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Cognitive impairment moderates the relationship between social capital and self-perceived health
Developing Topics surveyed. Conclusions: In conclusion, based on the result of the study the dependency level of the elderly eventually contributes to their quality of life. P4-402
THE DEVELOPMENT OF A PROTOTYPE OF ELDERLY NURSING POST WITH ELDERLYFRIENDLY FACILITIES AND INTEGRATED HEALTH INFORMATION IN DEPOK, INDONESIA
Ria Maria Theresa1, Indang Trihandini2, 1UPN Veteran Jakarta, Jakarta, Indonesia; 2University of Indonesia, Jakarta, Indonesia. Background: Aging is a phase of life that all human would have in their life. Ageing cause declining physical and psychological functions or degenerative process in him. The person in this situation is called elderly. Depok is an administrative city and one of the buffer cities for Jakarta. According to 2010 data, the ratio of green open land to the inhabited area consisting of residential, offices, and other city facilities is currently 55:45 despite the fact that the city authorities have allocated 50% of the city area for inhibited area and the other half for green open land. Depok was projected to be inhabited not more than 800,000 people in 2005, but now its population hits 1.700.949 inhabitants. As a result, the elderly population shows a growing trend. It is estimated that there are currently 204,060 elderly or 7.7% of the total population with life expectancy of 73 years, and this makes Depok as the second municipal city with the largest elderly population in Indonesia after Yogya. In addition, the elderly population has almost reached the national proportion of 8%. Of the 11 districts in Depok, Pancoran Mas, Sukma Jaya and Beji are the districts with higher proportion of the elderly. Methods: Case report in community services. Results: In line with the above condition, the mayor of Depok supports Depok as an elderly-friendly city. Some programs have been done by building a special lane for elderly for crossing in front of Bhakti Yudha hospital and Depok City Government compounds. Those crossing facilities are equipped with a button to turn on a red light if an elderly wants to cross the street. In addition, Depok city authorities provide a health program for the elderly in collaboration with the Health Department of Depok by establishing an Integrated Nursing Post at residential level. Now the number of the integrated nursing post has grown to 344 posts spreading over six districts in the city of Depok. Conclusions: The results ascertained through service to community program show that there are problems in terms of health, human resources and infrastructure faced by the integrated nursing posts in Depok. P4-403
COGNITIVE IMPAIRMENT MODERATES THE RELATIONSHIP BETWEEN SOCIAL CAPITAL AND SELF-PERCEIVED HEALTH
Jye Wang1, Ling-Hui Chang2, 1Chang Jung Christian University, Tainan, Taiwan; 2National Cheng-Kung University, Tainan, Taiwan. Background: People with cognitive impairments frequently experience decreased social contact and social interaction. Studies have shown that social capital predicts health outcomes. To date, few studies have determined how cognitive impairment affects the relationship between social capital and health. We hypothesize that cognition has a moderating effect on the relationship between social capital and self-perceived health. Methods: This population-based longitudinal-cohort study included 1646 communitydwelling elderly aged 65 and older from 2003 and 2007 waves of the Survey of Health and Living Status of the Elderly in Taiwan. 447 subjects were rated as cognitively impaired by a modified Short Portable Mental Status Questionnaire and 1169 were rated as normal. Social capital was measured by social trust, social participation, as well as receipt and provision of emotional and instrumental social support. Multivariate linear regression models were used for this stratified analysis. All models were controlled for age, gender, ethnicity, martial status, educational level, comorbidities, and health behaviors. Results: Between the two groups, there is no significant difference in self-perceived health, social trust, and provision of instrumental support. The cognitively impaired elderly received more instrumental support, less emotional support, and had lower level of social participation. Social trust and social participation were significant predictors of self-perceived health for both groups. However, these relationships were stronger for the cognitively impaired elderly. Receipt of emotional support significantly predicted
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self-perceived health in the normal group, but not in the cognitive impaired group. No other measures of social support predicted health in either group. Conclusions: The results show that cognition moderates the relationships between some measures of social capital and self-perceived health. The relationships between two measures of social capital (social trust and social participation) and self-perceived health were stronger in the cognitively impaired elderly. However, the relationship between emotional support and self-perceived health was stronger for the normal group. It suggests that different dimension of social capital may impact self-perceived health differently between cognitively impaired and normal elderly. Future study should further examine the effect of social capital on different health outcomes as well as whether cognitive function moderates these relationships, both in the community-dwelling and institutionalized elderly.
P4-404
IS AN ALTERED CIRCADIAN TEMPERATURE RHYTHM ASSOCIATED WITH BEHAVIORAL SYMPTOMS IN NURSING HOME RESIDENTS WITH DEMENTIA?
Lynn Woods1, Virginia King1, Cornelia Beck2, 1University of California, Los Angeles, Los Angeles, California, United States; 2University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States. Background: Behavioral symptoms of dementia (BSD) occur in 56-85% of persons with dementia, increasing their likelihood of being relocated into a nursing home (NH). While BSD have been linked to altered circadian cortisol rhythms, little work has investigated the link between BSD and other circadian rhythms such as core body temperature. The purpose of this study was to determine if the BSD of NH residents with dysregulated circadian temperature rhythms differ from those with normal temperature rhythms. Methods: In this descriptive pilot study, 17 NH residents with advanced dementia (mean age 87.06 6 7.45; 94.1% female) were videotaped over 2-4 days. The Modified Agitated Behavior Rating Scale was used to code BSD using Noldus, The Observer 5.0. Tympanic temperature was measured for each resident q3 hours, for 36 hours. Using SPSS, participants were divided into two groups (abnormal vs. normal temperature rhythms) based on the root mean square error of the residuals between the observed temperature curve and predicted curve generated using cosinor analysis for each person. Mean behavior scores were compared between groups using Mann-Whitney U tests. Results: No significant differences were found in BSD when residents with normal temperature rhythms were compared to those with abnormal temperature rhythms [Mean Total BSD across days: Normal: 5.31 6 4.41, Abnormal: 10.88 6 15. 53; p > 0.05]. Conclusions: While persons with an abnormal temperature exhibited a higher mean BSD, they also exhibited higher variability (SD) compared to those with a normal temperature rhythm. Higher variability (SD) may be one indication of circadian rhythm disruption in NH residents. Limitations include a small sample size, high heterogeneity, and aggregation across days of the data, all of which may mask an effect. Future research will involve the use of circadian rhythm as a predictor of BSD in NH residents with dementia. It will also assess targeted treatment strategies to "normalize" circadian rhythm and potentially ameliorate BSD.
P4-405
DETECTING AND CHARACTERIZING COMPLEX BEHAVIORAL SYMPTOMS OF PERSONS WITH DEMENTIA
Lynn Woods, Maria Yefimova, Mary Lynn Brecht, University of California, Los Angeles, Los Angeles, California, United States. Background: Behavioral symptoms in persons with dementia (BSD), such as yelling and restlessness, some of most challenging problems faced by elders and their caregivers affect between 56% and 83% elders with dementia. Detecting and quantifying complex, temporal BSD patterns using current analysis methods has hampered the development and refinement of tailored interventions. THEMEÔ provides a method of detecting complex non-sequential temporal patterns (T-patterns) of BSD not identifiable by traditional sequential methods. The purpose of this study was to use THEMEÔ to
THE DEVELOPMENT OF A PROTOTYPE OF ELDERLY NURSING POST WITH ELDERLYFRIENDLY FACILITIES AND INTEGRATED HEALTH INFORMATION IN DEPOK, INDONESIA
Ria Maria Theresa1, Indang Trihandini2, 1UPN Veteran Jakarta, Jakarta, Indonesia; 2University of Indonesia, Jakarta, Indonesia. Background: Aging is a phase of life that all human would have in their life. Ageing cause declining physical and psychological functions or degenerative process in him. The person in this situation is called elderly. Depok is an administrative city and one of the buffer cities for Jakarta. According to 2010 data, the ratio of green open land to the inhabited area consisting of residential, offices, and other city facilities is currently 55:45 despite the fact that the city authorities have allocated 50% of the city area for inhibited area and the other half for green open land. Depok was projected to be inhabited not more than 800,000 people in 2005, but now its population hits 1.700.949 inhabitants. As a result, the elderly population shows a growing trend. It is estimated that there are currently 204,060 elderly or 7.7% of the total population with life expectancy of 73 years, and this makes Depok as the second municipal city with the largest elderly population in Indonesia after Yogya. In addition, the elderly population has almost reached the national proportion of 8%. Of the 11 districts in Depok, Pancoran Mas, Sukma Jaya and Beji are the districts with higher proportion of the elderly. Methods: Case report in community services. Results: In line with the above condition, the mayor of Depok supports Depok as an elderly-friendly city. Some programs have been done by building a special lane for elderly for crossing in front of Bhakti Yudha hospital and Depok City Government compounds. Those crossing facilities are equipped with a button to turn on a red light if an elderly wants to cross the street. In addition, Depok city authorities provide a health program for the elderly in collaboration with the Health Department of Depok by establishing an Integrated Nursing Post at residential level. Now the number of the integrated nursing post has grown to 344 posts spreading over six districts in the city of Depok. Conclusions: The results ascertained through service to community program show that there are problems in terms of health, human resources and infrastructure faced by the integrated nursing posts in Depok. P4-403
COGNITIVE IMPAIRMENT MODERATES THE RELATIONSHIP BETWEEN SOCIAL CAPITAL AND SELF-PERCEIVED HEALTH
Jye Wang1, Ling-Hui Chang2, 1Chang Jung Christian University, Tainan, Taiwan; 2National Cheng-Kung University, Tainan, Taiwan. Background: People with cognitive impairments frequently experience decreased social contact and social interaction. Studies have shown that social capital predicts health outcomes. To date, few studies have determined how cognitive impairment affects the relationship between social capital and health. We hypothesize that cognition has a moderating effect on the relationship between social capital and self-perceived health. Methods: This population-based longitudinal-cohort study included 1646 communitydwelling elderly aged 65 and older from 2003 and 2007 waves of the Survey of Health and Living Status of the Elderly in Taiwan. 447 subjects were rated as cognitively impaired by a modified Short Portable Mental Status Questionnaire and 1169 were rated as normal. Social capital was measured by social trust, social participation, as well as receipt and provision of emotional and instrumental social support. Multivariate linear regression models were used for this stratified analysis. All models were controlled for age, gender, ethnicity, martial status, educational level, comorbidities, and health behaviors. Results: Between the two groups, there is no significant difference in self-perceived health, social trust, and provision of instrumental support. The cognitively impaired elderly received more instrumental support, less emotional support, and had lower level of social participation. Social trust and social participation were significant predictors of self-perceived health for both groups. However, these relationships were stronger for the cognitively impaired elderly. Receipt of emotional support significantly predicted
e53
self-perceived health in the normal group, but not in the cognitive impaired group. No other measures of social support predicted health in either group. Conclusions: The results show that cognition moderates the relationships between some measures of social capital and self-perceived health. The relationships between two measures of social capital (social trust and social participation) and self-perceived health were stronger in the cognitively impaired elderly. However, the relationship between emotional support and self-perceived health was stronger for the normal group. It suggests that different dimension of social capital may impact self-perceived health differently between cognitively impaired and normal elderly. Future study should further examine the effect of social capital on different health outcomes as well as whether cognitive function moderates these relationships, both in the community-dwelling and institutionalized elderly.
P4-404
IS AN ALTERED CIRCADIAN TEMPERATURE RHYTHM ASSOCIATED WITH BEHAVIORAL SYMPTOMS IN NURSING HOME RESIDENTS WITH DEMENTIA?
Lynn Woods1, Virginia King1, Cornelia Beck2, 1University of California, Los Angeles, Los Angeles, California, United States; 2University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States. Background: Behavioral symptoms of dementia (BSD) occur in 56-85% of persons with dementia, increasing their likelihood of being relocated into a nursing home (NH). While BSD have been linked to altered circadian cortisol rhythms, little work has investigated the link between BSD and other circadian rhythms such as core body temperature. The purpose of this study was to determine if the BSD of NH residents with dysregulated circadian temperature rhythms differ from those with normal temperature rhythms. Methods: In this descriptive pilot study, 17 NH residents with advanced dementia (mean age 87.06 6 7.45; 94.1% female) were videotaped over 2-4 days. The Modified Agitated Behavior Rating Scale was used to code BSD using Noldus, The Observer 5.0. Tympanic temperature was measured for each resident q3 hours, for 36 hours. Using SPSS, participants were divided into two groups (abnormal vs. normal temperature rhythms) based on the root mean square error of the residuals between the observed temperature curve and predicted curve generated using cosinor analysis for each person. Mean behavior scores were compared between groups using Mann-Whitney U tests. Results: No significant differences were found in BSD when residents with normal temperature rhythms were compared to those with abnormal temperature rhythms [Mean Total BSD across days: Normal: 5.31 6 4.41, Abnormal: 10.88 6 15. 53; p > 0.05]. Conclusions: While persons with an abnormal temperature exhibited a higher mean BSD, they also exhibited higher variability (SD) compared to those with a normal temperature rhythm. Higher variability (SD) may be one indication of circadian rhythm disruption in NH residents. Limitations include a small sample size, high heterogeneity, and aggregation across days of the data, all of which may mask an effect. Future research will involve the use of circadian rhythm as a predictor of BSD in NH residents with dementia. It will also assess targeted treatment strategies to "normalize" circadian rhythm and potentially ameliorate BSD.
P4-405
DETECTING AND CHARACTERIZING COMPLEX BEHAVIORAL SYMPTOMS OF PERSONS WITH DEMENTIA
Lynn Woods, Maria Yefimova, Mary Lynn Brecht, University of California, Los Angeles, Los Angeles, California, United States. Background: Behavioral symptoms in persons with dementia (BSD), such as yelling and restlessness, some of most challenging problems faced by elders and their caregivers affect between 56% and 83% elders with dementia. Detecting and quantifying complex, temporal BSD patterns using current analysis methods has hampered the development and refinement of tailored interventions. THEMEÔ provides a method of detecting complex non-sequential temporal patterns (T-patterns) of BSD not identifiable by traditional sequential methods. The purpose of this study was to use THEMEÔ to