- Email: [email protected]
Exploring clinical and behavioral factors that impact engagement in advanced care planning for persons with early cognitive impairment
Poster Presentations: P2
a national survey entitled “Mental Health and Quality of Life of Older Malaysians” conducted from 2003 through 2005 using a cross-sectional design. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy was used to measure dementia. A multiple binary logistic regression using Statistical Package for Social Sciences version 21 was conducted to assess the unique effect of food insufficiency in childhood on developing dementia in old age. Results: A notably higher prevalence of dementia was found in respondents who indicated they had experienced food insufficiency in childhood than in their food-sufficient counterparts (23.5% versus 14.3%). The findings from multiple logistic regression analysis revealed that food insufficiency in childhood would independently increase the risk of developing dementia in old age by 81%, after adjusting for sociodemographic factors (odds ratio ¼1.81, 95% confidence interval 1.13–2.92, P,0.01). Conclusions: Findings from the present study showing that food insufficiency in early life significantly contributes to dementia in later life highlight the importance of childhood living conditions in maintaining cognitive function in old age. It is, therefore, suggested that older adults with childhood food insufficiency might be targeted for programs designed to prevent dementia. Table 1 Results of Multiple Logistic Regression 95% C.I. for OR Variable Age (Ref: Young-Old) Old-old Oldest-old Sex (Male) Marital status (Married) Ethnicity (Malay) Stratum (Rural) Education (Ref: No formal) Primary Secondary and tertiary Food insufficiency
B
S.E.
OR
Lower
Upper
0.63 1.2 -0.47 -0.12 0.88 0.28
0.13 0.22 0.14 0.13 0.16 0.12
1.89*** 3.31*** 0.62*** 0.89 2.42*** 1.32*
1.46 2.15 0.47 0.68 1.76 1.04
2.44 5.1 0.82 1.15 3.33 1.68
-1.25 -1.89 0.6
0.14 0.43 0.24
0.29*** 0.15*** 1.81**
0.22 0.07 1.13
0.38 0.35 2.92
*p<0.05, **p<0.01, ***p<0.001 Hosmer and Lemeshow Test: c2 (8)¼10.10, p¼0.258
P2-281
EXPLORING CLINICAL AND BEHAVIORAL FACTORS THAT IMPACT ENGAGEMENT IN ADVANCED CARE PLANNING FOR PERSONS WITH EARLY COGNITIVE IMPAIRMENT
Sze Yan Tay1, John Davison2, Chong Jin Ng3, Philip Yap3, 1Singapore General Hospital, Singapore, Singapore; 2Middlemore Hospital, Auckland, New Zealand; 3Khoo Teck Puat Hospital, Singapore, Singapore. Contact e-mail: [email protected] Background: Advance care planning (ACP) is pertinent to holistic care for people with early cognitive impairment (ECI) who are generally still mentally capable of making rational decisions. People with ECI can remain in good physical health for extended periods of time despite eventual mental incapacity, making planning of health and social care needs in addition to end-of-life care decisions necessary. This study explores the willingness of people with ECI to engage in ACP and how clinical and behavioural variables shape their decisions. Methods: Ninety-six subjects with ECI
P599
(Mild Cognitive Impairment or early dementia, Clinical Dementia Rating¼0.5/1.0), assessed to have adequate insight (Clinical Insight Rating Scale), underwent an ACP information session after which they were assessed on their knowledge of dementia and willingness to engage in ACP. They were also interviewed on their beliefs and attitudes towards ACP with the Perceived Barriers Scale and Perceived Benefits Scale to ACP. Univariate analysis and subsequently logistic regression was used to determine factors which were significantly different between subjects willing or unwilling to engage in ACP based on their responses to the perceived barriers and benefits of ACP as well as sociodemographic and clinical variables. Results: Fifty-two subjects (54%) were keen on ACP. On univariate analysis, subjects with better executive function (Frontal Assessment Battery [FAB]) (t¼ -3.63, p<.0001), who were more educated (t¼-2.11, p¼.038) and had lower barriers to ACP (t¼ 2.47, p¼ .015), particularly “passive coping” (t¼ 2.83, p¼.006), were more keen on ACP. Logistic regression revealed that the combined predictive model with the factors education, FAB and passive coping as a whole reliably differentiated those unwilling to engage in ACP from those were willing (chi square ¼ 18.995, p¼.001 with df ¼ 4). Wald criterion showed that FAB (p¼.016) and passive coping (p¼.023) contributed most significantly to prediction. Conclusions: Better education and executive function predict willingness to engage in ACP and these factors are both instrumental in a person’s ability to acquire knowledge and understand information. Hence, initiating ACP discussions early and increasing efforts at education and providing tailored information are important interventions that may help facilitate completion of advance care plans.
P2-282
A COMPARATIVE STUDY OF CAREGIVING BURDEN AND THE EFFECTS OF THE CARE RECEIVER’S HELPFULNESS TO THE CAREGIVER AND CAREGIVER’S SELF-CARE ON CAREGIVING BURDEN BETWEEN DEMENTIA AND NON-DEMENTIA CAREGIVERS
Hae-Kyung Choi, Jeong-Eun Kim, Chungnam National University, Daejeon, South Korea. Contact e-mail: [email protected] Background: The purpose of this study was to compare the level of caregiving burden and the effects of care receiver’s economic, instrumental, emotional helpfulness to caregiver and caregiver’s self-care on caregiving burden between dementia and non-dementia caregivers in Korea. Methods: Data were collected from 125 nondementia (stroke, arthritis, Parkinson’s disease) caregivers and 71 dementia caregivers who were caring for spouse or parent. The instruments used in this study were Zarit Burden Interview to measure caregiving burden, care receiver’s helpfulness scale, caregiver’s daily self-care amount, caregiver’s economic and physical health status scale, Modified Barthel Index, and daily caregiving hours. Data were analyzed by t-test, Pearson correlation coefficient, and hierarchical regression. Results: Bivariate analysis by t-test indicated that the level of caregiving burden was significantly higher among dementia caregivers compared to non-dementia caregivers (mean¼51.8 vs. 45.8, t¼-3.25 p< .001). There were significant differences in the effects of care receiver’s helpfulness to caregiver and caregiver’s self-care on caregiving burden between dementia and non-dementia caregivers. Care receiver’s emotional helpfulness to caregiver and caregiver’s self-care were statistically significant factors predicting low caregiving burden
a national survey entitled “Mental Health and Quality of Life of Older Malaysians” conducted from 2003 through 2005 using a cross-sectional design. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy was used to measure dementia. A multiple binary logistic regression using Statistical Package for Social Sciences version 21 was conducted to assess the unique effect of food insufficiency in childhood on developing dementia in old age. Results: A notably higher prevalence of dementia was found in respondents who indicated they had experienced food insufficiency in childhood than in their food-sufficient counterparts (23.5% versus 14.3%). The findings from multiple logistic regression analysis revealed that food insufficiency in childhood would independently increase the risk of developing dementia in old age by 81%, after adjusting for sociodemographic factors (odds ratio ¼1.81, 95% confidence interval 1.13–2.92, P,0.01). Conclusions: Findings from the present study showing that food insufficiency in early life significantly contributes to dementia in later life highlight the importance of childhood living conditions in maintaining cognitive function in old age. It is, therefore, suggested that older adults with childhood food insufficiency might be targeted for programs designed to prevent dementia. Table 1 Results of Multiple Logistic Regression 95% C.I. for OR Variable Age (Ref: Young-Old) Old-old Oldest-old Sex (Male) Marital status (Married) Ethnicity (Malay) Stratum (Rural) Education (Ref: No formal) Primary Secondary and tertiary Food insufficiency
B
S.E.
OR
Lower
Upper
0.63 1.2 -0.47 -0.12 0.88 0.28
0.13 0.22 0.14 0.13 0.16 0.12
1.89*** 3.31*** 0.62*** 0.89 2.42*** 1.32*
1.46 2.15 0.47 0.68 1.76 1.04
2.44 5.1 0.82 1.15 3.33 1.68
-1.25 -1.89 0.6
0.14 0.43 0.24
0.29*** 0.15*** 1.81**
0.22 0.07 1.13
0.38 0.35 2.92
*p<0.05, **p<0.01, ***p<0.001 Hosmer and Lemeshow Test: c2 (8)¼10.10, p¼0.258
P2-281
EXPLORING CLINICAL AND BEHAVIORAL FACTORS THAT IMPACT ENGAGEMENT IN ADVANCED CARE PLANNING FOR PERSONS WITH EARLY COGNITIVE IMPAIRMENT
Sze Yan Tay1, John Davison2, Chong Jin Ng3, Philip Yap3, 1Singapore General Hospital, Singapore, Singapore; 2Middlemore Hospital, Auckland, New Zealand; 3Khoo Teck Puat Hospital, Singapore, Singapore. Contact e-mail: [email protected] Background: Advance care planning (ACP) is pertinent to holistic care for people with early cognitive impairment (ECI) who are generally still mentally capable of making rational decisions. People with ECI can remain in good physical health for extended periods of time despite eventual mental incapacity, making planning of health and social care needs in addition to end-of-life care decisions necessary. This study explores the willingness of people with ECI to engage in ACP and how clinical and behavioural variables shape their decisions. Methods: Ninety-six subjects with ECI
P599
(Mild Cognitive Impairment or early dementia, Clinical Dementia Rating¼0.5/1.0), assessed to have adequate insight (Clinical Insight Rating Scale), underwent an ACP information session after which they were assessed on their knowledge of dementia and willingness to engage in ACP. They were also interviewed on their beliefs and attitudes towards ACP with the Perceived Barriers Scale and Perceived Benefits Scale to ACP. Univariate analysis and subsequently logistic regression was used to determine factors which were significantly different between subjects willing or unwilling to engage in ACP based on their responses to the perceived barriers and benefits of ACP as well as sociodemographic and clinical variables. Results: Fifty-two subjects (54%) were keen on ACP. On univariate analysis, subjects with better executive function (Frontal Assessment Battery [FAB]) (t¼ -3.63, p<.0001), who were more educated (t¼-2.11, p¼.038) and had lower barriers to ACP (t¼ 2.47, p¼ .015), particularly “passive coping” (t¼ 2.83, p¼.006), were more keen on ACP. Logistic regression revealed that the combined predictive model with the factors education, FAB and passive coping as a whole reliably differentiated those unwilling to engage in ACP from those were willing (chi square ¼ 18.995, p¼.001 with df ¼ 4). Wald criterion showed that FAB (p¼.016) and passive coping (p¼.023) contributed most significantly to prediction. Conclusions: Better education and executive function predict willingness to engage in ACP and these factors are both instrumental in a person’s ability to acquire knowledge and understand information. Hence, initiating ACP discussions early and increasing efforts at education and providing tailored information are important interventions that may help facilitate completion of advance care plans.
P2-282
A COMPARATIVE STUDY OF CAREGIVING BURDEN AND THE EFFECTS OF THE CARE RECEIVER’S HELPFULNESS TO THE CAREGIVER AND CAREGIVER’S SELF-CARE ON CAREGIVING BURDEN BETWEEN DEMENTIA AND NON-DEMENTIA CAREGIVERS
Hae-Kyung Choi, Jeong-Eun Kim, Chungnam National University, Daejeon, South Korea. Contact e-mail: [email protected] Background: The purpose of this study was to compare the level of caregiving burden and the effects of care receiver’s economic, instrumental, emotional helpfulness to caregiver and caregiver’s self-care on caregiving burden between dementia and non-dementia caregivers in Korea. Methods: Data were collected from 125 nondementia (stroke, arthritis, Parkinson’s disease) caregivers and 71 dementia caregivers who were caring for spouse or parent. The instruments used in this study were Zarit Burden Interview to measure caregiving burden, care receiver’s helpfulness scale, caregiver’s daily self-care amount, caregiver’s economic and physical health status scale, Modified Barthel Index, and daily caregiving hours. Data were analyzed by t-test, Pearson correlation coefficient, and hierarchical regression. Results: Bivariate analysis by t-test indicated that the level of caregiving burden was significantly higher among dementia caregivers compared to non-dementia caregivers (mean¼51.8 vs. 45.8, t¼-3.25 p< .001). There were significant differences in the effects of care receiver’s helpfulness to caregiver and caregiver’s self-care on caregiving burden between dementia and non-dementia caregivers. Care receiver’s emotional helpfulness to caregiver and caregiver’s self-care were statistically significant factors predicting low caregiving burden