Perceived Social Determinants of Health Among Older, Rural-Dwelling Adults with Early-Stage Cognitive Impairment

Mattos, Meghan; Burke, Lora E.; Baernholdt, Marianne; Hu, Lu; Nilsen, Marci Lee; Lingler, Jennifer H.

doi:10.1177/1471301217694250

Cited by 12 publications

(21 citation statements)

References 26 publications

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“…Many studies highlighted lack of knowledge [52, 57, 60, 65-67, 71, 74, 81, 84-86, 88, 89, 91, 92] and some described it as "the main barrier for behavioural change" [60], including more recent studies [67,84,86]. Participants reported awareness of the general concept of dementia risk reduction [ [81].…”

Section: Plos Onementioning

confidence: 99%

“…Participant descriptions of specific behavioural requirements often suggested influence from personal or cultural identity, lifestyles and values [45, 49, 51-53, 57, 59, 60, 65-67, 71, 74, 81, 85]. Prominent examples included ascribing a protective value to "home-made and homegrown foods" [45], "exercising the spirit" [57] or "rural lifestyles" [49,51,52,60,66,67,71,74,81]. Some believed that they were already living "healthy lifestyles" that would reduce dementia risk and consequently did not need dementia risk reduction information because they "knew it already".…”

Section: Plos Onementioning

confidence: 99%

“…Dementia was highly feared across studies and lower dementia risk was correspondingly valued highly, particularly in carers, participants with MCI/SCD and people with a family history of dementia [44, 50, 58-60, 62, 67, 69, 74, 83]. Participant accounts attributed value to preserving "what matters in everyday life" [79], including optimising general function, quality of life, relationships, identity and independence; and minimising burdens on families and society [45,46,59,67,76,77,79,84,87]. A few participants, however, failed to value lower dementia risk [47,63,64,74,84,89] and some studies linked this to "a reduced sense of value for older citizens in society and dulled expectations" [47,89].…”

Section: Plos Onementioning

confidence: 99%

“…Participant valuations of lower dementia risk were often closely linked to stances regarding the plausibility and effectiveness of adopting dementia risk reduction behaviour patterns [45-47, 55, 64, 66, 69, 74, 75, 81, 84]. Beliefs that dementia risk reduction related behaviour patterns were "important" [67] were "frequent" or "striking" in some studies [45,80], although participants commonly and mistakenly assumed dementia risk reduction would ensure 'prevention': "if you take care of yourself, you are going to be okay, and if you don't, you won't" [80]. Participants were less emphatic in valuing lower dementia risk when aware that outcomes were probability-based, such as those who "voiced concern that efforts to reduce risk might be ineffective" [61,84].…”

Section: Plos Onementioning

confidence: 99%

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General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

et al. 2021

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Background Evidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population’s perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts. Methods and findings We searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data. Conclusions This systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.

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Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

See 2 more Smart Citations

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

et al. 2021

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“…Nine semi-structured interviews with participant-care partner dyads were conducted in participant’s homes. Details of the parent study have been described previously (Mattos, Burke, Baernholdt, Hu & Lingler, 2017). Briefly, a 14-question interview guide guided interviews, and there was one question that asked members of the dyad about their last SRC visit, with follow-up probes that encouraged participants to describe feelings and events during the visit.…”

Section: Methodsmentioning

confidence: 99%

Experiences Surrounding an Early-Stage Cognitive Diagnosis in Rural-Dwelling Older Adults

Mattos¹,

Nilsen²,

Lingler³

2018

Research in Gerontological Nursing

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Misdiagnosis, lack of specialists, and patient dismissal of symptoms can contribute to delayed detection of early cognitive impairment. Understanding patient perspectives during and around time of cognitive diagnosis is crucial, as reactions to diagnosis can impact disease management and overall health. The current study conducted semi-structured interviews to explore the experiences of rural-dwelling older adults (n = 9) and their caregivers (n = 10) surrounding diagnosis of mild cognitive impairment or early-stage Alzheimer's disease at a specialty research center (SRC). Content analysis was performed. Overall, researchers found that older adult participants experienced various cognitive symptoms pre-diagnosis and dyads experienced diagnostic uncertainty prior to the SRC visit. All individuals displayed a range of reactive and information-seeking actions. Nurses play significant roles in the diagnostic and post-diagnostic periods for patients with early-stage cognitive impairment, and clinical diagnostic expertise, appropriate and timely direction of resources, and identification and targeting of early interventions to promote cognitive health are particularly important to this underserved population. [Res Gerontol Nurs. 2018; 11(4):181-189.].

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Social determinants of health and cognitive performance of older adults living in rural communities: The Three Villages Study

Brutto

Mera

Rumbea

et al. 2022

Int J Geriat Psychiatry

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Objectives There is limited information on factors associated with poor cognitive performance in rural settings of Low‐ and Middle‐Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador. Methods Atahualpa, El Tambo and Prosperidad residents aged ≥60 years received measurement of SDH by means of the Gijon Scale together with a Montreal Cognitive Assessment (MoCA). The association between SDH and cognitive performance (dependent variable) was assessed by generalized linear models, adjusted for demographics, years of education, cardiovascular risk factors, symptoms of depression and biomarkers of structural brain damage. Results We included 513 individuals (mean age: 67.9 ± 7.3 years; 58% women). The mean score on the Gijon scale was 9.9 ± 2.9 points, with 237 subjects classified as having a high social risk (≥10 points). The mean MoCA score was 19.6 ± 5.4 points. Locally weighted scatterplot smoothing showed an inverse linear relationship between SDH and MoCA scores. SDH and MoCA scores were inversely associated in linear models adjusted for clinical covariates (β: −0.17; 95% C.I.: −0.32 to −0.02; p = 0.020), neuroimaging covariates (β: −0.17; 95% C.I.: −0.31 to −0.03; p = 0.018), as well as in the most parsimonious model (β: −0.16; 95% C.I.: −1.30 to −0.02; p = 0.026). Conclusions Study results provide robust evidence of an inverse association between SDH and cognitive performance. Interventions and programs aimed to reduce disparities in the social risk of older adults living in underserved rural populations may improve cognitive performance in these individuals.

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Perceived Social Determinants of Health Among Older, Rural-Dwelling Adults with Early-Stage Cognitive Impairment

Cited by 12 publications

References 26 publications

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

Experiences Surrounding an Early-Stage Cognitive Diagnosis in Rural-Dwelling Older Adults

Social determinants of health and cognitive performance of older adults living in rural communities: The Three Villages Study

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