Journal of Gerontological Nursing

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Abstract

Several screening tools are available to assess health literacy but they are underused, according to a presentation at the 36th Annual Congress of the Oncology Nursing Society.

Previous studies have shown that low health literacy adversely affects cancer incidence, mortality, and quality of life. Treatment decisions may not be fully comprehended and informed consent documents may be too complex, affecting medical decision making. Low health literacy has also been shown to increase hospitalization rates and emergency department visits, medication errors, and health care costs.

According to the researchers, several health literacy screening tools are readily available, including the Rapid Estimate of Adult Literacy in Medicine, the Test of Functional Health Literacy in Adults, the Wide Range Achievement Test, and the Newest Vital Signs assessment. The tests take nurses approximately 3 minutes to perform.

Once literacy is assessed, nurses should tailor their communications —oral and written—to match the patient’s level of understanding. For patients with low literacy, the researchers suggest:

Nurses can also refer patients to online resources for medical information and community programs that help improve health literacy levels.

For a literature review on health literacy, see the Online Advance Release article by Zamora and Clingerman available on the Journal of Gerontological Nursing’s website, http://slackjournals.com/JGN.

Source.“Health Literacy Tests Underutilized; May Improve Elderly Cancer Patients’ Care and Outcomes.” (2011, April 29). Retrieved July 22, 2011, from http://www.sciencedaily.com/releases/2011/04/110429202245.htm.

Older veterans who experienced traumatic brain injury (TBI) showed a more than two-fold increase in the risk of developing dementia, according to research presented at the Alzheimer’s Association International Conference 2011 in Paris.

The relationship between TBI and risk of dementia remains unclear, with some studies suggesting an increased risk and others finding no association. The researchers reviewed medical records of 281,540 U.S. veterans 55 and older who received care through the Veterans Health Administration and had at least one inpatient or outpatient visit during 1997–2000 and a follow up during 2001–2007, and who did not have a dementia diagnosis at the start of the study. They searched the database for TBI and dementia diagnoses and investigated whether TBI of any type was associated with greater risk of dementia, while taking into account demographics and other medical conditions, including psychiatric disorders.

The risk of dementia was 15.3% in those with a TBI diagnosis compared with 6.8% in those without a TBI diagnosis (p < 0.001). The adjusted hazard ratio for incident dementia in those with any TBI diagnosis was 2.3 (95% confidence interval: 2.1, 2.5)—a more than two-fold increase in the risk of developing dementia over 7 years—and was significant for all TBI types. Approximately 2% of older veterans had a TBI diagnosis during the study period.

The researchers suggest that there are several potential mechanisms by which TBI could increase dementia risk. Amyloid plaques similar to those found in the brains of people with AD are present in up to 30% of TBI patients who do not survive their injuries, regardless of age. It is possible that these injuries result in the death of axons and neurons, even after a single TBI. Loss of axons and neurons could result in earlier manifestation of Alzheimer’s symptoms.

Source.“Brain Injury May More Than Double Dementia Risk in Older Veterans.” (2011, July 18). Retrieved July 22, 2011, from http://www.prnewswire.com/news-releases/brain-injury-may-more-than-double-dementia-risk-in-older-veterans-125728743.html.

Improving and maintaining health factors not traditionally associated with dementia, such as denture fit, vision, and hearing, may lower a person’s risk for developing dementia, according to a study published in Neurology.

The study included 7,239 people 65 and older free of dementia from the Canadian Study of Health and Aging. After 5 years and again after 10…

Health Literacy Tests Underused

Several screening tools are available to assess health literacy but they are underused, according to a presentation at the 36th Annual Congress of the Oncology Nursing Society.

Previous studies have shown that low health literacy adversely affects cancer incidence, mortality, and quality of life. Treatment decisions may not be fully comprehended and informed consent documents may be too complex, affecting medical decision making. Low health literacy has also been shown to increase hospitalization rates and emergency department visits, medication errors, and health care costs.

According to the researchers, several health literacy screening tools are readily available, including the Rapid Estimate of Adult Literacy in Medicine, the Test of Functional Health Literacy in Adults, the Wide Range Achievement Test, and the Newest Vital Signs assessment. The tests take nurses approximately 3 minutes to perform.

Once literacy is assessed, nurses should tailor their communications —oral and written—to match the patient’s level of understanding. For patients with low literacy, the researchers suggest:

  • Developing written materials below fifth-grade reading levels.
  • Keeping content and format simple with shorter words and sentences.
  • Using larger, boldface, or underlined fonts; increasing space between lines; and using black ink.
  • Having a magnifying glass and good lighting available for older adults.
  • Ensuring patients have assistive devices, such as reading glasses and hearing aids.
  • Involving a significant other or caregiver.

Nurses can also refer patients to online resources for medical information and community programs that help improve health literacy levels.

For a literature review on health literacy, see the Online Advance Release article by Zamora and Clingerman available on the Journal of Gerontological Nursing’s website, http://slackjournals.com/JGN.

Source.“Health Literacy Tests Underutilized; May Improve Elderly Cancer Patients’ Care and Outcomes.” (2011, April 29). Retrieved July 22, 2011, from http://www.sciencedaily.com/releases/2011/04/110429202245.htm.

Brain Injury Can Increase Dementia Risk in Older Veterans

Older veterans who experienced traumatic brain injury (TBI) showed a more than two-fold increase in the risk of developing dementia, according to research presented at the Alzheimer’s Association International Conference 2011 in Paris.

The relationship between TBI and risk of dementia remains unclear, with some studies suggesting an increased risk and others finding no association. The researchers reviewed medical records of 281,540 U.S. veterans 55 and older who received care through the Veterans Health Administration and had at least one inpatient or outpatient visit during 1997–2000 and a follow up during 2001–2007, and who did not have a dementia diagnosis at the start of the study. They searched the database for TBI and dementia diagnoses and investigated whether TBI of any type was associated with greater risk of dementia, while taking into account demographics and other medical conditions, including psychiatric disorders.

The risk of dementia was 15.3% in those with a TBI diagnosis compared with 6.8% in those without a TBI diagnosis (p < 0.001). The adjusted hazard ratio for incident dementia in those with any TBI diagnosis was 2.3 (95% confidence interval: 2.1, 2.5)—a more than two-fold increase in the risk of developing dementia over 7 years—and was significant for all TBI types. Approximately 2% of older veterans had a TBI diagnosis during the study period.

The researchers suggest that there are several potential mechanisms by which TBI could increase dementia risk. Amyloid plaques similar to those found in the brains of people with AD are present in up to 30% of TBI patients who do not survive their injuries, regardless of age. It is possible that these injuries result in the death of axons and neurons, even after a single TBI. Loss of axons and neurons could result in earlier manifestation of Alzheimer’s symptoms.

Source.“Brain Injury May More Than Double Dementia Risk in Older Veterans.” (2011, July 18). Retrieved July 22, 2011, from http://www.prnewswire.com/news-releases/brain-injury-may-more-than-double-dementia-risk-in-older-veterans-125728743.html.

Improving Overall Health Can Lower Dementia Risk

Improving and maintaining health factors not traditionally associated with dementia, such as denture fit, vision, and hearing, may lower a person’s risk for developing dementia, according to a study published in Neurology.

The study included 7,239 people 65 and older free of dementia from the Canadian Study of Health and Aging. After 5 years and again after 10 years, they were evaluated for Alzheimer’s disease and all types of dementia. Participants were asked questions about 19 health problems not previously reported to predict dementia, including arthritis, trouble hearing or seeing, denture fit, chest or skin problems, stomach or bladder troubles, sinus issues, broken bones, and feet or ankle conditions, among others.

After 10 years, 2,915 of the participants had died, 883 were cognitively healthy, 416 had Alzheimer’s disease, 191 had other types of dementia, 677 had cognitive problems but no dementia, and the cognitive status of 1,023 participants was not clear.

The study found that each health problem increased a person’s odds of developing dementia by 3.2% compared with people without such health problems. Older adults without health problems at baseline had an 18% chance of developing dementia in 10 years, while such risk increased to 30% and 40% in those who had 8 and 12 health problems, respectively.

Source.“Keeping Up Your Overall Health May Keep Dementia Away.” (2011, July 13). Retrieved July 22, 2011, from http://medicalxpress.com/news/2011-07-health-dementia.html.

New Biomarker and Guidelines Aid Alzheimer’s Disease

A new biomarker may help identify which people with mild memory deficits will go on to develop Alzheimer’s disease (AD), according to a new study published in Neurology. The biomarker may be more accurate than the currently established biomarkers.

The study involved 58 people with mild cognitive impairment (MCI). A sample of cerebrospinal fluid of the participants was taken at the beginning of the study through a lumbar puncture. The concentrations in the cerebrospinal fluid of several proteins that are associated with AD were measured.

The participants were followed for nearly 3 years on average. At that point, 21 people had developed AD, 27 still had mild cognitive impairment, and 8 people had reverted back to their normal cognitive health. Two people had developed frontotemporal dementia, and their results were not included in the analysis.

The researchers found that the people who developed AD had significantly higher levels of the protein soluble amyloid precursor protein beta (sAPPβ) in their spinal fluid than those who did not develop AD. Those who developed AD had an average of 1,200 nanograms per milliliter, compared with 932 for those who did not develop the disease.

The researchers found that the best predictor of whether someone would develop AD was a combination of sAPPβ, the tau protein (an established marker of brain cell damage), and the age of the individual. When these factors were combined, the results were roughly 80% accurate in predicting whether the disease would develop.

The protein Aβ1–42, which has previously been considered a biomarker for AD, was not a predictive factor in this study.

In related AD news, Genetics in Medicine has published a new practice guideline on genetic counseling and testing for AD. The new guideline was developed in collaboration between members of the The American College of Medical Genetics and the National Society of Genetic Counselors.

Direct-to-consumer (DTC) tests are available for three known causative AD genes. However, even among patients with early-onset AD, no more than 5% of cases are caused by mutations in one of the three genes.

The new guidelines specify that “genetic testing for AD should only occur in the context of genetic counseling…and support by someone with expertise in this area.” Genetic testing for AD is never recommended in children or before birth. Home or DTC testing for the gene APOE is also not recommended due to its poor predictive value and the fact that no proven interventions exist to mitigate risk.

In families with early-onset AD potentially caused by a mutation in a strongly determinative gene, testing for causative genes may provide useful information on personal risk. However, those being tested must understand that no current drug or other treatment can reduce the risk of developing AD, regardless of the test results. If no family member with current AD is available for testing, testing of asymptomatic family members is usually unlikely to provide useful information.

In other situations, it is important to assess a person’s motivation for pursing genetic testing. Potential conflicts of interest must be addressed—including any disagreement within the family as to whether testing should be performed. Other important considerations include the possible psychological impact of testing, insurance (including life, long-term care, and disability), and privacy implications, among others.

Sources.“New Biomarker May Help With Early Diagnosis of Alzheimer’s Disease.” (2011, June 23). Retrieved July 27, 2011, from http://www.sciencedaily.com/releases/2011/06/110622162306.htm.“New Guidelines on Genetic Counseling and Testing for Alzheimer Disease.” (2011, July 7). Retrieved July 27, 2011, from http://www.newswise.com/articles/new-guidelines-on-genetic-counseling-and-testing-for-alzheimer-disease.

10.3928/00989134-20110722-99

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