Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans.
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2014-05
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Abstract
The objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed by the Short Portable Mental Status Questionnaire whereas vision, disability, and self-rated health (SRH) were determined by self-report. Vision impairment was present in 902 (18.5%) participants and cognitive impairment in 835 (13.6%), with 232 (3.5%) participants experiencing both impairments. Persons with the comorbidity experienced higher odds of disability than persons with either single impairment. The association of vision impairment with SRH was stronger among women (odds ratio [OR] = 6.79, 95% confidence interval [CI] = 4.64-9.92) than among men (OR = 1.71, 95% CI = 1.21-2.41). Concurrent cognitive and vision impairment is prevalent in older Singaporeans and is associated with high rates of disability. Gender differences in vision-dependent roles may affect the patient-perceived impact of this comorbidity.
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Whitson, Heather E, Rahul Malhotra, Angelique Chan, David B Matchar and Truls Østbye (2014). Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans. Asia-Pacific journal of public health, 26(3). pp. 310–319. 10.1177/1010539512443698 Retrieved from https://hdl.handle.net/10161/22887.
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Heather Elizabeth Whitson
Dr. Whitson is a geriatrician, memory care specialist, and clinical researcher. Her career is focused on improving care options and resilience for people with multiple chronic conditions. In particular, she has interest and expertise related to how aging biology and comorbidities impact brain health and risk for Alzheimer's disease. She is co-director of the Duke/UNC Alzheimer's Disease Research Center (Duke/UNC ADRC), which aims to transform dementia care and research in Eastern North Carolina while developing novel preventions and treatment strategies for Alzheimer's disease by identifying aging-related factors across the lifespan that drive risk, progression, or experience of dementia. The Duke/UNC ADRC conducts the Memory and Aging Study, which is tracking brain and cognitive changes in over 400 individuals at risk for dementia in later life. Dr. Whitson also co-Chairs the Alzheimer's Association's Clinical Practice Guideline panel for the use of blood-based biomarkers in the diagnosis of Alzheimer's disease. As a thought leader in a national collaborative focused on the biomedical aspects of resilience, Dr. Whitson seeks to better understand biological, psychological, and contextual factors that determine how well we "bounce back" after acute health stressors and why our resilience capacity changes with age. Dr. Whitson has contributed to work examining resilience to many types of health stressors, including surgery, dialysis, infection, vascular events, and vision loss - often focused on how these stressors affect the brain. She has led multiple studies to examine how the aging brain responds to the late-life stressor of vision loss, and she has developed a rehabilitation model to improve independence in older adults living with comorbid impairments in vision and cognition.
David Bruce Matchar
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
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