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Rates of Cognitive and Functional Impairments in Older Adults Residing in a Continuing Care Senior Housing Community

Published online by Cambridge University Press:  22 March 2021

Ryan Van Patten
Affiliation:
Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA92093, USA Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
Zanjbeel Mahmood
Affiliation:
Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA, USA
Tanya T. Nguyen
Affiliation:
Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA92093, USA Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
Jacqueline E. Maye
Affiliation:
Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
Ho-Cheol Kim
Affiliation:
Scalable Knowledge Intelligence, IBM Research – Almaden, San Jose, CA, USA
Dilip V. Jeste*
Affiliation:
Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA92093, USA Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
Elizabeth W. Twamley
Affiliation:
Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA92093, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA92093, USA Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA92161, USA
*
*Correspondence and reprint requests to: D.V. Jeste, Senior Associate Dean for Healthy Aging and Senior Care, Distinguished Professor of Psychiatry and Neurosciences, Estelle and Edgar Levi Memorial Chair in Aging, Director, Sam and Rose Stein Institute for Research on Aging, Co-Director, IBM-UCSD Center on Artificial Intelligence for Healthy Living, University of California San Diego, Co-Director of IBM-UCSD Artificial Intelligence for Healthy Living Center, 9500 Gilman Drive #0664, La Jolla, CA92023-0664, USA. E-mail: djeste@ucsd.edu

Abstract

Objective:

The current cross-sectional study examined cognition and performance-based functional abilities in a continuing care senior housing community (CCSHC) that is comparable to other CCSHCs in the US with respect to residents’ demographic characteristics.

Method:

Participants were 110 older adult residents of the independent living unit. We assessed sociodemographics, mental health, neurocognitive functioning, and functional capacity.

Results:

Compared to normative samples, participants performed at or above expectations in terms of premorbid functioning, attention span and working memory, processing speed, timed set-shifting, inhibitory control, and confrontation naming. They performed below expectation in verbal fluency and verbal and visual learning and memory, with impairment rates [31.4% (>1 SD below the mean) and 18.49% (>1.5 SD below the mean)] well above the general population (16% and 7%, respectively). Within the cognitive test battery, two tests of delayed memory were most predictive of a global deficit score. Most cognitive test scores correlated with performance-based functional capacity.

Conclusions:

Overall, results suggest that a subset of older adults in the independent living sector of CCSHCs are cognitively and functionally impaired and are at risk for future dementia. Results also argue for the inclusion of memory tests in abbreviated screening batteries in this population. We suggest that CCSHCs implement regular cognitive screening procedures to identify and triage those older adults who could benefit from interventions and, potentially, a transition to a higher level of care.

Type
Regular Research
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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References

REFERENCES

American Seniors Housing Association. (2013). Residents of Independent Living: How Today’s Residents Compare to Residents of 2001. Washington DC: American Seniors Housing Association.Google Scholar
Benedict, R.H.B., Groninger, L., Schretlen, D., Dobraski, M., & Shpritz, B. (1996). Revision of the brief visuospatial memory test: Studies of normal performance, reliability, and, validity. Psychological Assessment, 8(2), 145153 10.1037/1040-3590.8.2.145CrossRefGoogle Scholar
Biggs, S., Bernard, M., Kingston, P., & Nettleton, H. (2000). Lifestyles of belief: Narrative and culture in a retirement community. Ageing and Society, 20(6), 649672. https://doi.org/10.1017/S0144686X01007930 CrossRefGoogle Scholar
Blackstone, K., Moore, D.J., Franklin, D.R., Clifford, D.B., Collier, A.C., Marra, C.M.,… Heaton, R.K. (2012). Defining neurocognitive impairment in HIV: Deficit scores versus clinical ratings. The Clinical Neuropsychologist, 26(6), 894908. https://doi.org/10.1080/13854046.2012.694479 CrossRefGoogle ScholarPubMed
Brandt, J. & Benedict, R. (2001). Hopkins Verbal Learning Test- Revised: Professional manual. PAR.Google Scholar
Cahn-Weiner, D.A., Malloy, P.F., Boyle, P.A., Marran, M., & Salloway, S. (2000). Prediction of functional status from neuropsychological tests in community-dwelling elderly individuals. The Clinical Neuropsychologist, 14(2), 187195.10.1076/1385-4046(200005)14:2;1-Z;FT187CrossRefGoogle ScholarPubMed
Carson, N., Leach, L., & Murphy, K.J. (2018). A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. International Journal of Geriatric Psychiatry, 33(2), 379388.CrossRefGoogle ScholarPubMed
Choi, J. & Twamley, E.W. (2013). Cognitive rehabilitation therapies for Alzheimer’s disease: A review of methods to improve treatment engagement and self-efficacy. Neuropsychology Review, 23(1), 4862.10.1007/s11065-013-9227-4CrossRefGoogle ScholarPubMed
Delis, D.C., Kaplan, E., Kramer, J.H., 2001. Delis-Kaplan Executive Function System (DKEFS). San Antonio, TX: The Psychological Corporation.Google Scholar
Dong, Y., Sharma, V.K., Chan, B.P.L., Venketasubramanian, N., Teoh, H.L., Seet, R.C.S., & Chen, C. (2010). The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. Journal of the Neurological Sciences, 299(1–2), 1518.10.1016/j.jns.2010.08.051CrossRefGoogle Scholar
Field, A. (2018). Discovering Statistics Using IBM SPSS, (5th ed.). Sage.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state. Journal of Psychiatric Research, 12(3), 189198. https://doi.org/10.1016/0022-3956(75)90026-6 CrossRefGoogle ScholarPubMed
Fukui, T. & Lee, E. (2009). Visuospatial function is a significant contributor to functional status in patients with Alzheimer’s disease. American Journal of Alzheimer’s Disease & Other Dementias®, 24(4), 313321.10.1177/1533317509333903CrossRefGoogle ScholarPubMed
Gomar, J.J., Harvey, P.D., Bobes-Bascaran, M.T., Davies, P., & Goldberg, T.E. (2011). Development and cross-validation of the UPSA short form for the performance-based functional assessment of patients with mild cognitive impairment and Alzheimer disease. The American Journal of Geriatric Psychiatry, 19(11), 915922.10.1097/JGP.0b013e3182011846CrossRefGoogle ScholarPubMed
Gonzalez, R., Heaton, R.K., Moore, D.J., Letendre, S., Ellis, R.J., Wolfson, T.,… The Hnrc Group. (2003). Computerized reaction time battery versus a traditional neuropsychological battery: Detecting HIV-related impairments. Journal of the International Neuropsychological Society, 9(1), 6471. https://doi.org/10.1017/S1355617703910071 CrossRefGoogle ScholarPubMed
Hart, S., Smith, C.M., & Swash, M. (1988). Word fluency in patients with early dementia of Alzheimer type. British Journal of Clinical Psychology, 27(2), 115124.10.1111/j.2044-8260.1988.tb00759.xCrossRefGoogle ScholarPubMed
Heaton, R.K., Grant, I., Butters, N., White, D.A., Kirson, D., Atkinson, J.H.,… Group, T.H. (1995). The HNRC 500-Neuropsychology of HIV infection at different disease stages. Journal of the International Neuropsychological Society, 1(3), 231251. https://doi.org/10.1017/S1355617700000230 CrossRefGoogle ScholarPubMed
Heaton, R.K., Miller, S.W., Taylor, M.J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Psychological Assessment Resources, Inc.Google Scholar
Heaton, R.K., Paulsen, J.S., McAdams, L.A., Kuck, J., Zisook, S., Braff, D.,… Jeste, D.V. (1994). Neuropsychological deficits in schizophrenics: relationship to age, chronicity, and dementia. Archives of General Psychiatry, 51(6), 469476. https://doi.org/10.1001/archpsyc.1994.03950060033003 CrossRefGoogle ScholarPubMed
Holland, C., Boukouvalas, A., Wallis, S., Clarkesmith, D., Cooke, R., Liddell, L., & Kay, A. (2017). Transition from community dwelling to retirement village in older adults: Cognitive functioning and psychological health outcomes. Ageing and Society, 37(7), 14991526. https://doi.org/10.1017/S0144686X16000477 CrossRefGoogle Scholar
Hsu, Y.-H., Liang, C.-K., Chou, M.-Y., Liao, M.-C., Lin, Y.-T., Chen, L.-K., & Lo, Y.-K. (2014). Association of cognitive impairment, depressive symptoms and sarcopenia among healthy older men in the veterans retirement community in southern Taiwan: A cross-sectional study: Sarcopenia, cognition and depression. Geriatrics & Gerontology International, 14, 102108. https://doi.org/10.1111/ggi.12221 CrossRefGoogle Scholar
Huckans, M., Hutson, L., Twamley, E., Jak, A., Kaye, J., & Storzbach, D. (2013). Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults: Working toward a theoretical model and evidence-based interventions. Neuropsychology Review, 23(1), 6380.CrossRefGoogle Scholar
James, B.D., Boyle, P.A., Buchman, A.S., Barnes, L.L., & Bennett, D.A. (2011). Life space and risk of alzheimer disease, mild cognitive impairment, and cognitive decline in old age. The American Journal of Geriatric Psychiatry, 19(11), 961969. https://doi.org/10.1097/JGP.0b013e318211c219 CrossRefGoogle ScholarPubMed
Jeste, D.V. & Childers, J. (2017). Strategic planning for transformative senior living: Developing tomorrow’s leadership and workforce. Seniors Housing & Care Journal, 25(1), 113125.Google Scholar
Jeste, D.V., Glorioso, D., Lee, E.E., Daly, R., Graham, S., Liu, J.,… Kim, H.-C. (2019). Study of independent living residents of a continuing care senior housing community: Sociodemographic and clinical associations of cognitive, physical, and mental health. The American Journal of Geriatric Psychiatry, 27(9), 895907. https://doi.org/10.1016/j.jagp.2019.04.002 CrossRefGoogle ScholarPubMed
Kaplan, E.F., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test (2nd edition). Philadelphia: Lea & Febiger.Google Scholar
Kerr, J., Marshall, S.J., Patterson, R.E., Marinac, C.R., Natarajan, L., Rosenberg, D.,… Crist, K. (2013). Objectively measured physical activity is related to cognitive function in older adults. Journal of the American Geriatrics Society, 61(11), 19271931. https://doi.org/10.1111/jgs.12524 CrossRefGoogle ScholarPubMed
Kneale, D. (2013). What role for extra care housing in a socially isolated landscape? Housing Learning & Improvement Network. https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Reports/HLIN_Report_Isolation_SUMMARY.pdf Google Scholar
Kroenke, K., Spitzer, R.L., & Williams, J.B.W. (2001). The PHQ-9: Validity of a brie-f depression severity measure. Journal of General Internal Medicine, 16(9), 606613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Larner, A.J. (2012). Screening utility of the Montreal Cognitive Assessment (MoCA): In place of–or as well as–the MMSE?. International Psychogeriatrics, 24(3), 391396.CrossRefGoogle ScholarPubMed
Maeshima, S., Itakura, T., Nakagawa, M., Nakai, K., & Komai, N. (1997). Visuospatial impairment and activities of daily living in patients with Parkinson’s disease: A quantitative assessment of the cube-copying task. American Journal of Physical Medicine & Rehabilitation, 76(5), 383388.CrossRefGoogle ScholarPubMed
Mahmood, Z., Vella, L., Maye, J.E., Keller, A.V., Van Patten, R., Clark, J.M.R., & Twamley, E.W. (in press). Rates of cognitive and functional impairments in sheltered adults experiencing homelessness. Psychiatric Services. Google Scholar
Mausbach, B.T., Harvey, P.D., Goldman, S.R., Jeste, D.V., & Patterson, T.L. (2007). Development of a brief scale of everyday functioning in persons with serious mental illness. Schizophrenia Bulletin, 33(6), 13641372. https://doi.org/10.1093/schbul/sbm014 CrossRefGoogle ScholarPubMed
Mcalister, C., Schmitter-Edgecombe, M., & Lamb, R. (2016). Examination of variables that may affect the relationship between cognition and functional status in individuals with mild cognitive impairment: A meta-analysis. Archives of Clinical Neuropsychology, 31(2), 123147.Google ScholarPubMed
McClure, M.M., Bowie, C.R., Patterson, T.L., Heaton, R.K., Weaver, C., Anderson, H., & Harvey, P.D. (2007). Correlations of functional capacity and neuropsychological performance in older patients with schizophrenia: Evidence for specificity of relationships? Schizophrenia Research, 89(1), 330338. https://doi.org/10.1016/j.schres.2006.07.024 CrossRefGoogle ScholarPubMed
McCullough, K.C., Bayles, K.A., & Bouldin, E.D. (2019). Language performance of individuals at risk for mild cognitive impairment. Journal of Speech, Language, and Hearing Research, 62(3), 706722. https://doi.org/10.1044/2018_JSLHR-L-18-0232 CrossRefGoogle ScholarPubMed
McDougall, G.J. Jr, Becker, H., & Arheart, K.L. (2006). Older adults in the SeniorWISE study at risk for mild cognitive impairment. Archives of Psychiatric Nursing, 20(3), 126134.CrossRefGoogle ScholarPubMed
Mitchell, M. & Miller, L.S. (2008). Prediction of functional status in older adults: The ecological validity of four Delis–Kaplan Executive Function System tests. Journal of Clinical and Experimental Neuropsychology, 30(6), 683690.CrossRefGoogle ScholarPubMed
Mitchell, M.B., Miller, L.S., Woodard, J.L., Davey, A., Martin, P., Burgess, M., … & Georgia Centenarian Study. (2011). Regression-based estimates of observed functional status in centenarians. The Gerontologist, 51(2), 179189.CrossRefGoogle ScholarPubMed
Moore, R.C., Paolillo, E.W., Heaton, A., Fazeli, P.L., Jeste, D.V., & Moore, D.J. (2017). Clinical utility of the UCSD Performance-Based Skills Assessment—Brief (UPSA-B) in adults living with HIV: Associations with neuropsychological impairment and patient-reported everyday functioning difficulties. PLOS ONE, 12(8), e0183614. https://doi.org/10.1371/journal.pone.0183614 CrossRefGoogle ScholarPubMed
Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I.,… Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695699. https://doi.org/10.1111/j.1532-5415.2005.53221.x CrossRefGoogle ScholarPubMed
Netten, A., Darton, R., Bäumker, T., & Callaghan, L. (2011). Improving housing with care choices for older people: An evaluation of extra care housing.CrossRefGoogle Scholar
NIC Executive Summary (2018). Investing in Seniors Housing & Care Properties, 5th edition. National Investment Center for Seniors Housing & Care.Google Scholar
Ortman, J.M., Velkoff, V.A., & Hogan, H. (2014). An aging nation: the older population in the United States (pp. 251140). Suitland, MD, USA: United States Census Bureau, Economics and Statistics Administration, US Department of Commerce.Google Scholar
Overdorp, E.J., Kessels, R.P., Claassen, J.A., & Oosterman, J.M. (2016). The combined effect of neuropsychological and neuropathological deficits on instrumental activities of daily living in older adults: A systematic review. Neuropsychology Review, 26(1), 92106.CrossRefGoogle ScholarPubMed
Pan, C.W., Wang, X., Ma, Q., Sun, H.P., Xu, Y., & Wang, P. (2015). Cognitive dysfunction and health-related quality of life among older Chinese. Scientific reports, 5(1), 18.CrossRefGoogle ScholarPubMed
Patterson, T.L., Goldman, S., McKibbin, C.L., Hughs, T., & Jeste, D.V. (2001). UCSD Performance-Based Skills Assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27(2), 235245.CrossRefGoogle ScholarPubMed
Pereira, R., Pontes, M., Silva, A., Monteiro, E., Silva, C., Silva, L.,… Silva, J. (2015). Quality of life and the cognitive condition of elderly served in family health unit. International Archives of Medicine. https://doi.org/10.3823/1854 Google Scholar
Rebok, G.W., Ball, K., Guey, L.T., Jones, R.N., Kim, H.Y., King, J.W.,… ACTIVE Study Group (2014). Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society, 62(1), 1624. https://doi.org/10.1111/jgs.12607 CrossRefGoogle ScholarPubMed
Rosenberg, D.E., Bellettiere, J., Gardiner, P.A., Villarreal, V.N., Crist, K., & Kerr, J. (2016). Independent associations between sedentary behaviors and mental, cognitive, physical, and functional health among older adults in retirement communities. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71(1), 7883. https://doi.org/10.1093/gerona/glv103 CrossRefGoogle ScholarPubMed
Royall, D.R., Lauterbach, E.C., Kaufer, D., Malloy, P., Coburn, K.L., & Black, K.J. (2007). The cognitive correlates of functional status: A review from the Committee on Research of the American Neuropsychiatric Association. The Journal of Neuropsychiatry and Clinical Neurosciences, 19(3), 249265.CrossRefGoogle Scholar
Shippee, T.P. & Henning-Smith, C. (2015). Continuing care retirement communities. In Whitbourne, S. K. (Ed.), The Encyclopedia of Adulthood and Aging, John Wiley & Sons, Inc.Google Scholar
Sloan, F.A., Shayne, M.W., & Conover, C.J. (1995). Continuing care retirement communities: Prospects for reducing institutional long-term care. Journal of Health Politics, Policy and Law, 20(1), 7598. https://doi.org/10.1215/03616878-20-1-75 CrossRefGoogle ScholarPubMed
Taler, V. & Phillips, N.A. (2008). Language performance in Alzheimer’s disease and mild cognitive impairment: A comparative review. Journal of Clinical and Experimental Neuropsychology, 30(5), 501556. https://doi.org/10.1080/13803390701550128 CrossRefGoogle ScholarPubMed
Twamley, E.W., Ropacki, S.A.L., & Bondi, M. (2006). Neuropsychological and neuroimaging changes in preclinical Alzheimer’s disease. Journal of the International Neuropsychological Society, 12(5), 707735. https://doi.org/10.1017/S1355617706060863 CrossRefGoogle ScholarPubMed
Twamley, E.W., Thomas, K.R., Gregory, A.M., Jak, A.J., Bondi, M.W., Delis, D.C., & Lohr, J. B (2014). CogSMART compensatory cognitive training for traumatic brain injury: Effects over 1 year. Journal of Head Trauma Rehabilitation, 30(6), 391401.CrossRefGoogle Scholar
Twamley, E.W., Vella, L., Burton, C.Z., Heaton, R.K., & Jeste, D.V. (2012). Compensatory cognitive training for psychosis: Effects in a randomized controlled trial. The Journal of Clinical Psychiatry, 73(9), 12121219.CrossRefGoogle Scholar
Van Patten, R., Lee, E.E., Graham, S.A., Depp, C.A., Kim, H.-C., Jeste, D.V., & Twamley, E.W. (2019). The utility of the timed up-and-go test in predicting cognitive performance: A cross-sectional study of independent living adults in a retirement community. Journal of Applied Gerontology, 073346481987263. https://doi.org/10.1177/0733464819872636 Google Scholar
Van Patten, R., Vella, L., Mahmood, Z., Clark, J.M., Maye, J.E., & Twamley, E.W. (2020). Accuracy of case managers in estimating intelligence quotients and functional status of people experiencing homelessness. American Journal of Orthopsychiatry, 90(5), 586589.CrossRefGoogle ScholarPubMed
Vella, L., Patterson, T.L., Harvey, P.D., McClure, M.M., Mausbach, B.T., Taylor, M.J., & Twamley, E.W. (2017). Exploratory analysis of normative performance on the UCSD performance-based skills assessment-brief. Psychiatry Research, 256, 150155. https://doi.org/10.1016/j.psychres.2017.06.025 CrossRefGoogle ScholarPubMed
Wechsler, D. (2008). Wechsler Adult Intelligence Scale - Fourth Edition. San Antonio, TX: Pearson Assessment.Google Scholar
Wick, J. & Zanni, G. (2009). Aging in place: Multiple options, multiple choices. The Consultant Pharmacist, 24(11), 804812. https://doi.org/10.4140/TCP.n.2009.804 CrossRefGoogle ScholarPubMed
Wiles, J.L., Leibing, A., Guberman, N., Reeve, J., & Allen, R.E.S. (2012). The meaning of “aging in place” to older people. The Gerontologist, 52(3), 357366. https://doi.org/10.1093/geront/gnr098 CrossRefGoogle Scholar
Wilkinson, GS, Robertson, GJ. (2006). WRAT 4: Wide Range Achievement Test; Professional Manual (4th ed.). Lutz, FL: Psychological Assessment Resources, Inc.Google Scholar
Wrights, A.P., Fain, C.W., Miller, M.E., Rejeski, W.J., Williamson, J.D., & Marsh, A.P. (2015). Assessing physical and cognitive function of older adults in continuing care retirement communities: Who are we recruiting? Contemporary Clinical Trials, 40, 159165. https://doi.org/10.1016/j.cct.2014.12.003 CrossRefGoogle ScholarPubMed
Zarem, J.E. (2010). Today’s continuing care retirement community (CCRC). CCRC Task Force, American Seniors Housing Association.Google Scholar