The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to ...health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada.
Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only VI, hearing only HI), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments.
The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group.
The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.
Verb and action knowledge deficits are reported in persons with Parkinson's disease (PD), even in the absence of dementia or mild cognitive impairment. However, the impact of these deficits on ...combinatorial semantic processing is less well understood. Following on previous verb and action knowledge findings, we tested the hypothesis that PD impairs the ability to integrate event-based thematic fit information during online sentence processing. Specifically, we anticipated persons with PD with age-typical cognitive abilities would perform more poorly than healthy controls during a visual world paradigm task requiring participants to predict a target object constrained by the thematic fit of the agent-verb combination. Twenty-four PD and 24 healthy age-matched participants completed comprehensive neuropsychological assessments. We recorded participants' eye movements as they heard predictive sentences (The fisherman rocks the boat) alongside target, agent-related, verb-related, and unrelated images. We tested effects of group (PD/control) on gaze using growth curve models. There were no significant differences between PD and control participants, suggesting that PD participants successfully and rapidly use combinatory thematic fit information to predict upcoming language. Baseline sentences with no predictive information (e.g., Look at the drum) confirmed that groups showed equivalent sentence processing and eye movement patterns. Additionally, we conducted an exploratory analysis contrasting PD and controls' performance on low-motion-content versus high-motion-content verbs. This analysis revealed fewer predictive fixations in high-motion sentences only for healthy older adults. PD participants may adapt to their disease by relying on spared, non-action-simulation-based language processing mechanisms, although this conclusion is speculative, as the analyses of high- vs. low-motion items was highly limited by the study design. These findings provide novel evidence that individuals with PD match healthy adults in their ability to use verb meaning to predict upcoming nouns despite previous findings of verb semantic impairment in PD across a variety of tasks.
There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially ...given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi‐structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person‐centered; (2) provided by PSW with dementia‐specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia‐specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front‐line workers’ perspectives and how they can help revise current healthcare policies and inform future policy development.
Executive function deficit is an indicator of Alzheimer's-type dementia and manifests as disruptions of attentional control, memory, cognitive flexibility, planning, and reasoning, among other ...cognitive problems. Physical exercise is suggested to have a protective effect on global cognition with aging. However, whether it influences executive function in people living with Alzheimer's-type dementia specifically is unknown. The current systematic review examined the efficacy of physical exercise on executive function performance in community-dwelling older adults living with Alzheimer's-type dementia. An electronic search of databases retrieved randomized and non-randomized controlled trials of community-dwelling older adults diagnosed with Alzheimer's-type dementia who completed a physical exercise intervention and who were assessed using an executive function outcome measure. Methodological quality of six studies meeting the inclusion criteria published between 2009 and 2016 was scored independently by two raters using the Physiotherapy Evidence Database and a Cochrane informed domain-based assessment of risk of bias. Trends toward improvement in executive function scores were seen across all six studies, and significant improvement was seen in four of the eligible studies. Future studies should explore the benefits of the American College of Sports Medicine recommended 150 min of physical exercise per week with select measures of executive function.
Sex-related differences in changes in functional fitness over time were longitudinally assessed in older adults participating in a group-based multimodal exercise program. From a database, functional ...fitness scores were obtained for 89 older adults (71.6 ± 6.5 years old) who had completed two assessments, 5-8 years apart. Lower body strength, upper body strength, aerobic endurance, flexibility, and change of direction performances were compared over time and with normative values. Females (p = .02), but not males, had an improvement in upper body strength over time. Females were also more flexible than males at both assessments (p ≤ .02). Of those who had five consecutive assessments, females were more flexible than males (p ≤ .05) and had a faster change of direction ability (p < .001). When compared with normative values, our results indicate that typical time-related functional fitness loss can be attenuated with group exercise. Our results further support the need to tailor exercise prescription according to the individual.
To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS).
Retrospective, population-based, ...cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots.
We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration.
The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.
Background
Discussions concerning health care teams and patient‐related terminology remain an ongoing debate. Terms such as interdisciplinary, multidisciplinary and transdisciplinary, as well as ...interprofessional are ambiguously defined and frequently used, rightly or wrongly, interchangeably. Also, clarification on the terminology regarding patients is rarely explicitly addressed in the health care team’s literature, potentially resulting in confusion among health professional students, novice researchers, and practitioners.
Methods
A structured literature review was conducted. Electronic searches were performed from August 2018 to September 2019 on the following databases: CINHAL, Scopus, Science Direct, PubMed, Nursing and Allied Health and JSTOR. The following terms were used: ‘terminology’, ‘team(s)’, ‘nursing’, ‘health’, ‘medical’, ‘education’, ‘interprofessional’, ‘interdisciplinary’, ‘multidisciplinary’, ‘transdisciplinary’, ‘collaboration’, ‘patient’, ‘client’, ‘customer’, ‘user’ and ‘person’.
Results
Small but significant nuances in the use of language and its implications for patient care can be made visible for health professional education and clinical practice. Healthcare is necessarily interdisciplinary and therefore we are obligated, and privileged, to think more critically about the use of terminology to ensure we are supporting high‐quality evidence and knowledge application.
Conclusion
To avoid confusion and lack of consistency in the peer‐review literature, authors should be encouraged to offer brief definitions and the rationale for the use of a particular term or group of term. In addition, a deeper understanding of the values that each patient‐related term represents for particular disciplines or health care professions is essential to achieve a more comprehensive conceptual rigour.
Theories of grounded cognition emphasize the role of the motor system in the processing of action concepts. The present study investigated whether persons with Parkinson disease (PD) who have greater ...upper versus greater lower limb motor impairments show different patterns of performance when processing action verbs. PD patients and controls made action decisions on upper-limb (reach), lower-limb (kick), and psych verbs (think). The primary result was an interaction between PD motor dominance (PD upper vs lower limb motor impairments) and verb type (upper- vs lower-limb verbs). PD patients with greater upper limb impairments took longer to respond to upper-limb than to lower-limb verbs, whereas those with greater lower limb impairments performed similarly on the two verb types. Our results add to recent studies and theories that highlight the complexity of verb impairments in PD, semantic task effects, effector-specific sensorimotor cortex engagement, and fine-grained semantic features and their possible interactions with effector-specific impairments.
•First review to comprehensively represent multiple racialized groups while exploring dementia-related stigma.•Certain racialized groups associate dementia with other diseases.•There is significant ...shame and embarrassment associated with dementia, particularly in relation to family and household reputation.•Stigmatizing perceptions of dementia among racialized groups are profoundly rooted in religion and cultural beliefs.•Stigmatizing perceptions of dementia among racialized groups impact a delay in diagnosis, treatment, and participation in support programs.
A prominent gap exists in understanding stigma among racialized persons living with dementia, care partners, and community. A scoping review was conducted to explore stigmatizing perceptions of dementia among racialized groups living in Anglosphere countries. Eligible studies focused on dementia and stigma, and reported data on racialized groups (i.e., Black, Hispanic, South Asian, East Asian, Middle Eastern) living in Anglosphere countries (i.e., Canada, United States, United Kingdom, Ireland, Australia, New Zealand). All publication dates were included. Eligible studies were published in English. Scopus, CINAHL, PubMed, PsycINFO, Medline(Ovid), EMBASE databases were searched in November 2022. Data extraction and thematic analysis was performed on eligible studies using Corrigan's Model of Stigma. Themes were categorized into stereotypes, prejudices, and discrimination. Thirty-six studies were included. Themes aligning with stereotypes included derogatory and unpredictable labels, religious beliefs and mysticism toward dementia, and associating dementia with other diseases. Themes aligning with prejudices included shame or embarrassment of dementia. Themes aligning with discrimination included discouragement in help-seeking and isolation, and lack of social acceptance. Stigmatizing perceptions of dementia among racialized communities may delay diagnosis, treatment, and participation in support programs. Future studies must aim to educate and promote dementia awareness among racialized groups.
As large research initiatives designed to generate big data on clinical cohorts become more common, there is an increasing need to establish standard quality assurance (QA; preventing errors) and ...quality control (QC; identifying and correcting errors) procedures for critical outcome measures. The present article describes the QA and QC approach developed and implemented for the neuropsychology data collected as part of the Ontario Neurodegenerative Disease Research Initiative study. We report on the efficacy of our approach and provide data quality metrics. Our findings demonstrate that even with a comprehensive QA protocol, the proportion of data errors still can be high. Additionally, we show that several widely used neuropsychological measures are particularly susceptible to error. These findings highlight the need for large research programs to put into place active, comprehensive, and separate QA and QC procedures before, during, and after protocol deployment. Detailed recommendations and considerations for future studies are provided.
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