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Caring for those with Alzheimer's disease (AD) is mentally, physically and emotionally exhausting, and all too often caregivers are unaware of the resources available to them. Questionnaires were sent to the 20 AD support groups in Maine to gain a better understanding of caregiver needs and opinions. One hundred twenty questionnaires were returned by both current and former caregivers of patients with AD. A major problem reported was that many physicians did not provide adequate information about AD. Caregivers also indicated that they needed more information and training, as well as the support of others who were undergoing the same experience. Present caregivers indicated a greater need for direct services, while former caregivers cited a lack of knowledgeable health professionals. Both groups felt that personal or family counseling and workshops were valuable. The caregivers all expressed a strong interest in learning more about the disease, including genetic and biomedical aspects, even though some of the data are highly technical. Research on the perceived needs of caregivers can be useful in setting local and state objectives for helping families with health care problems. It must also be remembered that the requirements of the families of patients with AD change as the disease progresses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Importance treatment of dementia in individuals with comorbidities is complex, leading to potentially inappropriate prescribing (PIP). The impact of PIP in this population is unknown. Objective to estimate the rate of PIP and its effect on adverse health outcomes (AHO). Design retrospective cohort. Setting primary care electronic health records linked to hospital discharge data from England. Subjects 11,175 individuals with dementia aged over 65 years in 2016 and 43,463 age- and sex-matched controls. Methods Screening Tool of Older Persons' Prescriptions V2 defined PIP. Logistic regression tested associations with comorbidities at baseline, and survival analyses risk of incident AHO, adjusted for age, gender, deprivation and 14 comorbidities. Results the dementia group had increased risk of PIP (73% prevalence; odds ratio [OR]: 1.92; confidence interval [CI]: 83–103%; P  < 0.01) after adjusting for comorbidities. Most frequent PIP criteria were related to anti-cholinergic drugs and therapeutic duplication. Risk of PIP was higher in patients also diagnosed with coronary-heart disease (odds OR: 2.17; CI: 1.91–2.46; P  < 0.01), severe mental illness (OR: 2.09; CI: 1.62–2.70; P  < 0.01); and depression (OR: 1.81; CI: 1.62–2.01; P  < 0.01). During follow-up (1 year), PIP was associated with increased all-cause mortality (hazard ratio: 1.14; CI: 1.02–1.26; P  < 0.02), skin ulcer and pressure sores (hazard ratio: 1.66; CI: 1.12–2.46; P < 0.01), falls (hazard ratio: 1.37; CI: 1.15–1.63; P  < 0.01), anaemia (hazard ratio: 1.61; CI: 1.10–2.38; P  < 0.02) and osteoporosis (hazard ratio: 1.62; CI: 1.02–2.57; P  < 0.04). Conclusion patients with dementia frequently receive PIPs, and those who do are more likely to experience AHO. These results highlight the need to optimise medication in dementia patients, especially those with comorbidities. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Delirium is common in older adults, especially following hospitalization. Because low vitamin D levels may be associated with increased delirium risk, we aimed to determine the prognostic value of blood vitamin D levels, extending our previous genetic analyses of this relationship. DESIGN: Prospective cohort analysis. SETTING: Community‐based cohort study of adults from 22 cities across the United Kingdom (the UK Biobank). PARTICIPANTS: Adults aged 60 and older by the end of follow‐up in the linked hospital inpatient admissions data, up to 14 years after baseline (n = 351,320). MEASUREMENTS: At baseline, serum vitamin D (25‐OH‐D) levels were measured. We used time‐to‐event models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between vitamin D deficiency and incident hospital‐diagnosed delirium, adjusted for age, sex, assessment month, assessment center, and ethnicity. We performed Mendelian randomization genetic analysis in European participants to further investigate vitamin D and delirium risk. RESULTS: A total of 3,634 (1.03%) participants had at least one incident hospital‐diagnosed delirium episode. Vitamin D deficiency (<25 nmol/L) predicted a large incidence in delirium (HR = 2.49; 95% CI = 2.24–2.76; P = 3*10−68, compared with >50 nmol/L). Increased risk was not limited to the deficient group: insufficient levels (25–50 nmol/L) were also at increased risk (HR = 1.38; 95% CI = 1.28–1.49; P = 4*10−18). The association was independent of calcium levels, hospital‐diagnosed fractures, dementia, and other relevant cofactors. In genetic analysis, participants carrying more vitamin D–increasing variants had a reduced likelihood of incident delirium diagnosis (HR =.80 per standard deviation increase in genetically instrumented vitamin D:.73–.87; P = 2*10−7). CONCLUSION: Progressively lower vitamin D levels predicted increased risks of incident hospital‐diagnosed delirium, and genetic evidence supports a shared causal pathway. Because low vitamin D levels are simple to detect and inexpensive and safe to correct, an intervention trial to confirm these results is urgently needed. [ABSTRACT FROM AUTHOR]

Eldercare demands (ECD) may result in stress when finite resources needed to fulfill life roles (i.e., family, work) become scarce. ECD may be acquired, continue over time, or be relinquished. They thus may represent acute stress (immediate, severe) or chronic stress (persistent, milder). Workers at six U.S. manufacturing companies completed surveys (N = 520). ECD were operationalized as providing assistance to an adult aged 65+ years due to disability or illness. Workers were categorized into four ECD groups (persistent, relinquished, acquired, and none), and we examined the ECD groups' association with person-centric and work-centric outcomes. Respondents with acquired ECD had worse mental health and greater depressive symptoms than those with none, and those with persistent ECD had greater work stress and family–work conflict than those with none. Findings suggesting that acute stress is more related to person-centric outcomes and chronic stress is more related to work-centric outcomes could inform development of tailored interventions. [ABSTRACT FROM AUTHOR]

Background: Falls are a common reason that persons with cognitive impairment or dementia (PwCID) cannot remain at home. FallsTalk is a one‐month evidence‐based falls prevention program that focuses attention on the individual causes of losses of balance or falls. FallsTalk encourages new falls prevention behaviors, which have been shown to decrease falls. We adapted FallsTalk for family Caregiver (FCG) administration to a PwCID with a recent history of falls to determine if FallsTalk‐Caregiver could influence the number of new falls prevention behaviors reported by the FCG or the number of falls. Method: Thirty‐four Dyads (FCG+PwCID) were trained to conduct brief daily falls prevention discussions together. Dyads were randomly assigned to receive either standardized paper (FallsTalk,n = 14) or computer‐tailored (FallsTalk‐Caregiver,n = 20) discussion suggestions based on prior concerns expressed by the FCG. All Dyads had FallsTalk training, had daily discussions together and received weekly check‐in calls. The FCGs reported weekly on the number of falls and new falls prevention behaviors (#newFPBs); as well as any changes in the PwCID's health, care or living arrangements during the intervention period. FCGs continued to enter the number of falls and status changes weekly into a secure web‐site using a subject ID, until medical (significant health status change) or residential (no longer living at home permanently) endpoint was reached, or 52 weeks were completed. Poisson regression models compared the number of new falls prevention behaviors and weekly fall rate between groups. Fall rates were annualized for comparison with published residential care fall rates. Result: Dyads receiving FallsTalk‐Caregiver reported significantly more #newFPBs (MeanPaper = 5.34 (SEM = 0.68, CI = 3.48‐5.93), MeanComputer = 8.46 (SEM = 0.76, CI = 7.48‐10.40); p =.004) during the intervention month. FallsTalk‐Caregiver PwCIDs experienced a significantly lower fall rate (MeanPaper = 0.073/week (SEM =.015, CI = 0.049‐0.109), MeanComputer = 0.040/week (SEM =.008, CI = 0.027‐0.060); p =.047). Annualized fall rates (Falls/year for Dyads with > = 12 weeks) were (MeanPaper = 3.64/year, n = 13; MeanComputer = 2.08/year, n = 19. Conclusion: FallsTalk‐Caregiver provides an effective means to encourage new falls prevention behaviors to prevent losses of balance and falls. Despite the diversity of the Dyad's home environment and varied PwCID diagnoses, FCGs matched or bettered the annual fall rates achieved by professional caregivers in skilled nursing facilities (Resident Falls/year = 2.33 (Residents without a PwCID diagnosis); 4.05 (Residents with a PwCID diagnosis). [ABSTRACT FROM AUTHOR]

Objective: To determine whether emotional support, and proportion of emotional support provided by specific sources (e.g., family, other prisoners, clinicians), is associated with health-related self-efficacy among older prisoners. Method: Cross-sectional study of 140 older prisoners age ≥50 with chronic medical illness who completed face-to-face interviews. Logistic regression, controlling for demographic, incarceration, and clinical/behavioral factors evaluated the association between emotional support, operationalized as a score and as a proportion of total emotional support from specific sources, and health-related self-efficacy. Results: Higher emotional support scores, and greater proportion of support from clinicians, were associated with lower likelihood of poor health-related self-efficacy. Those with >50% of their emotional support coming from other prisoners had higher likelihood of poor self-efficacy. Discussion: Among older prisoners with chronic illness, higher emotional support, particularly from clinicians, is associated with lower likelihood of poor self-efficacy; relying on other prisoners for emotional support is associated with poor health-related self-efficacy. [ABSTRACT FROM AUTHOR]

This study analyzes the incidence of falls for older adults who transitioned from institutions to the community through the Connecticut Money Follows the Person demonstration program, identifying intrinsic and extrinsic fall risk factors for this population. This prospective cohort study analyzed data from 648 Money Follows the Person participants aged 65 years and older, using 6- and 12-month posttransition surveys. Of the 648 participants, 161 (25.2%) fell in the first 6 months after transition, while 156 (24.5%) fell between 6 and 12 months after transition. Unmet medical care needs, depressive symptoms, mistreatment, and previous falls significantly predicted falls. Given the vulnerability of this population and increased use of fall-related health services, fall prevention represents a critical element in posttransition care. Beyond previously identified risk factors, care providers should consider issues such as unmet medical care needs, depressive symptoms, and mistreatment in assessing fall risk. [ABSTRACT FROM AUTHOR]

Ventriculomegaly (expansion of the brain's fluid-filled ventricles), a condition commonly found in the aging brain, results in areas of gliosis where the ependymal cells are replaced with dense astrocytic patches. Loss of ependymal cells would compromise trans-ependymal bulk flow mechanisms required for clearance of proteins and metabolites from the brain parenchyma. However, little is known about the interplay between age-related ventricle expansion, the decline in ependymal integrity, altered periventricular fluid homeostasis, abnormal protein accumulation and cognitive impairment. In collaboration with the Baltimore Longitudinal Study of Aging (BLSA) and Alzheimer's Disease Neuroimaging Initiative (ADNI), we analyzed longitudinal structural magnetic resonance imaging (MRI) and subject-matched fluid-attenuated inversion recovery (FLAIR) MRI and periventricular biospecimens to map spatiotemporally the progression of ventricle expansion and associated periventricular edema and loss of transependymal exchange functions in healthy aging individuals and those with varying degrees of cognitive impairment. We found that the trajectory of ventricle expansion and periventricular edema progression correlated with degree of cognitive impairment in both speed and severity, and confirmed that areas of expansion showed ventricle surface gliosis accompanied by edema and periventricular accumulation of protein aggregates, suggesting impaired clearance mechanisms in these regions. These findings reveal pathophysiological outcomes associated with normal brain aging and cognitive impairment, and indicate that a multifactorial analysis is best suited to predict and monitor cognitive decline. [ABSTRACT FROM AUTHOR]

Objectives To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver ( FITT-C), on community support and healthcare use by dementia caregivers. Design Randomized, controlled trial. Setting Academic medical center. Participants Dyads (n = 250) of distressed informal dementia caregivers and care recipients. Intervention Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support ( TS; n = 117). Both groups received 16 telephone contacts from a master's-level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem solving, and other directive approaches based on assessment of critical areas (e.g., mood, behavior, family functioning, social support). TS provided supportive therapeutic strategies. Measurements Outcome variables were caregiver report of community support service use, number of visits to the emergency department ( ED) for caregivers and care recipients, and hospital stays for caregivers during the interventions. Results Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C used community support services at end of treatment significantly more than those receiving TS ( P = .02). FITT-C caregivers had a significantly lower rate of ED visits (rate difference 9.5%, P = .048) and hospital stays (rate difference 11.4%, P = .01) over the 6-month course of the intervention than TS caregivers. Care recipient use of community or medical resources did not differ according to group. Conclusion An entirely telephone-delivered intervention was effective in increasing caregiver engagement in community resources and reducing caregiver use of hospital-based healthcare resources. Results highlight the potential effect of FITT-C on healthcare use. [ABSTRACT FROM AUTHOR]

Objectives: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members.Methods: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class.Results: The majority of ride service users were female (77%) and aged 65-74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides.Conclusions: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people. [ABSTRACT FROM AUTHOR]

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver's perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community. [ABSTRACT FROM AUTHOR]