It is well known that depression predicts mortality in old age. However, little is known about the impact of positive emotions. We investigated the impact of positive life orientation on mortality ...and permanent institutional care in aged birth cohorts.
Participants (born 1904, 1909, and 1914) underwent detailed assessments with follow-up at 5 and at 10 years. Positive life orientation was determined as answering “yes” to all the following items: being satisfied with life, having zest for life, having plans for the future, feeling needed, seldom feeling lonely or depressed.
Of participants, 102 (20.8%) had a positive life orientation. After 10 years, 54.5% of them were alive, whereas in the rest of the sample 39.5% survived (
P
=
.004). After controlling for age, gender, and health measures, the impact of positive life orientation was still significant (HR
=
0.89, 95% CI 0.83–0.93). At 5 years, only 2.9% of those having a positive life orientation but 17.5% of the rest of the sample were in permanent institutional care (
P
=
0.003), with a positive life orientation remaining a significant protector against institutional care (OR 0.58, 95% CI 0.36–0.93).
Positive attitudes have a long-standing impact on prognosis in old age.
there is little research how older people's will-to-live predicts their survival.
to investigate how many years home-dwelling older people wish to live and how this will-to-live predicts their ...survival.
as a part of the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study, 400 home-dwelling individuals aged 75-90 were recruited into a cardiovascular prevention trial in Helsinki. In 2000, a questionnaire about the wishes of their remaining life was completed by 283 participants. Participants were inquired how many years they would still wish to live, and divided into three groups according to their response: group 1: wishes to live <5 years, group 2: 5-10 years, group 3: >10 years. Mortality was confirmed from central registers during a 10-year follow-up. The adjusted Cox proportional hazard model was used to determine how will-to-live predicted survival.
in group 1 wishing to live less than 5 years, the mean age and the Charlson comorbidity index were the highest, and subjective health the poorest. There were no differences between the groups in cognitive functioning or feeling depressed. Mortality was the highest (68.0%) among those wishing to live <5 years compared with those wishing to live 5-10 years (45.6%) or over 10 years (33.3%) (P < 0.001). With group 1 as referent (HR: 1.0) in the Cox proportional hazard model adjusting for age, gender, Charlson comorbidity index and depressive feelings, HR for mortality was 0.66 (95% CI: 0.45-0.95) (P = 0.027) and 0.47 (95% CI: 0.26-0.86) (P = 0.011) in groups 2 and 3, respectively.
the will-to-live was a strong predictor for survival among older people irrespective of age, gender and comorbidities.
We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. ...Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller private sector sample (total
n
= 1,268). Patients with other disorders impacting cognition were excluded. Detailed clinical and cognitive screening data (the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery CERAD-nb) were obtained from local health records. Adequate cognitive data were available for 389 patients with mild AD (31%) of the entire AD group. The main reasons for not including patients in analyses of cognitive performance were AD diagnosis at a moderate/severe stage (
n
= 266, 21%), AD diagnosis given before full register coverage (
n
= 152, 12%), and missing CERAD-nb data (
n
= 139, 11%). The cognitive performance of persons with late-onset AD (
n
= 284), mixed cerebrovascular disease and AD (
n
= 51), and other AD subtypes (
n
= 54) was compared with that of a non-demented sample (
n
= 1980) from the general population. Compared with the other AD groups, patients with late-onset AD performed the worst in word list recognition, while patients with mixed cerebrovascular disease and AD performed the worst in constructional praxis and clock drawing tests. A combination of national registers and local health records can be used to collect data relevant for cognitive screening; today, the process is laborious, but it could be improved in the future with refined search algorithms and electronic data.
The educational background and size of the elderly population are undergoing significant changes in Finland during the 2020s. A similar process is likely to occur also in several European countries. ...For cognitive screening of early Alzheimer's disease (AD), using outdated norms and cutoff scores may negatively affect clinical accuracy. The aim of the present study was to examine the effects of education, age, and gender on the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-nb) in a large register-based, clinical sample of patients with mild AD and nondemented at-risk persons from the general population (controls) and to examine whether corrected cutoff scores would increase the accuracy of differentiation between the 2 groups.
CERAD-nb scores were obtained from AD patients (n = 389, 58% women, mean age 74.0 years) and from controls (n = 1,980, 52% women, mean age 68.5 years). The differences in CERAD-nb performance were evaluated by univariate GLM. Differentiation between the 2 groups was evaluated using a receiver operating characteristic (ROC) curve, where a larger area under the ROC curve represents better discrimination. Youden's J was calculated for the overall performance and accuracy of each of the measures.
Of the demographic factors, education was the strongest predictor of CERAD-nb performance, explaining more variation than age or gender in both the AD patients and the controls. Education corrected cutoff scores had better diagnostic accuracy in discriminating between the AD patients and controls than existing uncorrected scores. The highest level of discrimination between the 2 groups overall was found for two CERAD-nb total scores.
Education-corrected cutoff scores were superior to uncorrected scores in differentiating between controls and AD patients especially for the highest level of education and should therefore be used in clinical cognitive screening, also as the proportion of the educated elderly is increasing substantially during the 2020s. Our results also indicate that total scores of the CERAD-nb are better at discriminating AD patients from controls than any single subtest score. A digital tool for calculating the total scores and comparing education-based cutoffs would increase the efficiency and usability of the test.
Abstract Objective To explore feelings and psychological well-being of spousal caregivers of persons with Alzheimer's disease related to caregiving and experiences with the service system and ...associated factors. Methods A cross-sectional survey of Alzheimer patients’ spouses included items on caregiving and the Psychological Well-being Scale (PWB). An open-ended question: “What kind of problems have you faced with the services?” was included. Those responding to the question ( n = 728) were analyzed combining both quantitative and qualitative responses. Results According to PWB, 10.8% had poor well-being. They had poorer subjective health, their care recipient had poorer functioning and they more often felt that their closest ones did not understand caregiving situation than those with better PWB. No difference existed between these groups in proportions satisfied with the services. In the responses of the open-ended question, the caregivers described both positive and negative feelings related to everyday caregiving as well as problems related to using services. Positive feelings were associated with being satisfied with services and caregivers’ good subjective health. Negative feelings included bitterness, feeling of being isolated and distress. Bitterness was associated with being dissatisfied with services, the relationship with the spouse or closest ones and poor PWB. Feeling isolated was associated with the view that the closest ones do not understand their situation. Conclusions Caregivers’ feelings are intertwined with their personal characteristics and life situation with their spousal relationship and closest ones. Traditional home service may not be equipped to deal with the complexity of these feelings. A more psychological approach is needed.
Abstract Introduction To investigate how frailty status affects the outcome of exercise intervention among home-dwelling participants with Alzheimer disease (AD). Methods This is a sub-group analysis ...of a randomized controlled trial. In this trial, home-dwelling participants with AD received either home-based or group-based exercise twice a week for one year ( n = 129); the control group received normal care ( n = 65). Both the intervention and control group were subdivided into two groups according to modified Fried criteria: prefrail (0–1 criteria) and advanced frailty (2–5 criteria). The Functional Independence Measure (FIM) and number of falls per person-years served as outcome measures. Results Whereas there was no significant difference in FIM between the prefrail intervention (PRI) and control (PRC) groups at 3 or 6 months, the PRI group deteriorated significantly slower at 12 months (−6.6 95% CI −8.6 to −4.5 for PRI and −11.1 95% CI −13.9 to −8.3 for PRC; P = 0.010). Similarly, there was no significant difference between the advanced frailty intervention (AFI) and control (AFC) groups at 3 months, but the difference became significant at 6 months (−8.1 95% CI −11.1 to −5.2 for AFI and −15.5 95% CI −20.0 to −11.1 for AFC; P = 0.007) and at 12 months (−8.9 95% CI −11.9 to −5.9 for AFI and −15.3 95% CI −20.2 to −10.3 for AFC; P = 0.031). There was also a significant difference in the number of falls in favor of PRI and AFI groups compared to their respective control groups. Conclusion A long-term exercise intervention benefited people with AD regardless of their stage of frailty. Trial registration : ACTRN12608000037303.
Delirium is common and serious acute syndrome among older people precipitated by multiple external factors such as acute illnesses, trauma, surgery, and drugs. The aim of this study was to find ...possible stressors and causative triggers for acute delirium and compare patients with or without dementia in this respect.
193 delirious patients from two separate delirium studies including settings of nursing homes and geriatric wards were thoroughly assessed for precipitating factors of delirium. Patients with and without dementia were compared for their clinical status, symptoms and signs, prognosis, and the profile of precipitating factors of delirium.
The patients with dementia (n=98) and without dementia (n=95) did not differ in their demographic factors, mean number of drugs, or their psychiatric symptoms. The patients with dementia had higher number of comorbidities, poorer cognition, and they were more often restrained than those without dementia. The mean number of precipitators for delirium was 2.6 among those without dementia and 2.0 among those with dementia (p=0.0019). Infections, metabolic conditions, trauma, and surgery were more common precipitating factors for delirium in those without than those with dementia. There was no difference in mortality between the groups.
Most patients had multiple precipitating factors for delirium irrespective of prior dementia. Those with dementia and decreased cognitive reserves needed lower number of etiologies to develop delirium. The profile of causative agents differed among patients with and without dementia.
•Delirium has very often multiple etiological factors.•Patients without prior dementia require more stress triggers than those with dementia.•The etiologies differ among patients with and without dementia.•Both groups had very poor prognosis and there was no difference between the groups in mortality.
Objectives:To examine the experiences of spousal care givers of Alzheimer patients to disclosure of dementia diagnosis and subsequent care.Methods:A random sample of 1943 spousal care givers of ...people receiving medication for Alzheimer disease (AD) was sent a cross-sectional postal survey about their opinions on the disclosure of dementia and follow-up care. A smaller qualitative study (n = 63) included open-ended questions concerning their experiences of the same topics.Results:The response rate for the survey was 77%. Of the respondents, 1214 of 1434 acknowledged themselves as their spouse’s care giver. The mean age of the care givers was 78.2 years, and that of demented spouses, 80.5 years. Of the care givers, 63% were women. The couples had long-lasting marriages (mean 52 years). Of the care givers, 93% reported that dementia had been disclosed openly to their spouse; 97% also preferred that physicians openly inform the patients of the dementia diagnosis, although 55% of their spouses with AD had developed depressive symptoms after the disclosure. Of the care givers, 71% felt they had received sufficient information about dementia. However, only 50% estimated that their spouses’ follow-up care had been well organised. The responses in the qualitative study indicated that many care givers felt grief and anxiety. They also expressed feelings of loneliness and uncertainty about how to deal with follow-up care for dementia.Conclusions:Elderly spousal care givers were quite satisfied with the information given them about dementia. However, the support with regard to the follow-up care of care-giving families failed to meet their needs adequately.
Abstract Background No previous studies have investigated the effectiveness and feasibility of self-management groups for people with dementia and their caregivers. Purpose We present the baseline ...findings of a randomized controlled trial examining the effectiveness of a psychosocial group intervention to enhance self-management skills of persons with dementia and their spouses and have evaluated the feasibility of the intervention. Subjects and methods Altogether 136 individuals with dementia living with their spousal caregivers in the community were recruited from the memory clinics. They were randomized into two arms: group-based self-management intervention ( n = 67 couples) and controls ( n = 69 couples). The patients and spouses met in separate closed groups once a week for 8 weeks. Intervention sessions were based on discussions, including topics according to participants’ preferences. Their aim was to enhance participants’ self-efficacy, problem-solving skills and peer support. Anonymous feedback from the intervention group was collected at 3 months. Results The mean age of participants with dementia was 76.8 years, 51 (38%) were females, and 98 (72%) were at a mild stage of dementia. Cognitive status was poorer in the intervention group than in controls MMSE; 19.9 (SD 5.7) vs. 21.7 (SD 3.7), P = 0.04. The participation rate in-group sessions was high among patients (93%, range 86–98%) and caregivers (93%, range 86–99%). Participants described the group sessions as beneficial and supportive. Conclusion We have successfully randomized 136 dyads in a self-management group rehabilitation trial. The feedback from participants was favourable, and the drop-out rate during the first 3 months was low.
Abstract Background The prevalence and overlap of psychotic symptoms among patients with dementia compared to those with delirium superimposed to dementia have received little attention. The aim of ...our study was to investigate the overlapping and distinguishing capability of psychotic symptoms among patients with dementia or with delirium superimposed to dementia, and to clarify their prognostic value. Methods We assessed 255 residents with dementia in nursing homes and acute geriatric wards for psychotic symptoms and delirium. The residents were divided into three groups: those with delirium (Group 1; n = 66), those with psychotic symptoms without delirium (Group 2; n = 74), and without psychotic symptoms or delirium (Group 3; n = 115). Results Of the participants, 30.9% suffered from delusions, 22.1% from visual hallucinations and 14.2% from auditory hallucinations. Delusions occurred more often in Group 2 than in Group 1. Of the subjects in Group 3, 6.5% suffered from misidentifications, whereas the respective figures in Groups 1 and 2 were 17.5% and 20.8%, respectively. Of those suffering from psychotic symptoms ( n = 109), one in three ( n = 35) suffered delirium, and two in three ( n = 74), psychotic symptoms without delirium. In the adjusted Cox proportional hazard model with Group 2 as the referent, we found no difference between the groups in mortality rates (Group 1: HR 0.98, 95% CI: 0.64–1.52 and Group 3: HR 1.49, 95% CI: 0.92–2.42). Conclusions Psychotic symptoms cannot be used to distinguish patients with dementia from those with delirium superimposed to dementia.
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