Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain ...multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries.
We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity.
Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression).
A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.
Objectives
To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs).
Design
Nationally ...representative, cross‐sectional, community‐based study.
Setting
Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health.
Participants
Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female).
Measurements
The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI.
Results
The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1–51.5%) and of MCI was 15.3% (95% CI=14.4–16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03–1.42; ≥4 conditions: OR=2.07, 95% CI=1.70–2.52).
Conclusion
These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs.
Perceived stress may be a modifiable risk factor for mild cognitive impairment (MCI) and ultimately dementia, but studies on this topic from low- and middle-income countries (LMICs) are lacking.
We ...assessed the association between perceived stress and MCI in six LMICs (China, Ghana, India, Mexico, Russia, and South Africa) using nationally representative data.
Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. A perceived stress score (range 0 lowest stress to 10 highest stress) was computed based on two questions from the Perceived Stress Scale. Multivariable logistic regression analysis was conducted to assess the as-sociation between perceived stress and MCI.
The mean (SD) age of the 32,715 participants was 62.1 (15.6) years and 51.7% were females. After adjustment for potential confounders including depression, in the overall sample, a one-unit increase in the perceived stress score was associated with a 1.14 (95% CI = 1.11-1.18) times higher odds for MCI. The association was similar among those aged 50-64 and ≥65 years. Countrywise analysis showed that there was a moderate level of between-country heterogeneity in this association (I2 = 59.4%), with the strongest association observed in Russia (OR = 1.33, 95% CI = 1.15-1.55).
If our study results are confirmed in prospective studies, addressing perceived stress may have an impact in reducing the risk for MCI and subsequent dementia in LMICs.
To determine whether the effect of multimorbidity on time to mortality is modified by level of social support and loneliness in a representative sample of 2113 participants aged 60+.
Vital status was ...ascertained through national registers or by asking participants' relatives. Baseline variables included number of illnesses, self-perceived social support (Oslo social support scale) and loneliness (UCLA loneliness scale). Kaplan-Meier survival curves were used to estimate the time to death by multimorbidity, social support and loneliness. Adjusted cox proportional hazards regression models were conducted to explore interactions between multimorbidity and social support and loneliness.
Multimorbidity was associated with low probability of survival, whereas high loneliness and low social support were not related with time to death. Only the interaction multimorbidity∗social support was significant. Participants with low social support and 2 chronic diseases, compared with none, presented lower probability of survival (HR=2.43, 95%CI=1.14–5.18, p<0.05), whereas the effect of multimorbidity, in comparison with not having chronic conditions, did not affect mortality if participants had high social support. For participants with low social support, there were no differences between having one, two or more than two diseases. When there is high social support, the probability of death is significantly lower if one or two chronic diseases are present, compared with more than two.
These findings indicate that having a supportive social environment increases the survival of people with physical illnesses, especially those with one or two. For those with more than two illnesses, survival remains unchanged regardless of the level of social support and other protective factors should be explored in future research. Geriatric health professionals are encouraged to evaluate social relationships and stimulate support given by relatives, friends or neighbors.
•Multimorbidity decreased survival in a representative sample of older adults.•High social support buffered the negative effect of multimorbidity on survival.•Loneliness did not affect survival, nor did it moderate the effect of multimorbidity.
We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview ...conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.
There are no studies on the association between food insecurity and mild cognitive impairment (MCI). Thus, cross-sectional, community-based data on individuals aged ≥50 years from the World Health ...Organization's Study on Global AGEing and Adult Health (SAGE) conducted in South Africa (2007⁻2008) were analyzed to assess this association. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The sample consisted of 3,672 individuals aged ≥50 years mean (SD) age 61.4 (18.3); 56% females. The prevalence of MCI was 8.5%, while 11.0% and 20.8% experienced moderate and severe food insecurity, respectively. After adjustment for potential confounders, moderate and severe food insecurity were associated with 2.82 (95%CI = 1.65⁻4.84) and 2.51 (95%CI = 1.63⁻3.87) times higher odds for MCI compared with no food insecurity, respectively. The OR for those aged ≥65 years with severe food insecurity was particularly high (OR = 3.87; 95%CI = 2.20⁻6.81). In conclusion, food insecurity was strongly associated with MCI among South African older adults. Future longitudinal research is required to assess whether addressing food insecurity may reduce risk of MCI and subsequent dementia.
The aims of this study were to analyze whether positive and negative affect, social support, and loneliness are factors longitudinally related to suicide ideation in the general population in ...different age groups. A total of 2,392 individuals from a nationally representative sample of the Spanish general population were evaluated in 2011–2012 and in 2014–2015. After including relevant control variables in the analyses, lower positive affect was prospectively related to ideation in 18‐ to 59‐year‐old individuals, whereas feelings of loneliness were related to ideation in 60‐year‐and‐older individuals. Social support was not associated with suicide ideation in any age group. These results are in line with the need for age‐tailored suicide prevention programs. The present findings might also suggest that health care professionals should consider feelings of loneliness rather than social support to assess the presence of suicide ideation in older people.
Socio-relational aspects are essential for mental wellbeing (MWB), especially in the oldest old age. Our study aims to explore the socio-relational aspects related to MWB in accordance with the ...experiences of the oldest old of four European countries; and to examine how these differ between Mediterranean and Nordic people. A total of 117 participants aged 80+ years old were recruited, and 23 focus groups were performed. Qualitative content analysis identified five main themes. Family seemed to be the most important driver of the MWB of the oldest old, followed by relationships with close friends. Participants felt better when they had a sense of being needed, cared for, and connected. Loneliness and isolation negatively affected MWB, although solitude was appreciated. Differences appeared between Mediterranean and Nordic regions. Initiatives to promote positive interactions with family and friends, as well as social activities within the community, may contribute to strengthening MWB in the oldest old.
Working memory (WM) refers to the capacity system for temporary storage and processing of information, which is known to depend on the integrity of the prefrontal cortex. Impairment in working memory ...is a core cognitive deficit among individuals with psychotic disorders. The Corsi block-tapping test is a widely-used instrument to assess visuospatial working memory. The traditional version is composed of 9 square blocks positioned on a physical board. In recent years, the number of digital instruments has increased significantly; several advantages might derive from the use of a digital version of the Corsi test.
This study aimed to compare the digital and traditional versions of the Corsi test in 45 patients with psychotic disorders and 45 healthy controls. Both groups completed a neuropsychological assessment involving attention and working memory divided into the two conditions.
Results were consistent between the traditional and digital versions of the Corsi test. The digital version, as well as the traditional version, can discriminate between patients with psychosis and healthy controls. Overall, patients performed worse with respect to the healthy comparison group. The traditional Corsi test was positively related to intelligence and verbal working memory, probably due to a more significant effort to execute the test.
The digital Corsi might be used to enhance clinical practice diagnosis and treatment.The digital version can be administered in a natural environment in real-time. Further, it is easy to administer while ensuring a standard procedure.
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