Longitudinal associations between subjective cognitive impairment, pain and depressive symptoms in home-dwelling older adults: Modelling within-person effects.

OBJECTIVES: Cognitive impairment, pain and depressive symptoms are common and interrelated factors in older adults. However, the directionality and specificity of their association remains unclarified. This study explored whether these factors prospectively increase reciprocal risk and examined the longitudinal association between these factors and quality of life (QoL). METHODS: This study used longitudinal data from The Older Persons and Informal Caregivers Survey Minimal Data Set (TOPICS-MDS; the Netherlands). Older adults self-reported cognitive impairment, pain, depressive symptoms and QoL at baseline and after 6 and 12 months of follow-up. The Random Intercept Cross-Lagged Panel Model was used to assess the prospective association between the three factors, while a multilevel linear regression analysis in a two-level random intercept model was used to examine the longitudinal associations between the three factors and QoL at the within-person level. RESULTS: The data of 11,582 home-dwelling older adults with or without subjective cognitive impairment were analysed. At the within-person level, pain at 6 months was associated with subsequent depressive symptoms (ß = 0.04, p = 0.024). The reverse association from depression to pain, and longitudinal associations between pain and subjective cognitive impairment and between depressive symptoms and subjective cognitive impairment were non-significant. Pain, depressive symptoms and subjective cognitive impairment showed a significant association with poor QoL 6 months later. CONCLUSIONS: A directional relationship was observed from pain to depressive symptoms. Pain reduction holds a potential benefit in the prevention of depressive symptoms, ultimately optimising the QoL of older adults.

Quality of care, spirituality, relationships and finances in older adult palliative care patients in Lebanon.

BACKGROUND: Despite making up a big proportion of the world population, older adults received little palliative care services. Moreover, palliative quality of care provided to older adults has been shown to be poor. Adequate clinician communication, familial support, and religious/spiritual support have been identified as main factors in providing good quality of care. The purpose of our study on Lebanese older adult palliative care patients is to assess the quality of palliative care in terms of access to care, patient-clinician relationship, and clinician-clinician communication, assess the degree of spirituality/religiousness of patients and their sense of purpose, to explore patients' relationships including friendships and social support and to assess the degree of financial hardship during the illness. METHODS: An observational cross-sectional design was used in this study of hospitalized older adults in three major medical centers in Lebanon over a period of 2 years from 2015 to 2017. Key physicians from each of the three medical centers recruited participants into the study to obtain a convenience sample (N=203). Quality of care was measured using 20 selected items from the Needs at the End of life Screening Tool (NEST). RESULTS: Patients reported easy access to care expressed by low median item scores ranging from the lowest 1.0 pertaining to lack of a problematic doctor choice to the highest 3.0 for ease of securing a hospital bed. Difficulty expressing their feelings to their healthcare providers had an average median of 5.0 with other items on communication having higher medians. The sample considered themselves to be highly religious or spiritual with a median score of 9.0 and identified an inclination to be more religious or spiritual after their illness with a median of 7.0. Social support was found to be good and financial hardships had low median scores ranging from 3.0 to 5.0. CONCLUSIONS: Older adults receiving palliative care reported ease of access to medical care, average communication, good spiritual and social status and minimal financial hardships. The authors recommend integrating spiritual and social aspects into the patients' palliative care to improve quality of care and quality of life.

Symptom prevalence and management in older adult patients in Lebanon.

OBJECTIVE: The purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates. METHOD: This study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon. RESULT: The mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age. SIGNIFICANCE OF RESULTS: Lack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.

Anemic Control in Patients with Chronic Kidney Disease: A Controversial Issue.

Anemia in chronic kidney disease doubles the risk of death and leads to many complications. Management includes erythropoietin-stimulating agent therapy, treatment of iron deficiency, patient education, and collaboration with the multidisciplinary team.