Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 7 of 7
Development of a theory-based intervention to increase cognitively able frail elders’ engagement with advance care planning using the behaviour change wheel
- Authors:
- COMBES S, et al
- Journal article citation:
- BMC Health Services Research, 21(712), 2021, Online only
- Publisher:
- BioMed Central Ltd
Background: Advance care planning (ACP) conversations support people to think about, discuss and document their beliefs, values and preferences regarding future care. This process means that should the person loose capacity in the future, care can be provided, consistent with their personal values and beliefs. The ACP process is particularly relevant for older people living with frailty (frail elders) as they are vulnerable to sudden deterioration. However, ACP is rarely undertaken by frail elders. The aim of this study was to develop an intervention to increase multidisciplinary health and social care professionals’ (H&SCPs) engagement of cognitively able, domestic-dwelling frail elders with ACP. Methods: Intervention development was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel. Multiple methods were used to understand ACP barriers and enablers: a systematic integrative review, a survey (n = 73 H&SCPs), and semi-structured interviews (n = 10 frail elders, n = 8 family members). A conceptual model, developed from the integrative review, underpinned data collection for the survey and interviews. Synthesis of this data, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change for ACP to be implemented and decide content and implementation for the intervention. Results: Following the Behaviour Change Wheel system, and based on the findings of the review, survey and interviews, the prototype intervention, Conversations on Living and Dying (CLaD), was developed. The CLaD prototype consisted of one 3.5-hour educational skills session for H&SCPs supported by a toolkit. Content focussed on the relevance of ACP for frail elders, experience of ACP by frail elders, and strategies H&SCPs could adopt to encourage frail elders’ engagement with ACP. Strategies include recognising the importance of relationships and living well now, preparing frail elders for ACP conversations and starting ACP early. Participants who took part in initial prototype refinement reported that the intervention helped them think differently about ACP and encouraged them to engage with frail elders. Conclusions: The use of behavioural theory enabled the development of CLaD, an evidence-based, theory-driven, person-centred intervention to support ACP engagement with frail elders. While feasibility testing is required, initial prototype refinement demonstrated that H&SCPs found the intervention to be acceptable, engaging, and clinically valuable in their practice with frail elders and their families. (Edited publisher abstract)
Cross-sectional and longitudinal relationship between neuroticism and cognitive ability in advanced old age: the moderating role of severe sensory impairment
- Authors:
- WETTSTEIN Markus, et al
- Journal article citation:
- Aging and Mental Health, 20(9), 2016, pp.918-929.
- Publisher:
- Taylor and Francis
Objectives: Gaining a comprehensive picture of the network of constructs in which cognitive functioning is embedded is crucial across the full lifespan. With respect to personality, previous findings support a relationship between neuroticism and cognitive abilities. However, findings regarding old age are inconsistent. In particular, little is known about potentially moderating variables which might explain some of the inconsistency. The authors' aim was to examine the moderating effect of severe sensory impairment on cross-sectional and longitudinal associations between neuroticism and cognitive functioning. Method: The study sample consisted of 121 visually impaired (VI), 116 hearing impaired (HI), and 150 sensory unimpaired older adults (UI). Mean age was 82.50 years (SD = 4.71 years). Neuroticism was assessed by the NEO Five Factor Inventory, and multiple established tests were used for the assessment of cognitive performance (e.g., subtests of the revised Wechsler Adult Intelligence Scale). Results: Bivariate correlations and multi-group structural equation models indicated stronger relationships between cognitive abilities and neuroticism in both sensory impaired groups (VI and HI) compared to UI older individuals. This relationship was attenuated but still significant in both sensory impaired groups when controlling for age, education and health (number of chronic conditions). In cross-lagged panel models, higher baseline neuroticism was significantly associated with lower cognitive performance four years later in VI and HI individuals. Conclusion: Results suggest that sensory impairment moderates both cross-sectional and longitudinal associations between neuroticism and cognitive function in advanced old age. (Edited publisher abstract)
Lack of associations between modifiable risk factors and dementia in the very old: findings from the Cambridge City over-75s cohort study
- Authors:
- DECKERS Kay, et al
- Journal article citation:
- Aging and Mental Health, 22(10), 2018, pp.1272-1278.
- Publisher:
- Taylor and Francis
Objectives: To investigate the association between modifiable risk and protective factors and severe cognitive impairment and dementia in the very old. Additionally, the present study tests the predictive validity of the ‘LIfestyle for BRAin health’ (LIBRA) score, an index developed to assess an individual's dementia prevention potential. Method: Two hundred seventy-eight individuals aged 85 years or older from the Cambridge City over-75s cohort study were followed-up until death. Included risk and protective factors were: diabetes, heart disease, hypertension, depression, smoking, low-to-moderate alcohol use, high cognitive activity, and physical inactivity. Incident severe cognitive impairment was based on the Mini-Mental State Examination (score: 0-17) and incident dementia was based on either post-mortem consensus clinical diagnostic assessments or death certificate data. Logistic regressions were used to test whether individual risk and protective factors and the LIBRA score were associated with severe cognitive impairment or dementia after 18 years follow-up. Results: None of the risk and protective factors or the LIBRA score was significantly associated with increased risk of severe cognitive impairment or dementia. Sensitivity analyses using a larger sample, longer follow-up period, and stricter cut-offs for prevalent cognitive impairment showed similar results. Conclusion: Associations between well-known midlife risk and protective factors and risk for severe cognitive impairment or dementia might not persist into very old age, in line with suggestions that targeting these factors through lifestyle interventions should start earlier in life.
Association between subjective memory complaints and nursing home placement: a four-year follow-up
- Authors:
- BOCH WALDORFF Frans, SIERSMA Volkert, WALDEMAR Gunhild
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.602-609.
- Publisher:
- Wiley
In order to evaluate whether elderly persons with subjective memory complaints may be regarded as a group of potentially vulnerable patients who need close follow-up, the authors investigated the risk of nursing home placement during a 4-year follow-up period. A prospective cohort survey was carried out. Cox proportional hazard models were used to examine the influence of risk factors on nursing home placement. Results showed that a total of 758 non-nursing home residents aged 65 years and older consulted the General Practitioners in October and November 2002, of whom 50 nursing home placements were observed. Subjective memory complaints were associated with an adjusted Hazard Ratio (HR) of 2.59 for nursing home placement. Other statistical significant covariates were MMSE < 24 (HR = 3.95), age and extreme anxiety/depression. The effect of subjective memory complaints is seen to moderate when subjects are older. The authors conclude that the data of this study indicated that in an elderly primary care population the presence of subjective memory complaints was a significant independent predictor for nursing home placement together with other known risk factors.
Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study
- Authors:
- KLIEGEL M., ZIMPRICH D., ROTT C.
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.430-437.
- Publisher:
- Taylor and Francis
The purpose of this study was to examine the hypothesis of whether early education and/or maintaining intellectual activities over the life-course have the power to protect against cognitive impairment even in extremely old adults. Ninety centenarians from the population-based Heidelberg Centenarian Study were assessed with a modified version of the Mini Mental State Exam (MMSE). Data about education, occupational status, and life-long intellectual activities in four selected domains were obtained. Results demonstrated that 52% of the sample showed mild-to-severe cognitive impairment. Analyzing the influence of early education, occupational status, and intellectual activities on cognitive status the authors applied several (logistic) regression analyses. Results revealed independent, significant and strong influence of both formal school education and intellectual activities on the cognitive status in very late life, even after controlling for occupational status. However, about one fourth of the effect of early education on cognitive status was exerted indirectly via the assessed intellectual activities. In summary, the present study provides first evidence for the conclusion that even with regard to cognitive performance in very old age, both early education and life-long intellectual activities seem to be of importance.
Mild cognitive impairment in the oldest old: a comparison of two approaches
- Authors:
- HONG T. B., JOHANSSON B., ZARIT S. H.
- Journal article citation:
- Aging and Mental Health, 7(4), July 2003, pp.271-276.
- Publisher:
- Taylor and Francis
The main purpose of the current investigation was to examine the predictive utility of two sets of criteria for mild cognitive impairment (MCI). A second purpose was to determine the incidence of MCI in a longitudinal, population-based sample of the oldest old in Sweden. The participants were from the larger ‘Origins of Variance in the Old-Old: Octogenarian Twins’ (OCTO-Twin) study, identified through the Swedish Twin Registry. Participants were initially aged 80 or above with a mean age of 83 and were re-examined after two, three, six and eight years. The sample for this study consisted of 263 elders that were randomly selected singletons from twin pairs. Mild cognitive impairment was rated at baseline using both Petersen’s and Ritchie’s criteria. Petersen’s criteria emphasize memory and memory complaint whereas Ritchie’s criteria use a broader set of cognitive indicators. The incidence rate was comparable to that of other studies, however, neither set of criteria predicted subsequent dementia. The failure to confirm subsequent dementia suggests that there may be many sources of MCI in very late life besides incipient dementia. The presence of a key informant, as well as the weighting of performance across domains by an experienced clinician, both of which are hard to quantify, may be the key elements that give predictive values to MCI in prior studies.
Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities
- Authors:
- FREUND Barbara, SZINOVACZ Maximiliane
- Journal article citation:
- Gerontologist, 42(5), October 2002, pp.621-633.
- Publisher:
- Oxford University Press
Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation. The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.