Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults

Lovett, Rebecca M.; Benavente, Julia Yoshino; Opsasnick, Lauren; Weiner‐Light, Sophia; Curtis, Laura M.; Wolf, Michael S.

doi:10.1177/07334648231166289

Cited by 3 publications

(2 citation statements)

References 50 publications

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“…This suggests that lower cognitive function, even outside of an actual diagnosis of ADRD, may result in older adults being underserved, due to reduced capacity to communicate or identify their symptoms or health care needs. Declines in cognitive functioning may also be associated with an inability to overcome other barriers, such as the availability of nearby providers to serve them, transportation resources and travel time, information and help seeking related to health, and understanding affordability and navigating health insurance (Lovett et al, 2023;Walsh et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Du,

Katz,

Shrestha

et al. 2024

J Appl Gerontol

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Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample ( n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care.

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Section: Discussionmentioning

confidence: 99%

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Du,

Katz,

Shrestha

et al. 2024

J Appl Gerontol

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“… 22 However, individuals with cognitive impairment, including those with COPD, may encounter barriers that hinder their ability to access appropriate care. 25 …”

Section: Introductionmentioning

confidence: 99%

Factors influencing patient-provider communication about subjective cognitive decline in people with COPD: Insights from a national survey

Stellefson,

Wang,

Campbell

2024

Chron Respir Dis

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Objective: While there is a growing body of evidence indicating a relationship between COPD and cognitive impairment, there is a gap in evidence regarding discussions of cognitive symptoms in healthcare settings. This study investigated the extent to which individuals with Chronic Obstructive Pulmonary Disease (COPD) and Subjective Cognitive Decline (SCD) self-reported confusion or memory loss with healthcare professionals. Methods: A secondary analysis of 2019 BRFSS data of US adults aged 45+ with COPD ( N = 107,204), using logistic regression to explore associations between socio-demographic and health-related indicators with discussion of cognitive symptoms with healthcare professionals. Results: Less than half (45.88%) of individuals reporting SCD discussed their cognitive symptoms with their healthcare provider. In the adjusted model, unemployed (AOR = 2.92, 95% CI: 1.70-5.02, p < .005), retired (AOR = 3.16, 95% CI: 1.37-7.30, p < .01), and current smokers (AOR = 1.73, 95% CI: 1.02-2.93, p < .05) were more likely to discuss cognitive decline with a healthcare professional than their counterparts. In contrast, males (AOR = 0.53, 95% CI: 0.32-0.86, p < .05) and binge drinkers (AOR = 0.49, 95% CI: 0.30-0.79, p < .01) were significantly less likely to do so when compared to their counterparts. Discussion: The study highlighted significant disparities in the likelihood of individuals with COPD discussing cognitive symptoms based on socio-demographic and health risk behaviors. Conclusion: Addressing gender disparities, occupational status, and personal health risks is crucial for improving patient-provider communication about SCD among adults with COPD.

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Subtypes of Older Adults Starting Long-Term Care in Japan: Unsupervised Machine Learning Approach

Hamasaki,

Iwagami,

Komiyama

et al. 2024

Preprint

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ObjectivesThe older population requiring long-term care (LTC) exhibits heterogeneity in physical and cognitive functions; however, an established classification is lacking. We aimed to identify distinct subgroups of older adults with LTC needs using unsupervised machine learning and to examine differences in their prognoses.DesignRetrospective cohort study.Setting and participantsUsing survey data for care-need certification (linked to LTC and medical insurance claims) in City A, Japan, we identified community-dwelling adults aged ≥ 65 years who started LTC. Data from City B were used for validation of clustering.MethodsWe applied latent class analysis to group the participants in City A, based on all 74 items (38 on physical functions, 9 on cognitive functions, 15 on behavioral problems, and 12 on medical procedures) in the Japanese standardized care-needs certification survey. Then, we examined the association between the identified subtypes and four outcomes, including death, hospitalization, nursing home admission, and care-need level deterioration, using regression models.ResultsAmong 3,841 participants in City A (median age, 83 years; 59.3% female), five subtypes were identified: (i) mild physical, (ii) mild cognitive, (iii) moderate physical, (iv) moderate multicomponent, and (v) severe multicomponent. The results of clustering were replicated in City B. Compared with the mild physical subtype, the severe multicomponent subtype showed the highest risk of death (adjusted hazard ratio [aHR] 2.56; 95% confidence interval [CI] 2.02–3.24), and nursing home admission (aHR 5.91; 95% CI 4.57–7.63). The moderate physical subtype showed a higher risk of hospitalization (aHR 1.32; 95% CI 1.16–1.49), and the moderate multicomponent subtype was more likely to experience care-need deterioration (adjusted odds ratio 1.67; 95% CI 1.26–2.22).Conclusions and ImplicationsThis study identified five subtypes of older adults who started LTC. These findings inform individualized care decisions and tailored planning of medical and LTC services.

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Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults

Cited by 3 publications

References 50 publications

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Factors influencing patient-provider communication about subjective cognitive decline in people with COPD: Insights from a national survey

Subtypes of Older Adults Starting Long-Term Care in Japan: Unsupervised Machine Learning Approach

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