Introduction
Hospital‐associated deconditioning (HAD) or post‐hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management ...of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions.
Materials and methods
We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as ‘post‐hospitalization syndrome’ or ‘deconditioning’. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality.
Results
From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre‐admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation.
Discussion
In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.
Key points
Many studies have been devoted to HAD in the last decade, with some consistent findings.
Most studies have focused on the physical dimensions of HAD.
Few mechanistic and intervention studies have been conducted.
The cognitive and psychological dimensions of HAD remain understudied.
A consensus definition of HAD and a clear research agenda are needed.
Background
Public health restrictions due to the COVID‐19 (SARS CoV‐2) pandemic have disproportionately affected informal caregivers of people living with long term health conditions. We aimed to ...explore levels of care burden, loneliness, and social isolation among caregivers of people with enduring physical and brain health conditions in English‐speaking regions worldwide, by investigating outcomes before and during the COVID‐19 pandemic.
Methods
A cross‐sectional anonymous online survey data from 2287 English‐speaking caregivers of people with long term health conditions from four English‐speaking regions (UK, Ireland, USA, New Zealand) included measures of care burden, loneliness, and social isolation, reported before and during the COVID‐19 pandemic. Analyses were descriptive, followed by an ordinal regression model for predictors of burden.
Results
Compared to pre‐pandemic levels, all caregivers experienced a significant increase in burden, loneliness, and isolation. Caregivers of people with both brain health and physical conditions were the most burdened and had the highest levels of loneliness and isolation compared to caregivers of people with either a brain health or physical condition only. The increase in care burden among caregivers of people with brain health challenges was associated with caregiver's gender, moderate and severe emotional loneliness, magnitude and frequency of isolation during the pandemic, and care circumstances (cohabitation with the care recipient, restrictions on the ability to provide care).
Conclusions
Health and social care interventions should target caregivers' care circumstances and psychological outcomes, particularly in women, accounting for the significant additional burden of care, loneliness, and isolation resulting from pandemic‐related restrictions.
Key points
This study highlights the significant negative impact that COVID‐19‐related restrictions have had on informal caregivers of people with enduring health conditions in four English speaking regions, globally.
Heightened levels of burden, loneliness, and social isolation occurred during the pandemic compared to pre‐pandemic in caregivers of people with enduring physical and brain health or physical health conditions.
The increase in burden in caregivers of people with brain health conditions was associated with caregiver factors (including gender, emotional loneliness, and increase in social isolation) and pandemic‐related external factors, such as cohabitation with the care recipient and the impact of COVID‐19‐related restrictions on the ability to provide care.
These findings have implications for policy development and healthcare interventions to target care circumstances and psychosocial outcomes of informal caregivers and ensure their equitable access to social support, taking into consideration pandemic‐related changes.
Abstract
Background
Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia ...prevalence has been widely reported in United States, but there are no relevant studies on this topic in low- and middle-income countries.
Methods
In a cross-sectional survey, 2944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia).
Results
The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p = .12) by self-identified race. Mean cognitive scores were similar across racial groups (p = .46). After controlling for age, sex, and education, greater proportion of African ancestry was not associated with cognitive performance (p = .17).
Conclusions
We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health.
Background
Informal caregivers may experience high levels burden. Prior to COVID‐19, loneliness and social isolation, and especially the discordance between them, were recognized for rapid ...aging‐related cognitive decline. The COVID‐19 has significantly increased social isolation and loneliness in caregivers. Thus, we aimed to explore the variables that were associated with higher care burden among all caregivers and only among caregivers for people living with dementia, and whether the increased burden could be associated with a discrepancy between loneliness and social isolation.
Method
‘Comparing Loneliness and Isolation in COVID‐19’ was an online global survey of over 20,000 respondents, including 5243 caregivers across 50 countries with enduring brain or/and physical health conditions. We first used a multilevel modelling to identify risk factors associated with higher burden. Then, we defined profiles of discrepancy between loneliness and social isolation, based on the differences between standardized score on a scale of loneliness and of social connectedness and estimated the association between the discrepancy and higher burden.
Result
In our sample, 74% of caregivers were female, 44% were caring for people with dementia, and 22% for people with multiple conditions, including dementia. The most prevalent age group was 60‐69 years old. Factors significantly associated with higher care burden were being female, having poorer financial situation, worse mental health during the pandemic, caring for people with dementia or intellectual disabilities, caring in the same home, being diagnosed with COVID, and changes of care abilities. 40% of caregivers consistently reported high level of loneliness and social isolation, 38% reported consistent lower levels of both, and two groups reported discordance (low levels of loneliness and high social isolation in 13%; high levels of loneliness and mild social isolation in 12%). The latter group was at the highest risk of self‐reported increased and intense care burden.
Conclusion
This represents the largest, most widespread survey on the impact of the COVID‐19 pandemic on caregivers of people with long‐term conditions to date and reflects the importance of capturing the nuances in the relationship between loneliness and social isolation in caregivers. It will be an important resource for support agencies and to inform policy.
Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio-demographic, health and lifestyle risk factors of incident dementia in Cuban older adults.
Data ...were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, health examinations, and cognitive tests at baseline (2003-2006) and 4.5 years later (2007-2010). Associations between risk factors (baseline) and incident dementia (follow-up) were examined using logistic regression.
Just over 9% of participants developed dementia. Overall, older age and low physical activity were associated with incident dementia. In those 65-74 years of age, depression, stroke and low physical activity were associated with incident dementia. In those ≥75 years of age, low physical activity, never eating fish, and smoking were associated with incident dementia.
Modifiable lifestyle factors play an important role in developing dementia in Cuban older adults. This knowledge opens up opportunities for preventive strategies.
Background
Dementia is a leading global cause of morbidity and mortality. There is evidence that population and community‐based interventions on early diagnosis of Dementia and Cognitive Impairment ...represent around US$10,000 of net savings per person with dementia across the disease course. They also avoid early or unnecessary admission to a care home or hospital and allows patients and their families to receive timely practical information, advice, and support. Only through receiving a diagnosis can they get access to available drug and non‐drug therapies that may improve their cognition and enhance their quality of life. This study aim is to identify existing evidence concerning the cost of implementing interventions strategies for the early diagnosis of Dementia and Cognitive Impairment from primary Care.
Methods
We systematically reviewed economic studies of community‐based interventions for diagnosing Dementia and Cognitive impairment from primary care. Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus were searched on 05/09/2022. Cost‐effectiveness, cost‐benefit, and cost‐utility studies were included, provided that the direct outcome of the intervention was the diagnosis of Dementia or Cognitive Impairment and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed.
Results
We included 45 studies, from 2,749 records offering economic evidence on dementia diagnosis. Most of the reviewed studies were cost‐effectiveness analysis (n = 15 34.4%) followed by cost‐utility analysis (n = 8 19.6%). Among 20,330 patients screened, 9555 scored positive for Dementia (47%), 33% had cognitive impairment (CI), and 20% were considered to have no cognitive deficit. The prevalence of dementia was 6.0% (95%CI: 4.8%‐7.3%) and the mean of interventions strategies cost was $120 (95%CI: $112‐$136) per patient screened for dementia and $3798 (95%CI: $3702‐$3823) per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record. Most studies (56.1%) didn’t meet the methodological requirements contained in the quality assessment framework.
Conclusions
Overall, interventions were cost‐effective and/or cost‐saving. However, there is a scarcity and low methodological quality of existing studies and the generalization from the available evidence is difficult because of the narrowness of cost measures in the literature.
•Financial constraints during austerity had significant negative impact on workforce, governance.•Increased funding enabled Ireland to expand access to care during Covid-19.•Financial resources ...empowered leaders to purchase flexibility and adapt effectively to pandemic.•Policy makers can utilise shocks as opportunities to support health system resilience.•Health system leaders can use shocks as catalysts for implementing long-term reforms.
This paper contrasts the Irish experience of the 2008 economic crisis and the Covid-19 pandemic, and the health system responses to these shocks, from the perspective of health system leaders working across both time periods. Based on semi-structured interviews with seven senior national and international officials, the research presented here forms the qualitative component of RESTORE, a five-year research project examining health system resilience and reform, funded through the Health Research Board's Research Leader Award in Ireland. Findings indicate that the financial crisis deeply impacted the Irish health system in relation to infrastructure and capacity, service delivery and workforce. Due to these legacy issues, Ireland's health system was in a relatively weak position when faced with the Covid-19 pandemic but the system proved adaptive and innovative during this time. Furthermore, the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding, a devolution in decision-making structures and a political commitment to the health system. Exploring lessons from the Irish response to these crises provides a case study for developing appropriate policy responses around financing and resource allocation, fostering support for healthcare among political leaders and policy makers, and preparing for future shocks. Furthermore, examining these experiences facilitates understanding around the impact of each crisis on the health system, exploring options for addressing legacy issues and considering practical steps to improve health system performance.
•COVID-19 has highlighted the importance of health system resilience.•Across the health system functions, metrics around financing receive the least attention.•Limited progress made with developing ...standardized qualitative metrics particularly around governance.•Few studies have really assessed the legacy or enduring impact of shocks.•Quantitative metrics of resilience need to be assessed against the severity and dynamics of shocks.
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
Background
Dementia not only affects the person diagnosed, but also their family and wider support network. Care partners are often unpaid and untrained. They face financial, social, and ...psychological stressors that impact their health and wellbeing and may ultimately affect the quality of care. Easy and timely access to information, training, services, social and financial support throughout a caring trajectory are vital elements of a holistic support system. This study aims to assess dementia‐specific support and services in different countries and healthcare settings and map those against the needs of care partners.
Methods
An exploratory analysis of publicly available information on dementia‐specific support and services in six countries conveniently sampled, including Belgium, the Democratic Republic of Congo, France, Ireland, Israel, and the UK. A descriptive analysis of the data was performed by the number and type of services, sector, and accessibility. Support and services were subsequently mapped against the taxonomy of needs of care partners of people with dementia identified from the literature.
Results
Preliminary results revealed that all selected countries except the Democratic Republic of Congo exhibited publicly accessible information on dementia‐specific support and services available in the capital, main cities, and rural areas. The public and NGO were the most prevalent sector providing the support. Depth, detail, and location of information on available services varied across countries, in some instances requiring visits to multiple governmental, public sector or quasi‐public sector sites. Final results will be presented at AAIC 2023.
Conclusion
Unmet needs are not just an individual issue, but a phenomenon linked to social and economic disadvantage and societal inequality. The creation and implementation of means to deliver multisectoral care, support and services for carer partners of people with dementia to meet their unique needs and prevent a decline in physical and mental health and social wellbeing is warranted irrespective of the healthcare setting, but particularly so in low‐ and middle‐income settings.
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