Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States

Zang, Emma; Guo, Anna; Pao, Christina; Lu, Nancy; Wu, Bei; Fried, Terri R.

doi:10.1177/08982643211060948

Cited by 3 publications

(4 citation statements)

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“…For example, despite comparable average levels across time, Group 2 (“high start, convex”) had higher mortality risks than Group 3 (“low start, concave”). The convex [ 21 , 39 ] and concave [ 21 , 40 , 41 ] shapes of general health status trajectories have also been found in previous studies examining populations not specific to PCIs. For example, a study reported two distinctly-shaped convex trajectories of self-rated health [ 41 ].…”

Section: Discussionsupporting

confidence: 68%

“…Number of siblings, number of children, and comorbidity were measured as continuous variables. Using these, we constructed categorical variables to capture potential nonlinear relationships between them the mortality, based on their distributions in our sample and previous studies [ 33 ]. These covariates were time-constant and were measured at baseline.…”

Section: Methodsmentioning

confidence: 99%

“…We applied GBTMs to identify distinct trajectory groups among PCIs and classify PCIs into these groups, assuming that there exist multiple latent subgroups with distinct trajectories within the PCI population [ 34 ]. Consistent with prior studies, we used the first observed cognitive impairment diagnosis in our data as the baseline, with years since first observed diagnosis as the time variable [ 21 ]. Based on the distributions of the general health status and physical functioning variables in our data (see Additional file 1 : Figure S2), we modeled general health status using a censored normal distribution and physical functioning using a zero-inflated Poisson distribution.…”

Section: Methodsmentioning

confidence: 99%

“…It is important to study this topic especially among PCIs because health trajectories may be more complex in this population compared to the general aging population. For example, there is substantial heterogeneity in trajectories of general health status among PCIs and declines in general health status are more common in this population compared to the general aging population in the U.S. [ 21 , 22 ]. The substantially heterogeneous health trajectories may lead to substantially different mortality risks.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment

et al. 2022

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Background The concern posed by the confluence of aging and cognitive impairment is growing in importance as the U.S. population rapidly ages. As such, we sought to examine the predictive power of physical functioning (PF) and general health status (GHS) trajectories on mortality outcomes among persons with cognitive impairment (PCIs). Methods We used group-based trajectory models to identify latent group memberships for PF trajectories in 1,641 PCIs and GHS trajectories in 2,021 PCIs from the National Health and Aging Trends Survey (2011–2018) and applied logistic regressions to predict mortality using these memberships controlling for individual characteristics. Results We identified six trajectory groups for PF and four groups for GHS. Trajectory group memberships for both outcomes significantly predicted mortality. For PF, group memberships largely captured the average levels over time, and worse trajectories (i.e., lower baselines and faster declines) were associated with higher odds of death. The highest mortality risk was associated with the group experiencing a sharp decline early in its PF trajectory, although its average level across time was not the lowest. For GHS, we observed two groups with comparable average levels across time, but the one with a convex-shape trajectory had much higher mortality risks compared to the one with a concave-shape trajectory. Conclusions Our findings highlighted that health trajectories predicted mortality among PCIs, not only because of general levels but also because of the shapes of declines. Close monitoring health deterioration of PCIs is crucial to understand the health burden of this population and to make subsequent actions.

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Section: Discussionsupporting

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment

et al. 2022

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Association Between Cognitive Trajectories and Subsequent Health Status, Depressive Symptoms, and Mortality Among Older Adults in the United States: Findings From a Nationally Representative Study

Zang,

Zhang,

Wang

et al. 2024

The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences

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Background Cognitive decline may be an early indicator of major health issues in older adults, though research using population-based data is lacking. Our objective was to assess the relationships between distinct cognitive trajectories and subsequent health outcomes, including health status, depressive symptoms, and mortality, using a nationally representative cohort. Methods Data were drawn from the National Health and Aging Trends Study. Global cognition was assessed annually between 2011 and 2018. The health status of 4,413 people, depressive symptoms in 4,342 individuals, and deaths among 5,955 living respondents were measured in 2019. Distinct cognitive trajectory groups were identified using an innovative Bayesian group-based trajectory model. Ordinal logistic, Poisson, and logistic regression models were used to examine the associations between cognitive trajectories and subsequent health outcomes. Results We identified five cognitive trajectory groups with distinct baseline values and subsequent changes in cognitive function. Compared to the group with stably high cognitive function, worse cognitive trajectories (i.e., lower baseline values and sharper declines) were associated with higher risks of poor health status, depressive symptoms and mortality, even after adjusting for relevant covariates. Conclusion Among older adults, worse cognitive trajectories are strongly associated with subsequent poor health status, high depressive symptoms, and high mortality risks. Regular screening of cognitive function may help to facilitate early identification and interventions for older adults susceptible to adverse health outcomes.

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Care Partners’ Engagement in Preventing Falls for Community-Dwelling Older People With Dementia

Zhou,

Berridge,

Hooyman

et al. 2024

The Gerontologist

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Background and Objectives Little is known about how to prevent falls in community-dwelling older people with dementia. Although their care partners adopt various behaviors to prevent their falls, it is unclear if these behaviors reduce falls for those with different levels of fall risk. Research Design and Methods Linking the 2015 and 2016 National Health and Aging Trends Study (NHATS) and the 2015 National Study of Caregiving (NSOC), we identified 390 community-dwelling older people with dementia with 607 care partners. We selected 26 NSOC items representing fall risk management (FRM) behaviors. We examined the prevalence and dimensionality of these behaviors and investigated associations between care partners’ behaviors in 2015 (T1) and older people’s falls in 2016 (T2) stratified by their fall incidence at T1, adjusting for covariates. Results Five domains of FRM were identified: mobility and safety assistance, medical service coordination, health management, social service coordination, and accommodation. For those who did not fall at T1, mobility and safety assistance and social service coordination were each associated with an increased risk of falling at T2 (adjusted incidence rate ratio [aIRR]=1.39, 95% confidence interval [CI]=1.06-1.83, p=0.019, aIRR=1.25, 95% CI=1.01-1.55, p=0.043). For those who had fallen at T1, social service coordination was associated with a decreased risk of falling at T2 (aIRR=0.83, 95% CI=0.73-0.94, p=0.004). Discussion and Implications The different impacts of dementia care partners' FRM behaviors emphasize the need to address specific behaviors when involving care partners in preventing falls for older people with dementia at varying levels of fall risk.

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Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States

Cited by 3 publications

References 50 publications

Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment

Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment

Association Between Cognitive Trajectories and Subsequent Health Status, Depressive Symptoms, and Mortality Among Older Adults in the United States: Findings From a Nationally Representative Study

Care Partners’ Engagement in Preventing Falls for Community-Dwelling Older People With Dementia

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