Older adults enjoyed the ATA. This opens doors to user-friendly technological interventions that may be effective in assisting older adults maintain and possibly even improve their cognitive function.
Objective
Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined.
Design
Secondary analysis of data from an on-going randomized clinical trial.
Setting
Eight SNFs located in central and northeast Pennsylvania.
Participants
One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%).
Measurements
Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge.
Results
On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up.
Conclusion
Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs
Objectives
We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure.
Design
In this secondary analysis we used control group data from an ongoing randomized clinical trial.
Setting/Participants
Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (± 6.83) years; 67.6% were female; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele.
Measures
We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; Confusion Assessment Method; and Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale.
Results
Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel Index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition.
Conclusion
For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function and greater length of stay during rehabilitation.
Subjective cognitive impairment (SCI) refers to an individual's everyday concerns related to cognitive functioning, which can exist even in the absence of objectively assessed impairment. SCI is common among older adults, and although symptoms may be mild, SCI is associated with subsequent cognitive decline as well as significant negative effects on everyday functional ability, mood, and social engagement. Despite the potential consequences, SCI is often underreported and undetected. Thus, it is critical to consider assessing for SCI among older adults to determine cognitive impairment risk and support early intervention to promote functional well-being and health management. The current article reviews factors related to SCI, evaluates existing methods for the assessment of SCI, and proposes a person-centered framework for enhancing assessment. Application of the framework is further illustrated through the use of clinical examples.
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