Hearing and Vision Loss May Speed Development of Cognitive Problems

Journal of the American Geriatrics Society Research Summary

Cognitive decline ranges in severity from mild cognitive impairment (MCI) to Alzheimer’s disease and related dementias (ADRD). It is marked by memory loss and difficulty thinking and making decisions. Cognitive decline is a significant, common challenge to older adults’ well-being and their ability to live independently.

Today, cognitive impairment and ADRD are major global public health and social concerns as the population of older adults rises around the world. By 2050, more than 152 million people will be affected by these conditions. That’s why many countries, including the United States, see the prevention of ADRD as a key public health priority and are studying programs to help stem these diseases.

One way to prevent cognitive impairment and ADRD is to treat the problems that raise the risk for developing them. Two of these risk factors are hearing and vision loss. Currently, about 60 percent of people aged 70 years or older are affected by hearing loss, 40 percent are affected by vision loss, and 23 percent of older adults have both vision and hearing loss. Some studies have suggested that having both hearing and vision loss may be linked to poorer cognitive function or to a faster rate of cognitive decline.

However, more specific studies are needed to obtain more accurate information about these two sensory problems and their relationship to cognitive decline, suggests a  research team that examined the associations between having loss of one sensory function — hearing or vision — and cognitive decline, as well as the associations between having both types of sensory loss and cognitive decline. They published their findings in the Journal of the American Geriatrics Society. Continue reading

For Older Adults, Preventing Flu is Key to Lessening Disability Risks

Journal of the American Geriatrics Society Research Summary

We tend to think of the flu as an illness that people recover from within a relatively short time. Unfortunately, that’s not always the case for older adults, who are more likely to experience difficulties getting around and living independently following a serious illness. Adding to the problem is the potential for additional health problems that can occur during a stay in the hospital. Hospitalized older adults potentially face delirium, an abrupt change in mental function which causes sudden confusion. They are also susceptible to hospital-acquired infections and can weaken if they lose their physical conditioning.

In fact, studies show that one-third of older adults will be discharged from the hospital with a new disability — and only 30 percent of them will regain their pre-admission ability levels for bathing, dressing, feeding themselves, and managing other activities of daily living, even one year after their discharge.

A decline in your ability to take care of yourself can mean a greater need for in-home support, admission to a long-term care facility, and even an increased risk of death.

That’s why a team of researchers designed a study to learn more about functional decline (the ability to take care of yourself) and serious disability in adults, aged 65 years and older, who are admitted to hospital for influenza and other acute respiratory illnesses. Their study was published in the Journal of the American Geriatrics Society. Continue reading

Critical Support: Nursing Homes Need Our Action NOW

Alice Bonner, PhD, RN, FAAN, Senior Advisor for Aging, Institute for Healthcare Improvement

Alice Bonner, PhD, RN, FAAN, Senior Advisor for Aging, Institute for Healthcare Improvement

This editorial is the work of four authors: two registered nurses with PhDs, one of whom is a former government/public health division director and one of whom leads a national foundation; a certified nursing assistant and director of a national CNA organization; and a nationally recognized health economist and nursing home expert. Their names and affiliations appear at the end of the article.

How We Got Here

For years, extended families formed the backbone of American communities. Children and young adults grew up living with parents and grandparents, or with the grandparents of friends and neighbors down the street. So why is it that we struggle with long-term care — how to create meaningful, purposeful living environments as we age? And why is it that skilled nursing and rehabilitation facilities and skilled nursing facilities (SNFs, historically called nursing homes) are always an afterthought, or completely invisible?

The greatest success story of the 20th century is human longevity; all of us love to tell the story of a relative or friend who has made it into their ninth or tenth decade. However, as a society we have not come to grips with how to care for older people. Antibiotics, pacemakers, renal dialysis, and artificial hearts are just a part of the story that has led to longevity — not to mention the extraordinary achievements of the public health system.

Why We Do This Work

Many of us have had a career focused on supporting or caring for older adults over decades. Why do we do this work? Because we believe we can create a comprehensive system of care, a continuum of health, housing, and social services that can better support ourselves — older people and our care partners —  in social engagement and the life of communities. Due to a variety of factors, some form of nursing home care will always be a part of that continuum.

Many not-for-profit associations, for-profit companies, and government agencies focus on creating environments for optimal aging.  The John A. Hartford Foundation, a foundation devoted to improving care for older adults, is dedicated to improving care of older adults in every place they reside.  Every day the team focuses on its mission and work with national and international organizations, government agencies, universities, and all components of the healthcare system, to try to create Age Friendly Health Systems. They are sorely lacking. Continue reading

Delirium Screening in Skilled Nursing Facilities

Journal of the American Geriatrics Society Research Summary

Delirium and Alzheimer’s disease and related dementias (ADRD) can play a role in the mental decline of older adults who enter skilled nursing facilities (SNFs) for rehabilitation after being hospitalized. Healthcare practitioners may mistake these conditions for each other or even overlook them, even though they are distinct conditions and require different treatments.

Delirium is a term that means “sudden confusion. ” It is an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium is a result of abnormal functioning of the brain and requires the attention of a healthcare professional.

On the other hand, ADRD is a progressive and chronic decline in your cognitive abilities. You can have delirium and ADRD at the same time. In fact, new research reveals that delirium is a strong predictor of new ADRD cases. About 15 percent of older adults admitted to SNFs after being hospitalized have delirium, and patients with delirium have a nearly 13 percent increased risk of receiving a new diagnosis of ADRD over the next four years.

Delirium and ADRD can be difficult for healthcare practitioners to tell apart, and older adults can have both conditions at the same time. However, the two conditions have not been studied together in older adults admitted to skilled nursing facilities.

In order to learn more about the relationship between delirium detection and a potentially premature or inappropriate diagnosis of ADRD, researchers conducted a study. They based their findings on their examination of Medicare data from 2011-2013 for new nursing home admissions. The study was published in the Journal of the American Geriatrics Society. Continue reading

Importance of Preventing Delirium in Hospitalized Older Adults

Journal of the American Geriatrics Society Research Summary

Though fever and respiratory problems are typically the most common symptoms of COVID-19, worrisome neurologic symptoms also occur in older adults. For example, in a study in Wuhan, China, 36 percent of older COVID patients had neurologic complaints, such as dizziness, pain, sleep disturbances, and problems with balance. Eight percent had impaired consciousness.

What’s more, geriatrics experts suggest that older age is also a risk factor for delirium, a term that means “sudden confusion.” Delirium refers to an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. The result of abnormal functioning of the brain, delirium requires the attention of a healthcare professional.

Healthcare practitioners have seen delirium affect patients hospitalized with infectious diseases, including severe respiratory diseases. Delirium can mean that a person has suffered an acute brain failure, which could be caused by dehydration, psychoactive drugs, or infection. Delirium can increase the length of an older adult’s hospital stay and can cause mobility problems as well as difficulty thinking and making decisions. This can lead to older adults’ need for long-term care and raises their risk of death.

In severe cases, COVID-19 causes serious lung problems. When this happens to someone hospitalized for the virus, the patient may need mechanical ventilation to help them breathe, which can lead to delirium.

A recent study showed that 26 out of 40 patients with severe COVID-19 infection had signs of delirium. But despite this early evidence, we know little about the effects of delirium on people with COVID-19. A team of geriatrics experts from the University of Sao Paulo, Brazil, created a study to learn more about delirium in older adults hospitalized with COVID-19. Their study was published in the Journal of the American Geriatrics Society.

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