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      Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: Analysis of interRAI data for home care and long-term care recipients in Ontario

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          Abstract

          Objectives

          The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada.

          Methods

          Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments.

          Results

          The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group.

          Conclusions

          The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.

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          Most cited references63

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          • Article: found

          Dementia prevention, intervention, and care

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            Causes and prevalence of visual impairment among adults in the United States.

            To estimate the cause-specific prevalence and distribution of blindness and low vision in the United States by age, race/ethnicity, and gender, and to estimate the change in these prevalence figures over the next 20 years. Summary prevalence estimates of blindness (both according to the US definition of < or =6/60 [< or =20/200] best-corrected visual acuity in the better-seeing eye and the World Health Organization standard of < 6/120 [< 20/400]) and low vision (< 6/12 [< 20/40] best-corrected vision in the better-seeing eye) were prepared separately for black, Hispanic, and white persons in 5-year age intervals starting at 40 years. The estimated prevalences were based on recent population-based studies in the United States, Australia, and Europe. These estimates were applied to 2000 US Census data, and to projected US population figures for 2020, to estimate the number of Americans with visual impairment. Cause-specific prevalences of blindness and low vision were also estimated for the different racial/ethnic groups. Based on demographics from the 2000 US Census, an estimated 937 000 (0.78%) Americans older than 40 years were blind (US definition). An additional 2.4 million Americans (1.98%) had low vision. The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness. Cataract was the leading cause of low vision, responsible for approximately 50% of bilateral vision worse than 6/12 (20/40) among white, black, and Hispanic persons. The number of blind persons in the US is projected to increase by 70% to 1.6 million by 2020, with a similar rise projected for low vision. Blindness or low vision affects approximately 1 in 28 Americans older than 40 years. The specific causes of visual impairment, and especially blindness, vary greatly by race/ethnicity. The prevalence of visual disabilities will increase markedly during the next 20 years, owing largely to the aging of the US population.
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              MDS Cognitive Performance Scale.

              Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.

                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 February 2018
                2018
                : 13
                : 2
                : e0192971
                Affiliations
                [1 ] Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
                [2 ] Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
                [3 ] Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
                [4 ] Department of Psychology, University of Toronto, Toronto, Ontario, Canada
                [5 ] Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
                [6 ] Faculty of Medicine/Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
                [7 ] Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [8 ] School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
                [9 ] Department of Psychology, University of Toronto, Mississauga, Ontario, Canada
                [10 ] Department of Psychology, Concordia University, Montreal, Quebec, Canada
                [11 ] School of Health Studies, Western University, London, Ontario, Canada
                [12 ] School of Optometry, University of Montreal, Montreal, Quebec, Canada
                [13 ] CRIR/MAB-Mckay Rehabilitation Centre of West-Central Montreal Health, Montreal, Quebec, Canada
                [14 ] CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Montreal, Quebec, Canada
                West Chester University of Pennsylvania, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3241-6580
                Article
                PONE-D-17-16697
                10.1371/journal.pone.0192971
                5814012
                29447253
                ac13e8c2-e615-4924-be89-ffd3f420f508
                © 2018 Guthrie et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 May 2017
                : 1 February 2018
                Page count
                Figures: 4, Tables: 8, Pages: 27
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award Recipient :
                Funded by: Canadian Consortium on Neurodegeneration in Aging
                Award Recipient :
                Funded by: Lloyd Carr-Harris Foundation
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;
                Award ID: 28881 & 30620
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000143, Alzheimer Society;
                Award Recipient :
                Financial support for this project was provided to DMG, JC, KH, PM, JBO, MKP-F, NAP, MYS and WW by the Canadian Consortium on Neurodegeneration in Aging (CCNA; http://ccna-ccnv.ca/en) and the CCNA/Alzheimer Society of Canada ( http://www.alzheimer.ca/en) who provided a graduate scholarship to JGSD. The CCNA and DMG are supported by a grant from the Canadian Institutes of Health Research (CIHR; http://www.cihr-irsc.gc.ca/e/193.html) with funding from several partners. This work also was supported financially through a grant from the Lloyd Carr-Harris Foundation ( http://www.lchf.ca/) to DMG. WW is supported by a Junior 1 Career Grant from the FRQ-S (# 28881 & 30620; http://www.frqs.gouv.qc.ca/en/). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Ophthalmology
                Visual Impairments
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Hearing Disorders
                Deafness
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Neurodegenerative Diseases
                Alzheimer's Disease
                Medicine and Health Sciences
                Health Care
                Long-Term Care
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognition
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Vision
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Vision
                Social Sciences
                Psychology
                Sensory Perception
                Vision
                Custom metadata
                Data are available from the Canadian Institute for Health Information for researchers who meet the criteria for access to confidential data. These data represent third party data that are not owned nor collected by the study authors. A data request form can be found here: https://www.cihi.ca/en/access-data-and-reports/make-a-data-request.

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