Examining the role of culture and cultural perceptions of aging and dementia in the recognition, diagnosis, and treatment of age-related cognitive impairment remains an understudied area of clinical neuropsychology. This paper describes a qualitative study based on a series of key informant group interviews with an Aboriginal Grandmothers Group in the province of Saskatchewan. Thematic analysis was employed in an exploration of Aboriginal perceptions of normal aging and dementia and an investigation of issues related to the development of culturally appropriate assessment techniques. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system: (1) cognitive and behavioural changes were perceived as a normal expectation of the aging process and a circular conception of the lifespan was identified, with aging seen as going back "back to the baby stage", (2) a "big change in culture" was linked by Grandmothers to Aboriginal health, illness (including dementia), and changes in the normal aging process, and (3) the importance of culturally grounded healthcare both related to review of assessment tools, but also within the context of a more general discussion of experiences with the healthcare system. Themes of sociocultural changes leading to lifestyle changes and disruption of the family unit and community caregiving practices, and viewing memory loss and behavioural changes as a normal part of the aging process were consistent with previous work with ethnic minorities. This research points to the need to understand Aboriginal perceptions of aging and dementia in informing appropriate assessment and treatment of age-related cognitive impairment and dementia in Aboriginal seniors.
To assess the robustness of the association between intelligence quotient (IQ) and mortality in older adults and to examine whether or not the association can be explained by more specific cognitive processes, including individual differences in executive functioning.
We examined the associations among Full Scale IQ, individual IQ subtest scores, and 10-year mortality among older community-dwelling, adult participants in the Canadian Study of Health and Aging, who were verified as disease and cognitive-impairment free at baseline via comprehensive medical and neurological evaluation (n = 516). Survival analysis including Cox proportional hazards regression models were used to examine mortality risk as a function of Full Scale IQ and its specific subcomponents.
An inverse association was found between IQ and mortality, but this did not survive adjustment for demographics and education. The association between IQ and mortality seemed to be predominantly accounted for by performance on one specific IQ subtest that taps executive processes (i.e., Digit Symbol (DS)). Performance on this subtest uniquely and robustly predicted mortality in both unadjusted and adjusted models, such that a 1-standard deviation difference in performance was associated with a 28% change in risk of mortality over the 10-year follow-up interval in adjusted models.
The association between IQ and mortality in older adults may be predominantly attributable to individual differences in DS performance.
The availability, accessibility and acceptability of services are critical factors in rural health service delivery. In Canada, the aging population and the consequent increase in prevalence of dementia challenge the ability of many rural communities to provide specialized dementia care. This paper describes the development, operation and evaluation of an interdisciplinary memory clinic designed to improve access to diagnosis and management of early stage dementia for older persons living in rural and remote areas in the Canadian province of Saskatchewan. We describe the clinic structure, processes and clinical assessment, as well as the evaluation research design and instruments. Finally, we report the demographic characteristics and geographic distribution of individuals referred during the first three years.
Although only 20-50% of individuals with dementia are diagnosed, early diagnosis enables patients and families to access interventions and services, and plan for the future. The current study explored the experiences of rural family caregivers in the period leading up to a diagnostic assessment at a Canadian memory clinic, their hopes and expectations of the assessment, and their experiences in the six months following diagnosis. Using a longitudinal, retrospective and prospective qualitative research design, caregivers of 30 patients referred to the clinic were interviewed during the diagnostic assessment process and again six months after the diagnosis. Most caregivers reported first noticing symptoms two years prior to diagnosis. The pre-diagnostic interviews revealed a prevalent 'need to know' among caregivers that drove the help-seeking process. Caregivers hoped that the diagnosis would have the benefits of 'naming it,' 'accessing treatment,' 'knowing what to expect,' and 'receiving guidance.' When asked six months later about the impact of the diagnosis, the main theme was 'acceptance and moving forward.' Caregivers reported that the diagnosis provided 'relief,' 'validation,' and 'improved access to services.' These findings can inform care practices of primary health care providers who represent the first point of contact regarding expectations and experiences of dementia-related diagnoses.
Administration mode, age, education, and practice effects were examined for the Mental Alternation Test (MAT), a brief orally administered measure of executive function. Participants (N = 135) between the ages of 65 and 85 years completed the MAT twice in person, twice over the telephone, or once in person and once over the telephone. MAT scores did not differ across administration modes. Furthermore, the MAT detected normative decreases in executive ability in later life. The correlation between MAT performance and educational attainment was small. Finally, practice effects, which were influenced by age, were found between administration times. These findings provide important implications for both research and clinical applications of the MAT in older populations.
This study examined nursing aides' (NAs) perspectives of specific incidents of combative behavior from nursing home residents with dementia, particularly their attributions for the behaviors.
This research is part of a larger mixed-method study exploring combative behavior as experienced by NAs. The data for this component were collected using a cross-sectional survey design. NAs used a prospective event-reporting log or "diary" to record consecutive incidents of combative resident behaviors.
Eleven rural nursing homes located in a mid-Western Canadian province.
Eighty-three full-time, part-time, and casual NAs.
NAs used the diary instrument to document details of each incident of combative behavior over a 144-hour period. Findings from the diaries were explored in subsequent focus groups (reported elsewhere).
The 83 NAs reported 409 incidents linked to residents with dementia, with a range of 1 to 28 incidents per aide. The frequency of incidents in the preceding month was reported as follows: none (11.1%), 1-5 times (58.7%), 6-10 times (11.1%), more than 10 times (19.0%). Most incidents occurred in residents' rooms (65%) during personal care, with the most frequent behaviors reported as slapping, squeezing, punching or hitting, and shoving. The main perceived causes of the behavior were cognitive impairment and residents not wanting care. NAs reported they could control or modify the cause in only 3% of incidents, and they were not optimistic about preventing future combative behaviors. They continued to provide care in 89% of incidents.
In the diaries, NAs identified resident-related factors (cognitive impairment and not wanting care) as the main causes of combative behavior, and they reported having no control over these factors. In the focus groups conducted to explore diary findings, NAs reported system-level factors, also beyond their control, which affected their practices and increased their risk of exposure to combative behavior. Taken together, the results of this research program suggest a need for a broad multifaceted strategy aimed at addressing the modifiable risk factors, which includes recognizing NAs as equal partners in a team process backed by strong organizational support and commitment.
Comment In: J Am Med Dir Assoc. 2012 Mar;13(3):195-621945459
Neuropsychological batteries are often translated for use across populations differing in preferred language. Yet, equivalence in construct measurement across groups cannot be assumed. To address this issue, we examined data from the Canadian Study of Health and Aging, a large study of older adults. We tested the hypothesis that the latent variables underlying the neuropsychological battery administered in French or English were the same (invariant). The best-fitting baseline model, established in the English-speaking Exploratory sample (n = 716), replicated well in the English-speaking Validation sample (n = 715), and the French-speaking sample (FS, n = 446). Across the English- and FSs, two of the factors, Long-term Retrieval and Visuospatial speed, displayed invariance, that is, reflected the same constructs measured in the same scales. In contrast, the Verbal Ability factor showed only partial invariance, reflecting differences in the relative difficulty of some tests of language functions. This empirical demonstration of partial measurement invariance lends support to the continued use of these translated measures in clinical and research contexts and illustrates a framework for detailed evaluation of the generality of models of cognition and psychopathology, across groups of any sort.
Recent advances in telehealth have improved access to health care for those in rural areas. It is important that examinations conducted via telehealth are comparable to in-person testing. A rural and remote memory clinic in Saskatoon provided an opportunity to compare scores on the Mini-Mental State Examination (MMSE) administered in-person and via telehealth.
After an initial one day assessment in Saskatoon, patients were seen in follow-up at 6 and 12 weeks. Individual patients were randomly assigned to either in-person follow-up assessment in Saskatoon or telehealth assessment in their home community. Patients who initially received in-person assessments were seen by telehealth for their next follow-up visit and vice-versa. The same neurologist administered MMSEs at all visits. The first 71 patients with both 6 and 12 week follow-up assessments were included in this study. The scores of in-person and telehealth MMSE administrations were compared using the methods of Bland and Altman as well as a paired t-test.
MMSE scores did not differ significantly between telehealth (22.34 +/- 6.35) and in-person (22.70 +/- 6.51) assessments.
Telehealth provides an acceptable means of assessing mental status of patients in remote areas.