Holly Bennett

Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country

Background There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England. Methods and Findings Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3–53.1) and CFAS II (62.7%, 95% CI: 54.8–70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%). Conclusions Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.

Exploring patterns of response across the lifespan: the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) study

BackgroundWith declining rates of participation in epidemiological studies there is an important need to attempt to understand what factors might affect response. This study examines the pattern of response at different adult ages within a contemporary cross-sectional population-based cohort, the Cambridge Centre for Ageing and Neuroscience (Cam-CAN).MethodsUsing logistic regression, we investigated associations between age, gender and Townsend deprivation level for both participants and non-participants. Weighted estimates of the odds ratios with confidence intervals for each demographic characteristic were calculated. Reasons given for refusal were grouped into three broad categories: ‘active’, ‘passive’ and illness preventing interview.ResultsAn association of age and participation was found, with individuals in middle age groups more likely to participate (age group 48–57 OR: 1.8, 95% CI: 1.5–2.2 and age group 58–67 OR: 2.1, 95% CI: 1.7–2.4). Overall, there was no difference in participation between men and women. An association with deprivation was found, with those living in the most deprived areas being the least willing to participate (fifth quintile OR: 0.6, 95% CI: 0.5–0.7). An interaction between age and gender was found whereby younger women and older men were more likely to agree to participate (p = 0.01).ConclusionOur findings highlight some of the factors affecting recruitment into epidemiological studies in the UK and suggest that targeted age-specific recruitment strategies might be needed to increase participation rates in future cohort investigations.

FORECASTING DEMENTIA CASES AND PREVALENCE: TAKING CURRENT RISK FACTOR PREVALENCE TRENDS INTO ACCOUNT

Background:Much work on identifying individuals at high risk of dementia has focused on the clinical concept of MCI, which attempts to capture an intermediate state between normal cognitive ageing and dementia from which progression can be predicted. However this emerging concept, regardless of specific name and definition, remains controversial. Multiple definitions for this state have been developed and tested. Two key ones, commonly used internationally, are amnestic-MCI and Cognitive Impairment no Dementia (CIND). The analysis presented here aims to provide contemporary MCI prevalence for the UK, and also test for changes in MCI and mild dementia prevalence over two decades using identical approaches to diagnosis in the Cognitive Function andAgeing Studies (CFAS I& II).Methods:MRCCFAS undertook baseline interviews in populations aged 65+ years from five identical centres in England andWales (1989–1994). Two decades later three of the original centres (CFAS I) were selected for new sampling (2008–2011) with the same geographical boundaries and approach methods (CFAS II). A comprehehensive cognitive spectrum was mapped in both cohorts, including those most popular within clinical communities. These included amnestic MCI (a-MCI), non-amnestic MCI (na-MCI), multi-domain MCI (m-MCI), CIND and mild dementia, amongst others. In cross sectional analysis, logistic regression models were used to obtain predicted probabilities of MCI which were then standardised to the UK population in the corresponding cohort year. Results: In cross sectional analysis, logistic regression models were used to obtain predicted probabilities of MCI. This study found a decline in prevalence of MCI for most definitions between 1991 and 2011 (mild dementia (1.9%) Severe Cognitive Impairment (SCI) (2.9%)), although a small proportion remained stable (MCI with impairment in activities of daily living) or increased (CIND (1%) & amnestic-MCI (2.2%)). Conclusions: Although previous studies have shown a decrease in dementia prevalence, this study provides evidence of a shift in the cognitive burden on the population, increasing prevalence of MCI outlines the growing burden of cognitive decline on an ageing population.

HAVE RISK FACTORS FOR DEMENTIA INCIDENCE CHANGED

Background:Much work on identifying individuals at high risk of dementia has focused on the clinical concept of MCI, which attempts to capture an intermediate state between normal cognitive ageing and dementia from which progression can be predicted. However this emerging concept, regardless of specific name and definition, remains controversial. Multiple definitions for this state have been developed and tested. Two key ones, commonly used internationally, are amnestic-MCI and Cognitive Impairment no Dementia (CIND). The analysis presented here aims to provide contemporary MCI prevalence for the UK, and also test for changes in MCI and mild dementia prevalence over two decades using identical approaches to diagnosis in the Cognitive Function andAgeing Studies (CFAS I& II).Methods:MRCCFAS undertook baseline interviews in populations aged 65+ years from five identical centres in England andWales (1989–1994). Two decades later three of the original centres (CFAS I) were selected for new sampling (2008–2011) with the same geographical boundaries and approach methods (CFAS II). A comprehehensive cognitive spectrum was mapped in both cohorts, including those most popular within clinical communities. These included amnestic MCI (a-MCI), non-amnestic MCI (na-MCI), multi-domain MCI (m-MCI), CIND and mild dementia, amongst others. In cross sectional analysis, logistic regression models were used to obtain predicted probabilities of MCI which were then standardised to the UK population in the corresponding cohort year. Results: In cross sectional analysis, logistic regression models were used to obtain predicted probabilities of MCI. This study found a decline in prevalence of MCI for most definitions between 1991 and 2011 (mild dementia (1.9%) Severe Cognitive Impairment (SCI) (2.9%)), although a small proportion remained stable (MCI with impairment in activities of daily living) or increased (CIND (1%) & amnestic-MCI (2.2%)). Conclusions: Although previous studies have shown a decrease in dementia prevalence, this study provides evidence of a shift in the cognitive burden on the population, increasing prevalence of MCI outlines the growing burden of cognitive decline on an ageing population.