TY - JOUR T1 - Functional limitations in older adults who have cognitive impairment without dementia. JF - J Geriatr Psychiatry Neurol Y1 - 2013 A1 - Tanya R Gure A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - John D Piette A1 - Brenda L Plassman KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Severity of Illness Index KW - Surveys and Questionnaires AB -

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

VL - 26 IS - 2 N1 - NLM Title Abbreviation: J Geriatr Psychiatry Neurol U1 - http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract U2 - PMC3726208 U4 - ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation ER - TY - JOUR T1 - Predictors of self-report of heart failure in a population-based survey of older adults. JF - Circ Cardiovasc Qual Outcomes Y1 - 2012 A1 - Tanya R Gure A1 - Ryan J McCammon A1 - Christine T Cigolle A1 - Todd M Koelling A1 - Caroline S Blaum A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Awareness KW - Chi-Square Distribution KW - Comorbidity KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Status KW - Health Surveys KW - Heart Failure KW - Humans KW - Insurance Claim Review KW - Logistic Models KW - Male KW - Medicare KW - Odds Ratio KW - Patients KW - Predictive Value of Tests KW - Self Report KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

PB - 5 VL - 5 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22592753?dopt=Abstract U2 - PMC3370939 U4 - medicare claims/heart disease/self-reported health ER - TY - JOUR T1 - Prevalence of cognitive impairment in older adults with heart failure. JF - J Am Geriatr Soc Y1 - 2012 A1 - Tanya R Gure A1 - Caroline S Blaum A1 - Bruno J Giordani A1 - Todd M Koelling A1 - Andrzej T Galecki A1 - Susan J Pressler A1 - Scott L Hummel A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Chi-Square Distribution KW - Cognition Disorders KW - Cross-Sectional Studies KW - Demography KW - Female KW - Heart Failure KW - Humans KW - Logistic Models KW - Male KW - Medicare KW - Prevalence KW - United States AB -

OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF).

DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.

SETTING: United States, community.

PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older.

MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.

RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15%, and the prevalence of mild cognitive impairment was 24%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95% confidence interval = 1.14-2.02).

CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.

PB - 60 VL - 60 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22882000?dopt=Abstract U2 - PMC3445700 U4 - Cognition/Cognitive impairment/Cardiovascular disease/heart Diseases/epidemiology/dementia/PREVALENCE ER - TY - JOUR T1 - Differences in functional impairment across subtypes of dementia. JF - J Gerontol A Biol Sci Med Sci Y1 - 2010 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Brenda L Plassman A1 - John D Piette A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Alzheimer disease KW - Dementia KW - Dementia, Vascular KW - Humans AB -

BACKGROUND: Dementia is a cause of disability in later life. Despite the importance of functional status to the diagnosis of dementia, limited information exists on differences in functional limitations by dementia subtype. We conducted a cross-sectional analysis using the Aging, Demographics, and Memory Study (ADAMS) to determine the extent of functional impairment among older adults with dementia due to different etiologies.

METHODS: The ADAMS sample consisted of 856 individuals aged 71 years and older originally surveyed as part of the Health and Retirement Study. Based on a comprehensive in-person cognitive evaluation, respondents were assigned to diagnostic categories of normal cognition, cognitive impairment not demented, and demented. Dementia subtypes were grouped into three categories: vascular dementia (VaD), Alzheimer's dementia (AD), and dementia due to other etiologies. For 744 of the 856 respondents, a proxy informant completed a questionnaire asking whether the respondent had difficulty completing instrumental activities of daily living and activities of daily living (ADLs).

RESULTS: Of 744 ADAMS participants, 263 had dementia: 199 (70.5%) with AD, 42 (16.9%) with VaD, and 22 (12.6%) were demented due to other etiologies. After adjustment for demographics, chronic illnesses, and dementia severity, participants with VaD (odds ratio [OR] 5.74; 95% confidence interval [CI] 2.60-12.69) and other etiologies of dementia (OR 21.23; 95% CI 7.25-62.16) were more likely to have greater than or equal to four ADL limitations compared with those with AD.

CONCLUSIONS: VaD is associated with significantly more ADL limitations than AD. These physical limitations should be considered when designing adult day care programs, which adequately accommodate the needs of non-AD patients.

PB - 65A VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20018827?dopt=Abstract U2 - PMC2844058 U4 - Aging/Dementia/Demographics/Memory/Older people/Alzheimers disease/Questionnaires/Disability/Disability ER - TY - JOUR T1 - The influence of long-term care insurance on the likelihood of nursing home admission. JF - J Am Geriatr Soc Y1 - 2009 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Insurance, Long-Term Care KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nursing homes AB -

OBJECTIVES: To determine the effect of long-term care (LTC) insurance on nursing home use.

DESIGN: Longitudinal analysis, 1998 to 2006 waves of the Health Retirement Study.

SETTING: Community-dwelling nationally representative sample.

PARTICIPANTS: Nineteen thousand one hundred seventy adults aged 50 and older, 1998 wave.

METHODS: Two groups of respondents were created at baseline: those with and without an LTC insurance policy. Respondents admitted to the nursing home from 1998 to 2006 were identified. Propensity scores were used to control for known predictors of LTC insurance possession. A Cox proportional hazards model was used to compare the probability of nursing home admission over 8 years of follow-up for respondents possessing LTC insurance and those without a policy.

RESULTS: Of the 19,170 respondents aged 50 and older in 1998, 1,767 (9.2%) possessed LTC insurance. A total of 1,778 (8.5%) were admitted to a nursing home during the 8-year period: 149 (8.7%) of those with LTC insurance and 1,629 (8.4%) of those without LTC insurance. The hazard ratio, adjusted for propensity score, for those with LTC insurance entering a nursing home compared with those without was 1.07 (95% confidence interval=0.83-1.38). Likelihood of nursing home admission was relatively low because the low-risk population included in the study, limiting the power to detect small differences in risk of nursing home utilization between groups.

CONCLUSION: There was no difference in nursing home utilization between low-risk older adults who did and did not possess an LTC insurance policy.

PB - 57 VL - 57 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19694868?dopt=Abstract U2 - PMC2810263 U4 - Long-Term Care/Insurance, Long Term Care/Nursing Homes ER - TY - JOUR T1 - Degree of disability and patterns of caregiving among older Americans with congestive heart failure. JF - J Gen Intern Med Y1 - 2008 A1 - Tanya R Gure A1 - Mohammed U Kabeto A1 - Caroline S Blaum A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Coronary Disease KW - Cross-Sectional Studies KW - Disabled Persons KW - Female KW - Health Surveys KW - Heart Failure KW - Hospitalization KW - Humans KW - Male KW - Nursing homes KW - United States AB -

OBJECTIVES: Although congestive heart failure (CHF) is a common condition, the extent of disability and caregiving needs for those with CHF are unclear. We sought to determine: (1) prevalence of physical disability and geriatric conditions, (2) whether CHF is independently associated with disability, (3) rates of nursing home admission, and (4) formal and informal in-home care received in the older CHF population.

METHODS: We used cross-sectional data from the 2000 wave of the Health and Retirement Study. We compared outcomes among three categories of older adults: (1) no coronary heart disease (CHD), (2) CHD, without CHF, and (3) CHF. Compared to those without CHF, respondents reporting CHF were more likely to be disabled (P < 0.001) and to have geriatric conditions (P < 0.001). Respondents reporting CHF were more likely to have been admitted to a nursing home (P < 0.05). CHF respondents were more functionally impaired than respondents without CHF.

RESULTS: The adjusted average weekly informal care hours for respondents reporting CHF was higher than for those reporting CHD but without CHF and those reporting no CHD (6.7 vs 4.1 vs 5.1, respectively; P < 0.05). Average weekly formal caregiving hours also differed among the three groups (1.3 CHF vs 0.9 CHD without CHF vs 0.7 no CHD; P > 0.05).

CONCLUSIONS: CHF imposes a significant burden on patients, families, and the long-term care system. Older adults with CHF have higher rates of disability, geriatric conditions, and nursing home admission.

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18030537?dopt=Abstract U2 - PMC2173919 U4 - Heart Diseases/DISABILITY/DISABILITY/Caregiving ER -