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The current study investigated whether older adults’ cognitive test scores at the time of long-term care nursing home admission are associated with psychological well-being over the first six months. We analyzed the link between Mattis Dementia Rating Scale (DRS-2) subscale scores and anxiety, depression, quality of life, and positive/negative affect.
Participants and Methods:
Participants were recently admitted long-term care residents from 13 nursing homes in the Louisville, KY area. Sixty-two older adults were administered the DRS-2 shortly after nursing home admission. Using a cutoff of less than 6 scaled score on the DRS-2, 52% of participants scored as cognitively impaired. Self-report measures of anxiety (RAID), depression (PHQ9), quality of life (QoL-AD), and positive/negative affect (Philadelphia Geriatric Center Affect Rating Scale) were collected at time of admission, and 3 and 6 months later.
Results:
The DRS-2 attention subscale significantly correlated with baseline depression symptoms. No other DRS-2 subscale or the DRS-2 total score correlated with anxiety, depression, quality of life, or affect ratings at admission. Baseline DRS-2 attention, initiation/perseveration, and memory had significant correlations with self-report measures at 3 and 6 months; these DRS-2 scores were selected for further analysis. Mixed ANOVAs found a significant main effect of group (impaired vs. not-impaired) for the initiation/perseveration subscale, memory subscale, and DRS-2 total score on negative affect; impairment in any of these domains was associated with lower reported negative affect at all three time points. There was no significant effect of cognitive scores on any other self-report measure. There was a significant, positive linear trend in quality of life over time. There was a significant quadratic trend in depression symptoms, with decreased depression reported at 3 months and increase at 6 months.
Conclusions:
Impaired performance on the DRS-2 was associated with lower negative affect over time. Cognitive impairment was not associated with anxiety, depression, quality of life, or positive affect. There appear to be reliable trends in some psychological factors regardless of cognitive scores, with an increase in quality of life over time and a temporary decrease in reported depression captured at 3 months. The relationship between cognitive impairment and negative affect should be interpreted with caution, as only 22 residents completed the affect self-report at all three time points. Overall, we found limited evidence of an association between cognitive scores at time of admission and self-reported psychological factors at 3 and 6 months.
This chapter clarifies and differentiates changes in cognitive functioning among the oldest old at the group and individual levels. Cross-sectionally, the oldest old demonstrate normative differences of being more physically and cognitively frail compared to younger groups. More variation and successful aging is observed at the individual level. Some oldest-old individuals can perform at the same levels as adults 20 to 40 years younger. Recent literature has recognized that the concept of cognitive vitality transcends the absence of dementia or dementing processes. We seek to clarify the concept of cognitive vitality because it has not been well defined in the literature either theoretically or operationally. This chapter addresses the following questions: 1) What is cognitive vitality and how does it contribute to the well-being of older adults? 2) What factors or resources contribute to cognitive vitality among the oldest old? and 3) What new directions can be identified for future research?
COGNITIVE FUNCTIONING AND VITALITY AMONG THE OLDEST OLD: IMPLICATIONS FOR WELL-BEING
Lay people and professionals alike fall prey to aging stereotypes and myths (Ory, Hoffman, Hawkins, Sanner, & Mockenhaupt, 2003), namely that cognitive decline is inevitable and there is nothing we can do about it. Empirical research has focused on comparing the cognitive performance of younger and older adults, often noting “deficits” in older adults' abilities without taking into account context and potentially meaningful qualitative differences in older adults' approaches to cognitive problems (e.g., Marsiske & Margrett, 2006).
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