Outcomes and interventions in the elderly with and without cognitive impairment: a longitudinal study

Abstract

ABSTRACT. Background: Clinical follow-up studies are necessary for a better understanding of the evolution of cognitive impairment as well as the development of better assessment and intervention tools. Objective: To investigate whether older people with preserved cognition (PC), mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) show differences in clinical outcomes and interventions after a 32-month period. Methods: One hundred twenty-four community-dwelling older people were included and classified in one of three groups (PC, MCI and mild AD). Information on clinical outcomes (deaths, new diagnoses, falls, need for assistance or changes in routine and hospitalizations) and interventions (increased use of medication, physiotherapeutic intervention, practice of physical exercise, etc.) in the 32-month period were collected by telephone or during a home visit on a single day. Results: Ninety-five participants (35 with PC, 33 with MCI and 27 with AD) were reevaluated after 32 months. The need for assistance/changes in routine was significantly higher in the AD group, especially with regard to basic activities of daily living. Unlike the other groups, the PC group did not show “other diagnoses” (urinary incontinence, prolapse, change in vision or autoimmune disease). No significant differences were found regarding other variables. Conclusions: Older people with and without cognitive impairment exhibited differences in some clinical outcomes after 32 months, such as need for assistance or changes in their routine and new diagnoses of specific diseases. Therefore, the multidimensionality of geriatric patients should be considered when planning assessments and interventions.

Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis

“…Three studies were included twice in the analyses because data were collected both retrospectively and prospectively. 32,36,44 Eleven studies were not included in the analysis of prevalence due to the following reasons; duplicate fall history information, [24][25][26]29 chart audit, 69 based on 'if the participant had ever fallen', 60 based on if the participant had fallen in the last 24-months, 67 falls in the past 32-months, 61 prospective falls over 24-months 34 and reported on two or more falls. 31,59 The most common method of falls prevalence data collection was retrospectively over 12 months and was collected with a single survey question or during an interview.…”

Evaluating the pragmatic characteristics of advance care planning outcome measures in dementia clinical trials: A scoping review

“…Alzheimer's disease and related dementias (AD/ADRD) are progressive and incurable and are the seventh leading cause of death in the United States 1 . Persons living with dementia (PLWD) suffer from progressive decline in cognition and function, resulting in compromised ability to make decisions for themselves and express their goals, values, and preferences for their healthcare 2–6 . As such, it is important for PLWD to discuss their healthcare goals and values and future care preferences as their disease progresses 7 .…”

“…1 Persons living with dementia (PLWD) suffer from progressive decline in cognition and function, resulting in compromised ability to make decisions for themselves and express their goals, values, and preferences for their healthcare. [2][3][4][5][6] As such, it is important for PLWD to discuss their healthcare goals and values and future care preferences as their disease progresses. 7 For PLWD, this is best done early in the illness trajectory when they can express what matters most to them, personal definitions of quality of life, and treatment preferences, commonly described as advance care planning (ACP).…”

Development of an Advance Care Planning Portal-Based Tool for Community-Dwelling Persons Living With Cognitive Impairment: The ACPVoice Tool

“…It is the seventh leading cause of death in the United States. [4][5][6][7][8][9] Persons living with dementia (PLWD) and those with mild cognitive impairment (MCI) are at high risk for poor outcomes including disability, mortality, [10][11][12][13] and high symptom burden affecting their quality of life (QoL) and that of their care partners. [14][15][16][17][18][19][20][21] As dementia progresses, decision-making capacity becomes compromised, and many patients receive non-beneficial, value-incongruent interventions at their end-of-life (EoL), without improvements in QoL, function, or survival.…”