Indian older adults and the digit span: a preliminary report / Idosos indianos e extensão de dígitos: um relatório preliminar

ABSTRACT: The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. Objective: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. Methods: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. Results: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. Conclusion: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

RESUMO: O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. Objetivo: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. Métodos: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. Resultados: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. Conclusão: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

Identifying Psychological Distress in Elderly Seeking Health Care.

Background: Psychological distress in the elderly with various illness conditions often goes unrecognized. Since psychological distress is treatable, it is important to recognize it at the earliest to enhance recovery. This is an interim analysis of screening data of the elderly seeking health care in a hospital in India, with a focus on the 12-item General Health Questionnaire (GHQ-12), a screening instrument for psychological distress and a rationale for a higher cutoff score in help seeking elderly. Materials and Methods: A retrospective analysis of screening data of psychological distress using GHQ-12 in the elderly seeking care for neuropsychiatric conditions was carried out. Traditionally, ≥2 is considered positive for distress by GHQ-12. Receiver Operating Characteristic (ROC) curve was used to define new cutoff points for psychological distress. Results: At ≥2, 2443 (50%) of the elderly screened were recognized to be psychologically distressed. Using an ROC and optimum sensitivity and specificity measures, a cutoff score of ≥4 was observed to detect 30% of the elderly who had diagnosable mental health disorders. Female sex, illiteracy, and multiple co-morbidities were the factors that were associated with higher cutoff scores on GHQ-12 proposed here and psychiatric morbidity thereof. Conclusion: There is greater psychological distress among the elderly seeking health care. Hence, it is important to screen them and identify those at higher risk. Using a higher cutoff score with a standardized instrument like GHQ-12 indicated that it was statistically valid to identify those elderly with higher distress in a busy out-patient setting.

Age, education and gender effects on neuropsychological functions in healthy Indian older adults / Efeitos da idade, educação e gênero nas funções neuropsicológicas em indianos adultos idosos saudáveis

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance. OBJECTIVE: To examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs. METHODS: This is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment. RESULTS: Stepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning. CONCLUSION: Education was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

É essencial o uso de testes específicos, sensíveis e culturalmente apropriados que reflitam o verdadeiro desempenho cognitivo. Todavia, vários fatores como idade, educação e gênero podem influenciar o desempenho neuropsicológico em testes. OBJETIVO: Examinar os efeitos de idade, educação e gênero na função neuropsicológica em adultos idosos usando medidas de rastreio cognitivo global, atenção, memória operacional, funções executivas, memória, construção, linguagem e sinais parietais focais. MÉTODOS: Este é um estudo normativo de corte transversal de 180 idosos vivendo em comunidade. Todos os paticipantes foram rastreados com o Exame do Estado Mental Hindu (HMSE), Escala de Atividades de Vida Diária para Índia (EASI), Inventário de Dominância Manual de Edinburgh (EDI) e MINI Screen seguidos por uma detalhada avaliação neuropsicológica. RESULTADOS: A análise de regressão stepwise revelou que a educação esteve associada ao melhor desempenho cognitivo em cada teste neuropsicológico. As mulheres tiveram desempenho significativamente melhor em medidas de memória. Além disso, a maioria dos analfabetos incluindo idosos com baixo nível educacional recusou-se a participar em medidas de função executiva. CONCLUSÃO: Educação foi o mais forte determinante do desempenho em testes neuropsicológicos seguido por idade e gênero. Nosso esrudo demonstra que idosos indianos saudáveis com baixo nível educacional tem desempenho pobre em medidas de planejamento e memória de trabalho. Medidas tradicionais de planejamento e memória de trabalho devem ser evitadas ou usadas cautelosamente na presença de baixa escolaridade. Há necessidade urgente do desenvolvimento de tarefas de funções executivas especialmente para idosos indianos com baixo nível educacional.

Cost of dementia care in India: Delusion or reality.

Context: In 2010, nearly 37 lakh Indians have been estimated to be suffering from dementia. Estimated costs of care in published literature do not reflect the actual expenses of individual households. Hence, a household budget approach was undertaken to arrive at the costs of dementia care in India. Materials and Methods: We identified and listed the different components of care, classified the applicability of care for the different components with respect to mild, moderate, and severe cases. This framework was utilized to assign costs of care and arrive at the household costs of care for a Person with Dementia (PwD) in both urban and rural areas. Results: The total expense was similar to that reported by individual households. The annual household cost of caring for a person with dementia in India, depending on the severity of the disease, ranged between INR 45,600 to INR 2,02,450 in urban areas and INR 20,300 to INR 66,025 in rural areas. Costs increased with increasing severity of the disease process. The costs of informal care contributed to nearly half of the total costs either in rural or urban area. With increasing severity, proportion of medical costs decreased while social cost increased. Medical costs in rural areas were nearly one-third of the total costs as against less than one-fifth in urban areas. Conclusion: The household budget model realistically estimated the household costs of care. It is hoped that the comprehensive and generic framework would prompt health professionals, researchers, and policy makers in India to catalyze geriatric health services, particularly for care for PwD.