Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review.
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SUBMITTER: Pellicer-Espinosa I
PROVIDER: S-EPMC8966106 | biostudies-literature | 2022 Apr
REPOSITORIES: biostudies-literature
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Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review.
Pellicer-Espinosa Isabel I Díaz-Orueta Unai U
Journal of applied gerontology : the official journal of the Southern Gerontological Society 20211202 4
This study presents a systematic review on existing cognitive screening tools for mild cognitive impairment and dementia in populations with low education and literacy levels. Cochrane Library, PubMed and LILACS databases were examined for studies including adults aged 50 years old or older with low educational level. 61 articles were included. Despite its frequent use, studies on Mini-Mental State Examination (MMSE) revealed that educational level biased the score obtained, regardless of other ...[more]
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Project description:Background/objectivesMany older adults receive unnecessary screening colonoscopies. We previously conducted a survey using a national online panel to assess older adults' preferences for how clinicians can discuss stopping screening colonoscopies. We sought to assess the generalizability of those results by comparing them to a sample of older adults with low health literacy.DesignCross-sectional survey.SettingBaltimore metropolitan area (low health literacy sample) and a national, probability-based online panel-KnowledgePanel (national sample).ParticipantsAdults 65+ with low health literacy measured using a single-question screen (low health literacy sample, n = 113) and KnowledgePanel members 65+ who completed survey about colorectal cancer screening (national sample, n = 441).MeasurementsThe same survey was administered to both groups. Using the best-worst scaling method, we assessed relative preferences for 13 different ways to explain stopping screening colonoscopies. We used conditional logistic regression to quantify the relative preference for each explanation, where a higher preference weight indicates stronger preference. We analyzed each sample separately, then compared the two samples using Spearman's correlation coefficient, the likelihood ratio test to assess for overall differences between the two sets of preference weights, and the Wald test to assess differences in preference weights for each individual phrases.ResultsThe responses from the two samples were highly correlated (Spearman's coefficient 0.92, p < 0.0001). The most preferred phrase to explain stopping screening colonoscopy was "Your other health issues should take priority" in both groups. The three least preferred options were also the same for both groups, with the least preferred being "The doctor does not give an explanation." The explanation that referred to "quality of life" was more preferred by the low health literacy group whereas explanations that mentioned "unlikely to benefit" and "high risk for harms" were more preferred by the national survey group (all p < 0.001).ConclusionAmong two different populations of older adults with different health literacy levels, the preferred strategies for clinicians to discuss stopping screening colonoscopies were highly correlated. Our results can inform effective communication about stopping screening colonoscopies in older adults across different health literacy levels.
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Project description:Background and objectivesHearing loss is the largest potentially modifiable risk factor for dementia. Early evaluation and intervention are crucial for older adults with cognitive impairment. However, pure-tone audiometry (PTA), the gold standard, may have limitations. This study reviewed auditory tests for detecting hearing loss in this population, comparing to PTA.Materials and methodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review in PubMed, Scopus, and Embase. Ten studies (1,071 participants) comparing auditory tests and PTA in patients with dementia and mild cognitive impairment were included.ResultsElectrophysiological and behavioral tests demonstrated strong correlation and accurate hearing impairment detection compared to PTA. Conversely, self-reported assessment showed weaker correlations when aligned with hearing thresholds.ConclusionsThis study highlights the potential of electrophysiological and behavioral auditory tests in detecting hearing impairment in older adults with cognitive impairment, emphasizing the need for further research to develop practical screening protocols for this vulnerable population.
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Project description:Backgroundcognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes.Methodswe conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed.Results23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71-0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A's Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74-0.94).Conclusionshigh clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED.The review protocol was registered in PROSPERO (CRD42018082509).
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Project description:Introduction and objectivesThe experiences and changes that come along with old age may lead to a feeling of loneliness, usually followed by negative physical and mental manifestations. In this systematic review, we evaluated the existing tools to assess loneliness in older adults.MethodsWe performed a literature search in the Web of Science, Medline, and PsycINFO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After, we examined the psychometric properties of the instruments with a focus on reliability, validity, and main conclusions.ResultsWe included 27 articles published between 1996 and 2021.ConclusionTo date, there are few instruments to assess loneliness in older adults. In general, they present adequate psychometric properties, although it is true that some scales show somewhat low levels of reliability and validity.
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Project description:BackgroundNumerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations.ObjectiveThis systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission's Digital Competence (DigComp) Framework.MethodsElectronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use.ResultsSearches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ≥50 years (10/27) or ≥60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59%). Scores on the CCAT ranged from 34 (34/40, 85%) to 40 (40/40, 100%). Most instruments measured 1 or 2 of the DigComp Framework's elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including "digital content creation" and "safety."ConclusionsThe current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like "digital content creation" and "safety" that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged.
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Project description:ObjectiveTo investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.Data sources/study settingHealth Literacy and Cognition in Older Adults ("LitCog," prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.Study designStudy participants completed structured, in-person interviews administered by trained research assistants.Data collectionHealth literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.Principal findingsAll health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.ConclusionsCognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.
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Project description:BackgroundThe internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies.ObjectiveThis study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument.MethodsWe conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology.ResultsThis study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated.ConclusionsThe eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence.
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Project description:BackgroundOlder adults, identified as 65 years and over, a population for which low health literacy is prevalent, represented most people attending primary health care services provided by the Health Service Executive (HSE) in Ireland in 2019. Any limitation in a person's health literacy, specifically their ability to access, understand and use health information, can affect their ability to make healthcare related decisions. Information on the evidence for health literacy interventions is also required by healthcare providers and policy makers to inform decision-making and service development to improve outcomes for older people. This review aimed to synthesise the evidence on health literacy interventions and health literacy-related outcomes for older adults. The specific objectives were to (1) identify what health literacy interventions exist in relation to older adults' ability to access, understand, and use health information, (2) determine the health literacy-related outcomes of these interventions, and (3) identify any trends or patterns which may exist between intervention type and outcome.MethodsThis review was conducted by following PRISMA guidelines. The electronic databases PubMed, Embase and Scopus were searched for relevant studies concerning health literacy interventions for older persons. Study data were subsequently analysed using a narrative thematic approach in the context of the three key health literacy characteristics; the ability to access, understand and use health information.ResultsThirty-four studies were identified that met the inclusion criteria. The findings show a potential link between individual-focussed health literacy interventions and positive health literacy-related outcomes in relation to older persons' ability to understand and use health information. The review also found that use of health literacy level assessment tools varied with studies either using different tools for the same older adult cohort, or failing to assess pre-intervention health literacy levels altogether.ConclusionsThe potential trend found between individual-focused interventions and positive health literacy outcomes suggests that implementing health literacy-related interventions directly to the individual is key. Furthermore, our study found an inconsistency amongst the included studies in relation to the implementation of health literacy assessment tools, with different tools used across most studies, and some studies choosing not to utilise any assessment tool.
| S-EPMC11863724 | biostudies-literature
Project description:BackgroundCognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered.ObjectivesThis study aims to determine the association between HL and CF among older adults.MethodsData was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried's Criteria were used to assess the CF status.ResultsA total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p < 0.001). Based on the HLS-M-Q18 index scores, the robust group had a higher HL index score than those in the CF group: 36.1 (SD = 10.5) and 33.4 (SD = 8.6), respectively, p < 0.05. In binary logistic regression, limited HL, increasing age, lower income, lower education level and rural locality were associated with the increase of CF occurrence. Older adults with limited HL have 2.6 times higher odds of having CF.ConclusionApproximately two-thirds of multiethnic older adults in the study had limited HL, with those with limited HL has 2.6 times higher odds of having CF. These findings emphasize the importance of addressing HL to improve their health outcomes and well-being.
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Project description:OBJECTIVES:The objective of this systematic review was (1) to give an overview of the available short screening instruments for the early detection of Alzheimer's disease (AD) and (2) to review the psychometric properties of these instruments. METHODS:First, a systematic search of titles and abstracts of PubMed and Web of Science was conducted between February and July 2015 and updated in April 2016 and May 2018. Only papers written in English or Dutch were considered. All full-text papers about cognitive screening instruments for the early detection of AD were included, resulting in the identification of 38 pencil and paper tests and 12 computer tests. In a second step, the psychometric quality of these instruments was evaluated. Therefore, the same databases were searched again to identify papers that described the psychometric properties of the instruments meanwhile applying diagnostic criteria for the diagnostic groups included. RESULTS:Out of 1454 papers, 96 clearly discussed the psychometric properties of the instruments. Eighty-nine papers discussed pencil and paper tests of which 80 were validated in a memory clinic setting. Based on the number of studies (31 articles) and the sensitivity (84%) and specificity (74%) values, the Montreal Cognitive Assessment (MoCA) seems to be a promising (pencil and paper) screening test for memory clinic testing as well as for population screening. Regarding computer tests, validation studies were only available for 7 out of 12 tests. CONCLUSIONS:A large number of screening tests for AD are available. However, most tests are only validated in a memory clinic setting and description of the psychometric properties of the instruments is limited. Especially, computer tests require further research. The MoCA is a promising instrument, but the specificity to detect early AD is rather low.
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