Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents

Impact of functional level on cognitive function in adults aged 45 and older than 45 years in the Korean Longitudinal Study of Aging

OBJECTIVE

This study aimed to analyse the potential factors affecting cognitive function, focusing on the functional level, by utilising longitudinal data from adults aged 45 years and older.

METHODS

This was a secondary data analysis using data from the Korean Longitudinal Study of Aging (KLoSA) covering multiple waves of the survey. Cognitive function was measured using the Korean mini-mental state examination (K-MMSE), and activities of daily living (ADL), instrumental activities of daily living (IADL), diseases, hearing and visual impairments, and depression were included as independent variables. A fixed-effects model was used to assess the influence of independent variables on cognitive function over time.

RESULTS

Cognitive function, as measured using the K-MMSE, declined significantly, with the proportion of participants with normal cognition decreasing from 76% in the first wave to 68% in the eighth wave. Cognitive impairment and suspected dementia cases increased over time, and the average K-MMSE score dropped from 25.44 ± 5.31 to 24.71 ± 5.56. Panel regression analysis showed that impairments in ADL (b = -.44, p < .001) and IADL (b = -.64, p < .001), depression, and hearing and visual impairments were significantly associated with lower cognitive function. In addition, hypertension, cancer, heart disease, cerebrovascular accidents, psychiatric diseases and arthritis were significantly associated with cognitive decline. After adjusting for these factors, cognitive function still decreased significantly over time, explaining 75% of the variance in K-MMSE scores (R2 = .75).

CONCLUSIONS

This study confirmed that IADL and ADL predict cognitive impairment, with IADL limitation significantly contributing to cognitive decline in the study participants. Evaluating IADL, ADL, and other chronic health conditions in adults aged 45 and older can help identify individuals at risk for cognitive impairment.

Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study

INTRODUCTION

Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents' wishes and goals. Decision to transfer to hospital, when not aligned with the resident's wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.

METHOD AND ANALYSIS

We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.

ETHICS AND DISSEMINATION

Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.

TRIAL REGISTRATION

Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY).

Development of a predictive model for loss of functional and cognitive abilities in long-term care home residents: a protocol

INTRODUCTION

Long-term care (LTC) residents require extensive assistance with daily activities due to physical and cognitive impairments. Medical treatment for LTC residents, when not aligned with residents' wishes, can cause discomfort without providing substantial benefits. Predictive models can equip providers with tools to guide treatment recommendations that support person-centred medical decision-making. This study protocol describes the derivation and validation of time-to-event predictive models for (1) permanent loss of independence in physical function, (2) permanent severe cognitive impairment and (3) time alive with complete dependence for those with disability starting from the date of onset.

METHODS AND ANALYSIS

We will use population-based administrative health data from the Institute for Clinical Evaluative Sciences of all LTC residents in Ontario, Canada, to construct the derivation and internal validation cohorts. The external validation cohort will use data from LTC residents in Alberta, Canada. Predictors were identified based on existing literature, patient advisors and expert opinions (clinical and analytical). We identified 50 variables to predict the loss of independence in physical function, 58 variables to predict the loss of independence in cognitive function and 36 variables to predict the time spent in a state of dependence. We will use time-to-event models to predict the time to loss of independence and time spent in the state of disability. Full and reduced models (using a step-down procedure) will be developed for each outcome. Predictive performance will be assessed in both derivation and validation cohorts using overall measures of predictive accuracy, discrimination and calibration. We will create risk groups to present model risk estimates to users as median time-to-event. Risk groups will be externally validated within the Alberta LTC cohort.

ETHICS AND DISSEMINATION

Ethics approval was obtained through the Bruyère Research Institute Ethics Committee. Study findings will be submitted for publication and disseminated at conferences. The predictive algorithm will be available to the general public.

From Nature to Treatment: The Impact of Pterostilbene on Mitigating Retinal Ischemia-Reperfusion Damage by Reducing Oxidative Stress, Inflammation, and Apoptosis

Retinal ischemia-reperfusion (I/R) injury is a critical pathogenic mechanism in various eye diseases, and an effective therapeutic strategy remains unresolved. Natural derivatives have recently reemerged; therefore, in our present study, we examined the potential therapeutic effects of a stilbenoid that is chemically related to resveratrol. Pterostilbene, recognized for its anti-inflammatory, anti-carcinogenic, anti-diabetic, and neuroprotective properties, counteracts oxidative stress during I/R injury through various mechanisms. This study explored pterostilbene as a retinoprotective agent. Male Sprague Dawley rats underwent retinal I/R injury and one-week reperfusion and were treated with either vehicle or pterostilbene. After this functional electroretinographical (ERG) measurement, Western blot and histological analyses were performed. Pterostilbene treatment significantly improved retinal function, as evidenced by increased b-wave amplitude on ERG. Histological studies showed reduced retinal thinning and preserved the retinal structure in the pterostilbene-treated groups. Moreover, Western blot analysis revealed a decreased expression of glial fibrillary acidic protein (GFAP) and heat shock protein 70 (HSP70), indicating reduced glial activation and cellular stress. Additionally, the expression of pro-apoptotic and inflammatory markers, poly(ADP-ribose) polymerase 1 (PARP1) and nuclear factor kappa B (NFκB) was significantly reduced in the pterostilbene-treated group. These findings suggest that pterostilbene offers protective effects on the retina by diminishing oxidative stress, inflammation, and apoptosis, thus preserving retinal function and structure following I/R injury. This study underscores pterostilbene's potential as a neuroprotective therapeutic agent for treating retinal ischemic injury and related disorders.

Multi-colour reflective metagrating with neutral transparency for augmented reality

This paper presents the design and experimental validation of an all-dielectric and transparent metagrating-based metalens. Leveraging multiple guided mode resonances simultaneously, the metagrating enables the generation of two or more spectrally narrow reflection peaks. These peaks are achieved through the precise engineering of guided mode resonances, allowing for the reflection of a comb of vibrant and saturated colours. In addition to the investigation of underlying mechanisms, we introduce an analytical numerical method that facilitates rapid engineering of the spectral positions of the reflection peak comb. Experimental validation is provided for a bichromatic sample. Such metagrating can be promising for augmented reality systems, supporting individuals with mild to moderate cognitive impairments by delivering visual and textual stimuli that can improve indoor navigation, home safety, communication, and decision-making.

[Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study]

Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study Abstract: Background: Hearing impairment is common among the elderly. More than half of individuals 80 years and older exhibit severe hearing loss, and few retain good hearing performance. This impairment significantly affects both community participation and nursing care. Aim: This study aimed to examine the impact of hearing impairment on everyday life of employees and residents at long-term care facilities. We further sought to identify how employees perceive hearing care in order to identify potential for improvement. Methods: This sub-project of a larger study comprised guided focus groups with employees of long-term care facilities. The sample included six focus groups of nurses and nursing care assistants from long-term care facilities (n = 42). Collected data were analyzed using qualitative content analysis. Results: Hearing impairment hinders elderly resident participation in the nursing process and complicates daily communication between residents and nursing staff. Hearing impaired residents are less able to take part in group activities and tend to withdraw from the community. Lack of an effective hearing support structure renders hearing care services inaccessible to some residents. Conclusions: Optimized service structures, targeted assistance and training opportunities for employees specific to hearing impairment can provide sustainable hearing care for the elderly.

Prediction Model for Cognitive Impairment among Disabled Older Adults: A Development and Validation Study

Disabled older adults exhibited a higher risk for cognitive impairment. Early identification is crucial in alleviating the disease burden. This study aims to develop and validate a prediction model for identifying cognitive impairment among disabled older adults. A total of 2138, 501, and 746 participants were included in the development set and two external validation sets. Logistic regression, support vector machine, random forest, and XGBoost were introduced to develop the prediction model. A nomogram was further established to demonstrate the prediction model directly and vividly. Logistic regression exhibited better predictive performance on the test set with an area under the curve of 0.875. It maintained a high level of precision (0.808), specification (0.788), sensitivity (0.770), and F1-score (0.788) compared with the machine learning models. We further simplified and established a nomogram based on the logistic regression, comprising five variables: age, daily living activities, instrumental activity of daily living, hearing impairment, and visual impairment. The areas under the curve of the nomogram were 0.871, 0.825, and 0.863 in the internal and two external validation sets, respectively. This nomogram effectively identifies the risk of cognitive impairment in disabled older adults.

Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review

BACKGROUND

Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized.

OBJECTIVE

To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults.

METHODS

Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers.

RESULTS

Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items.

CONCLUSIONS

The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Identifying predictors of cognitive decline in long-term care: a scoping review

BACKGROUND

Cognitive impairment can cause social, emotional, and financial burdens on individuals, caregivers, and healthcare providers. This is especially important in settings such as long-term care (LTC) homes which largely consist of vulnerable older adults. Thus, the objective of this study is to review and summarize current research examining risk factors of cognitive decline in older adults within LTC.

METHODS

This scoping review includes primary observational research studies assessing within-person change in cognition over time in LTC or equivalent settings in high resource countries. A mean participant age of ≥ 65 years was required. Searches were conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PyscInfo on June 27th, 2022 and included articles published during or after the year 2000. Title, abstract, and full-text screening was performed by two independent reviewers using Covidence. Specific predictors along with their associated relation with cognitive decline were extracted by a team of reviewers into a spreadsheet.

RESULTS

Thirty-eight studies were included in this review. The mean sample size was 14 620. Eighty-seven unique predictors were examined in relation to cognitive decline. Dementia was the most studied predictor (examined by 9 of 38 studies), and the most conclusive, with eight of those studies identifying it as a risk factor for cognitive decline. Other predictors that were identified as risk factors included arterial stiffness (identified by 2 of 2 studies), physical frailty (2 of 2 studies), sub-syndromal delirium (2 of 2 studies), and undergoing the first wave of COVID-19 lockdowns (2 of 2 studies). ADL independence was the most conclusive protective factor (3 of 4 studies), followed by social engagement (2 of 3 studies). Many remaining predictors showed no association and/or conflicting results.

CONCLUSIONS

Dementia was the most common risk factor, while ADL independence was the most common protective factor associated with cognitive decline in LTC residents. This information can be used to stratify residents by risk severity and provide better personalized care for older adults through the targeted management of cognitive decline.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study

Introduction

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits.

Objectives and hypothesis

The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education).

Methods

Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained.

Results and discussion

Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.