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    Physical Frailty and Cognitive Impairment in Older U.S. Nursing Home Residents

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    Authors
    Yuan, Yiyang
    Faculty Advisor
    Kate L. Lapane
    Academic Program
    Clinical and Population Health Research
    UMass Chan Affiliations
    Population and Quantitative Health Sciences
    Document Type
    Doctoral Dissertation
    Publication Date
    2022-02-28
    Keywords
    Physical frailty
    Cognitive impairment
    Nursing home
    Latent class analysis
    Group-based trajectory modeling
    Epidemiology
    
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    Abstract
    Background For the 1.2 million older adults residing in U.S. nursing homes, little is known about their experience with physical frailty and cognitive impairment, two critical interrelated aging conditions. Methods Minimum Data Set 3.0 was used. Physical frailty was measured by FRAIL-NH and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale. Demographic and clinical characteristics were adjusted accordingly. Aim 1 described the prevalence of physical frailty and cognitive impairment and longitudinally examined the association between two conditions with the non-proportional odds model. Aim 2 used latent class analysis to identify physical frailty subgroups and estimated their association with cognitive impairment using multinomial logistic regression. Aim 3 fitted group-based trajectory models to identify physical frailty trajectories and cognitive impairment trajectories and quantified the association between the two sets of trajectories. Main Results Around 60% of older residents were physically frail and 68% had moderate/severe cognitive impairment, with improvement and worsening observed in both conditions, particularly in the first three months. Older residents with moderate/severe cognitive impairment were consistently and increasingly more likely to be frail. Three physical frailty subgroups were identified at admission. Greater cognitive impairment was associated with higher odds to belong to “severe physical frailty”. Five physical frailty trajectories and three cognitive impairment trajectories were identified over the first six months. One in five older residents were “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Conclusion Findings emphasized the need for care management tailored to the heterogeneous presentations and progression trajectories of physical frailty and cognitive impairment.
    DOI
    10.13028/r7w2-p162
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/31407
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/r7w2-p162
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