Associations between Cognitive Function, Hospitalizations and Costs in Nursing Homes: A Cross-sectional Study

Association between intrinsic capacities limitations and annual healthcare costs in Nursing Home residents

BACKGROUND

The aim of this study is to analyse the associations of annual Intrinsic Capacities (IC) impairment evolution with the annual cost of care in Nursing Home (NH) residents. This was a prospective, longitudinal and multicenter study. NH residents in the Occitanie region (south of France), 60 years and older with moderate level of dependency were included in the study and were followed during 12 months.

METHODS

IC was assessed for four of the six IC domains (Cognitive, locomotion, vitality and psychological). Longitudinal IC impairment trajectories of residents were built using the K-means Longitudinal method. Costs were assessed from the healthcare payer's perspective and include direct medical and non-medical costs. Descriptive analyses of costs and characteristics as well as general linear models were carried out.

RESULTS

Three hundred forty-five residents (86 years old on average and mostly women) were included. Mild, moderate and severe impairment profiles were clustered. For the cognitive domain, we observe a total cost decrease of 1552€ between the most severe impairment profile and the less severe profile, led by medication costs. For the locomotion, psychological and vitality domains we observed a total cost increase of 1,672€, 3,869 € and 1,709€ for the most severe impairment profile in comparison with the less severe profile, respectively. This cost increase was driven by hospitalisation for the psychological and the vitality domains and by physiotherapist costs for the locomotion domain. Medication costs decrease with the severity of impairment whatever the IC domain considered.

CONCLUSIONS

Our study is the first aiming to estimate the association between impairment on IC domains and healthcare costs in NH. The implementation of clusterization highlight resident's profiles using data driven process, which may facilitate the implementation of personalized health strategies.

Effectiveness of non-pharmacological therapies for preventing frailty in older people: An umbrella review

PURPOSE

This study aimed to synthesize and assess evidence on non-pharmacological interventions for older adults, including those with prefrailty and frailty.

MATERIALS AND METHODS

A comprehensive review of randomized trials and cohort studies on non-pharmacological interventions for individuals aged ≥60 was conducted using MEDLINE, CENTRAL, and Web of Science through April 2023.

RESULTS

Of the 285 papers screened, 13 met the eligibility criteria. Participants aged 62-98 years were studied across 42,917 individuals. Four systematic reviews (SR) focused on healthy older adults, seven on prefrailty, and eleven on frailty. Interventions included exercise therapy (7 articles), nutritional therapy (3 articles), exercise games (1 article), and combined exercise and nutritional therapy (2 articles). Non-pharmacological interventions showed improvement in frailty in 1 out of 1 SR and prevention of frailty progression in 3 out of 4 SRs. Improvements in physical function were noted in 9 out of 12 SRs, muscle strength in 8 out of 11, and muscle mass in 4 out of 6. Exercise interventions enhanced strength, mass, and function in older adults, including those with prefrailty or frailty, whether alone or combined with other components. Combined exercise and nutritional therapy were found to be more effective than monotherapy. Outcomes related to falls, cognitive function, and quality of life were controversial, and no positive effect on mortality was observed.

CONCLUSIONS

Exercise therapy, including multicomponent interventions, can prevent frailty and improve physical function, strength, and muscle mass. Nutritional therapy has some advantages, but its combination with exercise therapy is recommended.

Exploring the relationship of sleep duration on cognitive function among the elderly: a combined NHANES 2011-2014 and mendelian randomization analysis

BACKGROUND

As one of the key features of sleep, sleep duration (SD) has been confirmed to be associated with multiple health outcomes. However, the link between SD and cognitive function (CF) is still not well understood.

METHODS

We employed a combined approach utilizing data from the National Health and Nutrition Examination Survey (NHANES 2011-2014) and Mendelian Randomization (MR) methods to investigate the relationship between SD and CF. In the NHANES cross-sectional analysis, the association between these variables was primarily examined through multivariate linear regression to explore direct correlations and utilized smoothing curve fitting to assess potential nonlinear relationships. To ensure the robustness of our findings, subgroup analyses were also conducted. MR analysis was used to assess the causal relationship between SD and sleeplessness on CF. After excluding confounding factors, univariate and multivariate MR were performed using inverse variance weighting (IVW) as the main analysis method, and sensitivity analysis was performed.

RESULTS

The results of our cross-sectional study indicate a notable negative association between SD and CF, forming an inverted U-shaped curve with the inflection point occurring at SD = 6 h. This relationship remains consistent and robust across subgroup analyses differentiated by variables such as age, levels of physical activity, and frequency of alcohol intake. In MR analysis, IVW analysis showed no causal relationship between SD and sleeplessness on CF (Both P > 0.05).

CONCLUSION

Cross-sectional studies suggest the existence of an inverted U-shaped correlation between SD and CF among the elderly. However, MR analysis did not reveal a causal relationship between SD and CF, which the lack of nonlinear MR analysis may limit. These findings provide evidence from a sleep perspective for optimizing cognitive strategies in older adults.

Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of virtual reality (VR) exergames on physical function, cognition and depression among older nursing home residents.

METHODS

A systematic review and meta-analysis were conducted. The PubMed, Ovid, Embase, Cochrane, CINAHL, and Web of Science databases were searched for relevant studies from inception until June 1, 2023. The reviewers independently completed the study selection, data extraction and quality assessment. Subgroup analyses were conducted to explore the sources of between-study heterogeneity and to determine whether participant or intervention characteristics influenced effect sizes.

RESULTS

Eighteen studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high, and the overall evidence grade was moderate. VR exergames had a large effect on physical function, including mobility [SMD=-0.66, P < 0.001], balance [SMD=0.95, P < 0.001], and lower limb strength [SMD=0.53, P = 0.0009]; and a moderate effect on cognition [SMD=0.48, P = 0.02] and depression [SMD=-0.72, P = 0.03]. Subgroup analyses revealed that a training frequency of 2 sessions per week and coordinating with physiotherapists yielded greater improvements in mobility (P = 0.009; P = 0.0001). VR exergames had especially beneficial effects on balance for physically fit participants (P = 0.03) and on cognition for participants with cognitive impairment (P = 0.01). Additionally, regarding the improvement of depression, commercial VR exergames were superior to self-made systems (P = 0.03).

CONCLUSION

VR exergames can provide a positive impact on physical function, cognition and depression among older nursing home residents. The study also demonstrated the different benefits of exergames between participants who were physically fit and those with cognitive impairment, which is considered as an innovative, cost-efficient and sustainable approach. Specifically, commercial VR exergame programs with a frequency of 2 sessions per week and coordinating with physiotherapists may be the most appropriate and effective option.