The Journal of Antibiotics, Published online: 08 August 2019; doi:10.1038/s41429-019-0217-5
Nocardamin glucuronide, a new member of the ferrioxamine siderophores isolated from the ascamycin-producing strain Streptomyces sp. 80H647
Little population‐level evidence exists to guide the development of interventions for people with dementia in non–nursing home settings. We hypothesized people living at home with moderately severe dementia would differ in social, functional, and medical characteristics from those in either residential care or nursing home settings.
Retrospective cohort study using pooled data from the National Health and Aging Trends Study, an annual survey of a nationally representative sample of Medicare beneficiaries.
US national sample.
Respondents newly meeting criteria for incident moderately severe dementia, defined as probable dementia with functional impairment: 728 older adults met our definition between 2012 and 2016.
Social characteristics examined included age, sex, race/ethnicity, country of origin, income, educational attainment, partnership status, and household size. Functional characteristics included help with daily activities, falls, mobility device use, and limitation to home or bed. Medical characteristics included comorbid conditions, self‐rated health, hospital stay, symptoms, and dementia behaviors.
Extrapolated to the population, an estimated 3.3 million older adults developed incident moderately severe dementia between 2012 and 2016. Within this cohort, 64% received care at home, 19% in residential care, and 17% in a nursing facility. social, functional, and medical characteristics differed across care settings. Older adults living at home were 2 to 5 times more likely to be members of disadvantaged populations and had more medical needs: 71% reported bothersome pain compared with 60% in residential care or 59% in nursing homes.
Over a 5‐year period, 2.1 million people lived at home with incident moderately severe dementia. People living at home had a higher prevalence of demographic characteristics associated with systematic patterns of disadvantage, more social support, less functional impairment, worse health, and more symptoms compared with people living in residential care or nursing facilities. This novel study provides insight into setting‐specific differences among people with dementia.
Most forms of dementia are associated with progressive cognitive and noncognitive impairments that can severely affect fitness to drive. Whether safe driving is still possible in the single case, however, is often difficult to decide and may be dependent on both severity and type of the respective dementia syndrome. Particularly in early disease stages, Alzheimer disease dementia (ADD) and different types of non‐Alzheimer dementias, such as vascular dementia (VaD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and Parkinson disease dementia (PDD), might differentially affect fitness to drive.
To examine the effects of severity and type of dementia on driving fitness, we conducted a systematic review with qualitative narrative synthesis, involving different driving outcomes in different forms and stages of dementia.
Literature research included MEDLINE and PsycINFO databases with a focus on the most relevant and recent publications on the topic.
The population of interest included older drivers in different stages of ADD and different forms of non‐Alzheimer dementias (VaD, FTD, DLB, and PDD).
Narrative description of driving outcomes in the population of interest.
Overall, previous studies suggest that driving fitness is severely impaired in moderate and severe dementia, irrespective of the type of dementia. In milder disease stages, fitness to drive appears to be more severely impaired in non‐Alzheimer dementias than in ADD, since the non‐Alzheimer syndromes are not only associated with driving‐relevant cognitive but noncognitive risk factors, such as behavioral or motor symptoms.
Based on these findings, practical recommendations are presented, including a risk evaluation for driving safety, depending on severity and type of different dementia syndromes.
Preparing for future long‐term care (LTC) needs is a critical component of successful aging. Clinicians with aging patient panels may be a valuable source of information about the importance of LTC planning and the mechanisms available to do so, including private LTC insurance (LTCi). This article provides an overview, from a clinician's perspective, of current LTC financing and the key questions patients should consider when assessing LTCi. Although actual purchasing decisions likely require support from impartial financial experts, clinicians may be well positioned to help initiate difficult conversations about LTC planning and point patients to unbiased resources concerning LTCi.
Diet quality has been associated with health outcomes and quality of life. However, the association between diet quality and mortality in older people, those aged 80 years and older, is understudied. Therefore, we conducted a prospective study to examine whether better diet quality, assessed by a validated dietary screening tool (DST), was associated with lower mortality in those aged 80 years and older.
Our study included 1990 participants (812 men and 1178 women), with a mean age of 84.1 years at baseline (ranging from 80 to 102 years old), from the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Baseline descriptive information was obtained in 2009, and the DST was administered via mailed survey. The DST is composed of 25 food‐ and behavior‐specific questions associated with dietary intake that generate a diet quality score ranging from 0 (lowest) to 100 (highest). Death was identified using electronic medical record and the Social Security Death Index data. Hazard ratios (HRs) and 95% confidence intervals (CIs) across three diet quality categories were calculated by using Cox proportional hazards models after adjusting for potential confounders.
Over 8 years of follow‐up (October 2009‐February 2018), 931 deaths were documented. Higher diet quality was associated with lower mortality risk (P‐trend = .04). Participants with high diet quality (defined as DST scores >75) had significantly lower risk of mortality compared with those with low diet quality (defined as DST scores <60) after adjusting for potential risk factors (adjusted HR = 0.76; 95% CI = 0.59‐0.97).
Diet quality, assessed by DST, is significantly associated with risk of mortality in older adults aged 80 years and older in our prospective cohort. Our results indicate that nutrition may have an important role in healthy aging, and more studies are needed to develop appropriate dietary recommendations for older persons.
