Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Division of Preventative Medicine, Northwestern University, Chicago, Illinois, USA.
J Am Geriatr Soc. 2022 Sep;70(9):2646-2652. doi: 10.1111/jgs.17927. Epub 2022 Jun 20.
Older adults frequently defer decisions about their aging-in-place/long-term care (AIP-LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP-LTC planning.
As part of the PlanYourLifespan (PYL)-LitCog study, we longitudinally examined AIP-LTC decision-making among a cohort (LitCog) of community-based older adults (65 years and older) recruited from hospital-associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence-based online intervention that facilitates AIP-LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP-LTC decision-making. Cross-sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP-LTC decision-making.
Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non-White), subjects were more likely to have made AIP-LTC decisions if they had adequate inductive reasoning (ETS letter sets total-OR = 1.14 (95% CI = 1.03-1.27; p < 0.05)) and adequate working memory (size judgment span total-OR = 1.76 (95% CI = 1.13-2.73; p < 0.05)). There were no differences in decision-making observed in verbal abilities, long-term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision-making response at baseline.
Inductive reasoning and working memory are critical to AIP-LTC decision-making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP-LTC needs.
老年人经常推迟有关他们就地养老/长期护理（AIP-LTC）需求的决策。因此，当老年人的阿尔茨海默病恶化时，家庭成员/朋友成为替代决策者。我们试图了解认知的哪些方面会影响老年人的 AIP-LTC 规划。
作为 PlanYourLifespan（PYL）-LitCog 研究的一部分，我们对来自伊利诺伊州芝加哥医院附属初级保健诊所的社区老年人（65 岁及以上）队列（LitCog）进行了 AIP-LTC 决策的纵向研究，对他们进行了广泛的认知测试。PlanYourLifespan.org（PYL）是一种基于证据的在线干预措施，可以促进 AIP-LTC 规划。受试者接受基线测试，接受 PYL 在线干预，然后在 1、6 和 12 个月时接受关于 AIP-LTC 决策的调查。进行了横断面逻辑回归分析，以检查影响 AIP-LTC 决策的认知变量。
在接受采访的 293 名老年人中（平均年龄 73.0 岁，40.4%为非白人），如果他们具有足够的归纳推理能力（ETS 字母集总数的优势比[OR]为 1.14（95%置信区间[CI]为 1.03-1.27；p<0.05））和足够的工作记忆能力（大小判断跨度总数的优势比[OR]为 1.76（95%CI 为 1.13-2.73；p<0.05）），他们更有可能做出 AIP-LTC 决策。在言语能力、长期记忆或处理速度方面，没有观察到决策方面的差异。所有分析均调整了参与者的性别、种族、年龄和基线时的决策反应。
归纳推理和工作记忆对 AIP-LTC 决策至关重要。常规筛查这些特定的认知领域对于确定目标人群并帮助老年人及时为未来的 AIP-LTC 需求做好准备非常重要。
