Vandeweerd
- a The Harrell Center for the Study of Family Violence, Department of Community and Family Health, College of Public Health , University of South Florida , Tampa , FL
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Schulze J, Glaeske G, van den Bussche H, Kaduszkiewicz H, Koller D, Wiese B, Hoffmann F. Prescribing of antipsychotic drugs in patients with dementia: a comparison with age-matched and sex-matched non-demented controls. Pharmacoepidemiol Drug Saf 2013; 22:1308-16. [DOI: 10.1002/pds.3527] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/21/2013] [Accepted: 09/09/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Jana Schulze
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Gerd Glaeske
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Hendrik van den Bussche
- Institute of Primary Medical Care; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Hanna Kaduszkiewicz
- Institute of Primary Medical Care; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Daniela Koller
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
| | - Birgitt Wiese
- Institute of Biometrics; Hannover Medical School; Hannover Germany
| | - Falk Hoffmann
- Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research; University of Bremen; Bremen Germany
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Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances. Eur Neuropsychopharmacol 2013; 23:1034-42. [PMID: 23498307 DOI: 10.1016/j.euroneuro.2013.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 11/21/2022]
Abstract
Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.
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Volkert J, Schulz H, Härter M, Wlodarczyk O, Andreas S. The prevalence of mental disorders in older people in Western countries - a meta-analysis. Ageing Res Rev 2013; 12:339-53. [PMID: 23000171 DOI: 10.1016/j.arr.2012.09.004] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To conduct a meta-analysis assessing the prevalence of mental disorders in older people in Europe and North America. METHOD Studies that reported prevalence rates of mental disorders in older people from the general population were identified through MEDLINE, PsycINFO, Web of Science, and reference lists for the period between January 2000 and December 2011. Studies were included if they reported prevalence rates of mental disorders in older people (50+ years) from the community. The final sample comprised 25 studies. Prevalence rates were extracted, and effect sizes were transformed into logits. Random-effects models were calculated due to significant heterogeneity. In meta-regression analyses possible sources of bias, including age of onset, gender distribution, and risk of bias were examined. To analyze the robustness of the results, sensitivity analyses were performed. Publication bias was assessed with funnel plots and the Egger method. RESULTS Disorders with the highest prevalence estimates were dimensional depression (19.47%), lifetime major depression (16.52%), and lifetime alcohol use disorders (11.71%). Disorders with the lowest estimates were current and lifetime drug use disorders (0.34% and 0.19%, respectively), and current bipolar disorder and current agoraphobia (both 0.53%). CONCLUSION The majority of studies investigated major depression, panic disorder and social phobia. Future research requires a larger database on the epidemiology of mental disorders in the elderly. Furthermore, an improvement to the methodology that addresses the challenges of older age and produces comparable data, including the use of instruments tailored to the needs of older people, is required.
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Almici M, Sartori S, Lombardi F, Bonomini C, Geroldi C, Zanetti O. Too many hidden patients. The exclusion of individuals with Alzheimer's disease from Alzheimer's disease pharmacological clinical trials. J Am Geriatr Soc 2012; 60:1596-7. [PMID: 22889034 DOI: 10.1111/j.1532-5415.2012.04068.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Dementia is an important disease in older age. Existing studies on dementia mortality face limitations. For instance, they are based on prevalent, small, or geographically limited samples or do not include controls. We aimed to study survival after the first diagnosis of dementia compared with a control group. METHODS We analyzed claims data of a German health insurance company, including 1,818 incident dementia cases and 7,235 age- and sex-matched non-dementia controls (53% male; mean age 78.8 years). The follow-up was five years. We assessed survival with the Kaplan-Meier curves and performed Cox proportional hazard regression, also including nursing care dependency and comorbidities. RESULTS The cumulative five-year mortality was 53.5% in the dementia cases and 31.1% in the control group (hazard ratio: 2.1). Even after adjusting for comorbidities and nursing care, the mortality risk was 1.5 times higher for patients with incident dementia than for controls. Nursing care dependency showed high influence on mortality, likewise in dementia patients and controls. CONCLUSIONS Although some factors, such as education or the type and severity of dementia, could not be included in the analyses, our study shows a clear influence of dementia on mortality irrespective of age, sex, care dependency, and comorbidities. The strongest influence on mortality was found for dementia patients with nursing care dependency. Taking into account their mortality of around 70% in care level 1 and up to 80% in care levels 2 and 3, healthcare delivery to these patient groups should strongly consider elements of palliative care focusing on the quality of life.
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Hoffmann F, van den Bussche H, Wiese B, Schön G, Koller D, Eisele M, Glaeske G, Scherer M, Kaduszkiewicz H. Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry 2011; 11:190. [PMID: 22145796 PMCID: PMC3262154 DOI: 10.1186/1471-244x-11-190] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 12/06/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany. METHODS We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression. RESULTS On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis. CONCLUSIONS It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.
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Affiliation(s)
- Falk Hoffmann
- University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany
| | | | - Birgitt Wiese
- Institute of Biometrics, Hannover Medical School, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniela Koller
- University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany
| | - Marion Eisele
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Gerd Glaeske
- University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Bremen, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Hanna Kaduszkiewicz
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany
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Wu B, Goedereis EA, Crout RJ, Plassman BL, DiNapoli EA, McNeil DW, Wiener M, Boone ML, Wiener RC, Kao E, Bai L. Recruitment of rural and cognitively impaired older adults for dental research. SPECIAL CARE IN DENTISTRY 2010; 30:193-9. [PMID: 20831737 DOI: 10.1111/j.1754-4505.2010.00150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recruitment of community-dwelling older adults, particularly those with cognitive impairment and those residing in rural areas, has been consistently challenging for researchers, especially in the dental field. This study reports on recruitment experiences from an ongoing study investigating the association between oral health and cognitive status in later life. Multiple recruitment strategies, including educational presentations and traveling to participants' homes, were used to enroll rural elderly participants with various levels of cognitive function. In general, multipronged, proactive recruitment strategies were more effective than traditional, passive methods in reaching participants with varying degrees of cognitive impairment. The outcome of this study suggests that successful recruitment of such populations involves gaining the support of staff at relevant community organizations, informing community members (including older adults and their family members) of the project and the importance of oral health, and making data collection sites accessible for older adults.
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Affiliation(s)
- Bei Wu
- The University of North Carolina Greensboro, Gerontology Program, Greensboro, North Carolina, USA.
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Nejati V, Asadi A. Semantic and phonemic verbal fluency in blinds. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2010; 39:235-242. [PMID: 19911280 DOI: 10.1007/s10936-009-9136-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A person who has suffered the total loss of a sensory system has, indirectly, suffered a brain lesion. Semantic and phonologic verbal fluency are used for evaluation of executive function and language. The aim of this study is evaluation and comparison of phonemic and semantic verbal fluency in acquired blinds. We compare 137 blinds and 124 sighted people in verbal fluency task. The tasks were phonemic and semantic verbal fluency test that subjects should be generate as many word as possible in a limited amount of time for a given letter (Phonemic fluency) or a given category (Semantic fluency). Independent T Test was used to comparing blind with sighted. Findings show significant difference between two groups so that that sighted subjects have higher performance in semantic verbal fluency task (p = 0.000). Comparing sighted and blind subjects in phonemic verbal fluency task shows performance in sighted subjects (p = 0.000). Based on this study blinds have lower performance in semantic and phonemic verbal fluency task as a executive function of frontal lobe.
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Affiliation(s)
- Vahid Nejati
- Cognitive neuroscience, Psychology Department, Shahid Beheshti University, Tehran, Iran.
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van Goor H. [Selective loss of participants as a consequence of under-coverage and non-response in research among the aged: an overview]. Tijdschr Gerontol Geriatr 2009; 40:2-16. [PMID: 19326697 DOI: 10.1007/bf03088471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article presents an overview of biases in studies among the aged as a consequence of under-coverage and non-response. The question studied is whether participants and non-participants in research differed in their socioeconomic status (education; income; SES of neighbourhood), social integration (marital status; living arrangements; social participation; ethnicity) and health (general health situation; mortality in the period after study; lifestyle and risk factors, namely obesity and alcohol abuse; contact with physicians). In all, 65 studies were reviewed. The results showed that research participants had a higher socioeconomic status, were more integrated socially and in better health than research non-participants. The differences (effect sizes) were small to moderate. On the basis of these results, we can conclude that univariate distributions and prevalence estimates as well as relationships between variables in published research will frequently be biased.
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Affiliation(s)
- H van Goor
- Vakgroep Sociologie, Faculteit Gedrags- en Maatschappijwetenschappen, Rijksuniversiteit Groningen, Groningen.
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Fitzpatrick AL, Fried LP, Williamson J, Crowley P, Posey D, Kwong L, Bonk J, Moyer R, Chabot J, Kidoguchi L, Furberg CD, DeKosky ST. Recruitment of the elderly into a pharmacologic prevention trial: the Ginkgo Evaluation of Memory Study experience. Contemp Clin Trials 2006; 27:541-53. [PMID: 16949348 DOI: 10.1016/j.cct.2006.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 01/18/2006] [Accepted: 06/20/2006] [Indexed: 11/25/2022]
Abstract
The difficulty involved in recruiting healthy older adults into clinical trials, especially those involving pharmacologic agents, is an important issue in research. The Ginkgo Evaluation of Memory (GEM) Study, a double-blind, placebo-controlled randomized clinical trial evaluating Ginkgo biloba to prevent dementia, successfully recruited 3072 participants age 75 years and older at four U.S. sites from September 2000 through June 2002. Using targeted mailing lists, an estimated 243,400 study brochures were mailed out to potential participants. Subsequent attempts were made to reach 14,603 households by telephone, from which 12,186 (83.4%) successful contacts were made. Overall, telephone or in-person evaluations identified 2149 (17.6%) ineligible persons for cognitive (20.6%), medical (49.4%), or other (30.0%) reasons. A total of 6944 (57.0%) refused participation resulting in 3072 enrolled into the study, a recruitment rate of 25.2% based on telephone contacts made or 1.3% of all mailed brochures. Recruitment rates were stable over the 21-month enrollment period but were higher for the two urban centers than the two rural ones. Recruitment was dependent most on mailing lists available, density of older adults in the catchment areas, and Institutional Review Board restrictions. Men and persons under age 85 were more likely to enroll. Primary reason for refusals involved lack of interest (48.4%) or self-perceived poor health (16.2%). Over 9% were unwilling to give up current Ginkgo supplementation or would not accept assignment to placebo. An additional 7% did not want another medication and almost 4% had care-giving responsibilities which prevented involvement. Mass mailings were the most successful approach for recruitment at all four sites and the method through which the vast majority of interviewees had learned about the study. Information on the experience of the GEM Study recruitment may be helpful to other clinical trials attempting to randomize older adults into prevention trials.
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Riedel-Heller SG, Busse A, Angermeyer MC. The state of mental health in old-age across the 'old' European Union-- a systematic review. Acta Psychiatr Scand 2006; 113:388-401. [PMID: 16603030 DOI: 10.1111/j.1600-0447.2005.00632.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The paper provides the first syllabus on the prevalence of mental disorders in old-age focusing on surveys conducted in the 15 countries, which comprised the 'old' European Union. METHOD A systematic search of the literature published from 1990 onwards was conducted. RESULTS Mental disorders in old-age are common. The most serious threats to mental health in old-age are posed by dementia and depression. It is a clear cut finding that dementia exponentially increases with age. The basic issue of whether depression increases or decreases with age remains unsolved. Databases on substance use, mild cognitive impairment, psychotic syndromes, anxiety, and somatoform disorders in old-age are much smaller, making conclusions difficult to draw. CONCLUSION Numerous questions in the field remain to be answered. Concerted action is needed to produce comparable data across Europe.
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Bertone A, Wittich W, Watanabe D, Overbury O, Faubert J. The effect of age-related macular degeneration on non-verbal neuropsychological test performance. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.05.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Paulino Ramirez Diaz S, Gil Gregório P, Manuel Ribera Casado J, Reynish E, Jean Ousset P, Vellas B, Salmon E. The need for a consensus in the use of assessment tools for Alzheimer's disease: the Feasibility Study (assessment tools for dementia in Alzheimer Centres across Europe), a European Alzheimer's Disease Consortium's (EADC) survey. Int J Geriatr Psychiatry 2005; 20:744-8. [PMID: 16035121 DOI: 10.1002/gps.1355] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To ensure that all Alzheimer centres across Europe are capable of using a similar method of data collection. Information about the patient assessment tools used by each participating centre was obtained and normal clinical practice in each EADC centre was documented by collecting data from routine new patient consultation. METHODS Twenty new consecutive patients with objective memory impairment were recruited in each Alzheimer centre over 6 months. Each patient consultation was carried out according to routine clinical practice. Patient data were recorded using the anonymous patient protocol (demographic, diagnosis, MMSE score, patient assessment scales, and most prominent behavioural problem). Information about neuropsychological assessment tools used in each centre was take to account to harmonise research practice for future multicentre collaboration. RESULTS Seven hundred and four patients from 36 memory clinics in 13 countries across Europe participated in the study. [M:F ratio 0.67. Mean age 75.4 SD 9.3 (51-102) Mean MMSE 21 SD 6 (0-30)] Five hundred and fifty-five patients had a clinical diagnosis of dementia [Alzheimer's disease (68.5%), vascular dementia (10.3%), frontal lobe dementia (5.6%), Lewy body dementia (4.1%), mixed dementia (5.6%)]. Duration of symptoms: 0-6 months 6.5%; 6-12 months 16.1%; 1-2 years 30.5%; 2-5 years 46.9%. Assessment scales used: Clinical Dementia Rating (CDR) 48.9%, Reisberg's Global Deterioration Scale (GDS) 38.6%, ADL/IADL (Lawton and Brody, 1969) 37.5%, Neuropsychological Inventory (NPI) 28.6%, Geriatric Depression Scale 22%, ADL (Katz et al., 1963) 19.2%, ADAS-Cog 14.9%, Cornell Scale for Depression 12.9%, Grober and Bushke Selective Reminding Test 11.5%, ADCS/ADL 7.7%. 64.8% of the patients experienced behavioural symptoms: apathy 13.6%; anxiety 12.8%; dysphoria 9.9%; irritability 7.8%; agitation 5.5%; hallucinations 3.6%; delusions 3.6%, sleep disorder 2.4%; desinhibition 2%. CONCLUSIONS The most common type of cognitive decline was Alzheimer's disease followed by mild cognitive impairment and vascular dementia. CDR, GDS Reisberg, and ADL/IADL were used widely (40-50%). The NPI, geriatric depression scale and ADL (Katz, 1963) were only used in 20% of the centres. We verified large differences in the tools use in the EADC centres to evaluate patients with dementia across Europe. There is a need for a consensus in the use of assessment tools for dementia in Alzheimer's centres in Europe.
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Abstract
Dementia is an important public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality. This review on dementia is restricted to European Union countries where the overwhelming majority of studies have been undertaken, and will also refer to the EURODEM publications which may be considered to be the principal European reference point in this area. In subjects aged over 65, crude prevalence rates for dementia varied between 5.9% and 9.4%. We discuss the major problems limiting the use of these estimations, limits which may differ according to the area of application, be it etiological research or care provision.
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Affiliation(s)
- C Berr
- INSERM E361, Pathologies of the Nervous System, Clinical and Epidemiological Research, Hôpital La Colombière, 34093 Montpellier Cedex 5, France.
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Jousilahti P, Salomaa V, Kuulasmaa K, Niemelä M, Vartiainen E. Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women. J Epidemiol Community Health 2005; 59:310-5. [PMID: 15767385 PMCID: PMC1733044 DOI: 10.1136/jech.2004.024349] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To assess total and cause specific mortality among participants and non-participants of large population based health surveys. DESIGN A prospective follow up study. Baseline surveys were conducted in 1972, 1977, 1982, 1987, and 1992. Study end points were overall, cardiovascular, cancer and violent mortality, and deaths related to smoking and alcohol. Study cohorts were followed up until the end of 2000 through computerised record linkage. All analyses were adjusted for age. SETTING Finland. PARTICIPANTS Participants and non-participants of five population based risk factor surveys. The samples included 54 372 men and women aged 25 to 64 years at baseline. MAIN RESULTS The average participation rate was 81.7% among men and 87% among women. At eight year follow up, the non-participating men had twice and non-participating women 2.5-fold higher overall mortality than the participating men and women. Non-participants had also significantly higher cause specific mortality, except cancer and smoking related mortality among women. Relative differences in mortality were largest in violent and alcohol related deaths. Non-participants had considerably higher overall mortality than smoking participants, and their mortality was threefold compared with non-smoking participants. CONCLUSIONS Observed differences in mortality show that health behaviour and health status substantially differ between non-participants and participants. Low participation rate may considerably bias the results of population based health surveys.
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Affiliation(s)
- Pekka Jousilahti
- National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
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Chouliara Z, Kearney N, Worth A, Stott D. Challenges in conducting research with hospitalized older people with cancer: drawing from the experience of an ongoing interview-based project. Eur J Cancer Care (Engl) 2004; 13:409-15. [PMID: 15606707 DOI: 10.1111/j.1365-2354.2004.00543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older people with cancer often face the prospect of cognitive and physical frailty, increased vulnerability of psychological distress and limited access to resources. These factors present ethical and methodological challenges for conducting research in such patients, especially interviews in acute care settings. This paper discusses these challenges using experiences from an ongoing research project. The project is a patient-focused study on the perceptions of older people with cancer regarding information provided to them, decision making and treatment. Interviews with patients aged 65 or over with a cancer diagnosis are conducted in two clinical settings, care of the elderly wards and a cancer centre whilst they are in-patients. Patients' cognitive and physical status are assessed using clinical measures, whereas socio-demographic and medical data are obtained from patient files. Ethical challenges, including procedures to obtain valid consent, as well as methodological choices, including recruitment procedures and patient conditions are presented and debated with reference to previous literature. Suggestions for future research with older people with cancer are made based both on current experience and previous literature.
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Affiliation(s)
- Z Chouliara
- Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling, Stirling, UK.
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Responding to the Challenges of Recruiting and Retaining Homebound Older Men and Women in a Study of Nutrition and Function. ACTA ACUST UNITED AC 2002. [DOI: 10.1300/j052v22n02_02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 2002; 14:499-508. [PMID: 12674491 DOI: 10.1007/bf03327351] [Citation(s) in RCA: 189] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS This investigation examined the ability of a four-item Health-Related Quality of Life (HRQOL) scale to predict short-term (30-day) and long-term (1-year) physician visits, hospitalization, and mortality among older adults. METHODS Subjects included 84065 individuals aged 65 and older who completed a mail version of the Centers for Diseases Control's Behavioral Risk Factor Surveillance System (BRFSS) Core HRQOL Module. HRQOL dimensions represented by the module include global self-rated general health, recent physical health, recent mental health, and recent activity limitation. RESULTS In analysis of covariance models controlling for demographic factors and comorbidity, the number of physician visits within 30 days and 1 year differed significantly across categories of each HRQOL item. In Cox regression models controlling for the same covariates, all four HRQOL questions were significant predictors of 30-day and 1-year hospitalization and mortality. CONCLUSIONS These results signify that all four dimensions of HRQOL represented by the BRFSS Core HRQOL Module are important predictors of both short-term and long-term adverse health events among older adults. This brief scale may be particularly useful for assessing the health of older adults in clinical settings and large-scale epidemiological studies.
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Affiliation(s)
- Kelli L Dominick
- Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina 27705, USA.
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der Wiel ABV, van Exel E, de Craen AJM, Gussekloo J, Lagaay AM, Knook DL, Westendorp RGJ. A high response is not essential to prevent selection bias: results from the Leiden 85-plus study. J Clin Epidemiol 2002; 55:1119-25. [PMID: 12507676 DOI: 10.1016/s0895-4356(02)00505-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We tested the hypothesis that an additional effort to increase the response rate would diminish selection bias in a community-based cohort study. In the Leiden 85-plus Study, all subjects of the town of Leiden who had reached their 85th birthday were informed of the study by mail and then asked to participate by telephone. In an additional recruitment stage, those subjects who did not participate directly were visited and personally asked to participate. When these subjects refused, some nonresponse questions were asked. In this way we collected data on the whole source population. Of 691 eligible elderly subjects, 511 subjects (74%) participated directly. Of those who did not participate directly, 88 subjects participated after the additional effort. The response rate increased from 74% to 87%. Compared to the 511 subjects who directly participated, the 88 subjects who entered the study after the additional effort had poorer health and lower survival. The subjects who refused were more healthy and had poorer mood. The direct sample did not differ from the source population with respect to socio-demographics, health, and mortality. In conclusion, we showed that given a moderately high direct response the additional effort was effective in increasing the response rate, but was also selective and was not necessary to prevent selection bias.
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Affiliation(s)
- A Bootsma-van der Wiel
- Leiden 85-plus Study, Leiden University Medical Center, C2-R Gerontology and Geriatrics, Department of Internal Medicine, P.O. Box 9600, The Netherlands
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Busse A, Sonntag A, Bischkopf J, Matschinger H, Angermeyer MC. Adaptation of dementia screening for vision-impaired older persons: administration of the Mini-Mental State Examination (MMSE). J Clin Epidemiol 2002; 55:909-15. [PMID: 12393079 DOI: 10.1016/s0895-4356(02)00449-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In epidemiologic field studies on the prevalence and incidence of dementia the problems associated with the cognitive testing of visually impaired individuals are rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the Mini-Mental State Examination for the visually impaired (MMSE-blind) was employed from which all items requiring image processing had been omitted. To be able to interpret the test results and include vision-impaired individuals in the field study, the scores for the full MMSE were estimated by conducting linear transformation of the scores obtained on the MMSE-blind. The method of linear transformation is based on certain theoretical assumptions that are examined in this article. Linear transformation of scores has proved to be a valid procedure only for individuals with very high or very low cognitive performance. Thus, evaluation of the estimated full MMSE scores based on the norms for the original MMSE is not recommended. A blind version of the MMSE with age- and education-specific norms that has been validated as a screening tool for dementia is therefore presented.
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Affiliation(s)
- Anja Busse
- Klinik und Poliklinik für Psychiatrie der Universität Leipzig, Johannisallee 20, 04317 Leipzig, Germany.
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