Assessment of appropriateness of screening community-dwelling older people to prevent functional decline.

OBJECTIVES: To identify appropriate screening conditions, stratified according to age and vulnerability, to prevent functional decline in older people. DESIGN: A RAND/University of California at Los Angeles appropriateness method. SETTING: The Netherlands. PARTICIPANTS: A multidisciplinary panel of 11 experts. MEASUREMENTS: The panelists assessed the appropriateness of screening for 29 conditions mentioned in guidelines from four countries, stratified according to age (60-74, 75-84, ≥85) and health status (general, vital, and vulnerable) and received a literature overview for each condition, including the guidelines and up-to-date literature. After an individual rating round, panelists discussed disagreements and performed a second individual rating. The median of the second ratings defined the appropriateness of screening. RESULTS: The panel rated screening to be appropriate in three of the 29 conditions, indicating that screening was expected to prevent functional decline. Screening for insufficient physical activity was considered appropriate for all three age and health groups. Screening for cardiovascular risk factors and smoking was considered appropriate for the general and vital population aged 60 to 74. Of the 261 ratings, 63 (24%) were classified as uncertain, of which 42 (67%) concerned the vulnerable population. The panelists considered conditions inappropriate mainly because of lack of an adequate screening tool or lack of evidence of effective interventions for positive screened persons. CONCLUSION: The expert panel considered screening older people to prevent functional decline appropriate for insufficient physical activity and smoking and cardiovascular risk in specific groups. For other conditions, sufficient evidence does not support screening. Based on their experience, panelists expected benefit from developing tests and interventions, especially for vulnerable older people.

Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia.

BACKGROUND: Most studies examining psychotropic medication use on cognition in older persons with dementia include measures of global cognitive function. The present study examined the relationship between different types of psychotropic medication and specific cognitive functions in older people with dementia. METHODS: Two hundred and six institutionalized older adults with dementia (180 women, mean age 85 years) were administered neuropsychological tests. Psychotropic medication use was extracted from their medical status and categorized as: sedatives, antidepressants and antipsychotics. RESULTS: Analysis of covariance revealed that psychotropic consumers, and particularly those who used antipsychotics, performed worse on neuropsychological tests of executive/attentional functioning than non-consumers. There were no differences between consumers of other classes of psychotropic drugs and non-consumers. The number of psychotropic drugs used was inversely related to executive/attentional functioning. CONCLUSIONS: These findings show that in institutionalized older adults with dementia, specific impairment of cognitive function, i.e. executive/attentional impairments, are associated with antipsychotic medication use. Future longitudinal studies are recommended.

Exploring the relationship between cognition and self-reported pain in residents of homes for the elderly.

BACKGROUND: Pain poses a major problem in older adults, specifically for those living in homes for the elderly. Previous research indicates that the presence of pain may be associated with changes in cognitive functions. It is unclear, however, how the reported experience of pain relates to cognitive functioning in elderly people with chronic pain. The present study was intended to examine the relationship between clinical pain experience and neuropsychological status in residents of homes for the elderly. METHODS: Forty-one residents suffering from arthritis or arthrosis completed tests measuring memory, processing speed, and executive function. The sensory-discriminative and the affective-motivational aspects of clinical pain were measured. RESULTS: Performance on executive function tests was positively related to self-reported pain experience. No relationship was observed between pain and memory or processing speed performance. CONCLUSION: The present study shows that executive functioning is related to the severity of subjectively reported pain. Possible explanations for this association are discussed.

Executive ability in relation to blood pressure in residents of homes for the elderly.

The objective of the present study was to examine whether blood pressure (BP) relates to various executive functions in residents of homes for the elderly. Several cognitive tests measuring flexibility, fluency, inhibition, planning, and working memory were administered. Associations between these executive functions and systolic and diastolic BP (SBP and DBP) were examined. The results revealed that normal SBP (<120 mmHg) related to better fluency and flexibility performance, whereas no significant effects of DBP were noted. The present study indicates that specifically SBP might be important with regard to executive ability in residents of homes for the elderly.