Harmonizing Ethno-Regionally Diverse Datasets to Advance the Global Epidemiology of Dementia.

This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention-351.2 (SD 93.5); and two-hours post intervention-315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories' mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents' agitation and improve their emotional wellbeing in rural aged care homes. 

Person-Centred, Culturally Appropriate Music Intervention to Improve Psychological Wellbeing of Residents with Advanced Dementia Living in Australian Rural Residential Aged Care Homes

Abstract In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer’s disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.

Future Directions for the HRS Harmonized Cognitive Assessment Protocol

<title>Abstract</title> PURPOSE There is a longstanding need for a consistent approach to estimate the prevalence of child abuse to inform programs, policies, and research. A key step in achieving a consistent approach is to examine current differences in the application of cut-offs in the public health reporting of child abuse. METHODS To address this issue, this exploratory study applied item response theory (IRT) to determine standard cut-points for two types of child abuse, namely physical and sexual abuse, using nationally representative data from the 2018 Survey of Safety in Public and Private Spaces. Two different cut-offs from the literature were considered in the IRT models. The first cut-off (i.e., cut-off 1) estimated the proportion of individuals who experienced abuse in childhood (before age 15 years) using a frequency of one or more times. In contrast, a second cut-off (i.e., cut-off 2) was more conservative, requiring experiencing a higher frequency of abuse across all items. RESULTS Model fit statistics and option characteristic curves suggested a good fit for physical abuse using cut-off 2. In contrast, a good fit was obtained for sexual abuse using cut-off 1. CONCLUSION This study provides support towards using cut-off 2 for physical abuse and cut-off 1 for sexual abuse. <bold>C</bold>onsistent approaches to measuring child abuse is important to improve our understanding of the epidemiology of child abuse, as well as approaches to its assessment, treatment, and prevention. Future research should explore the feasibility of using IRT methods to establish cut-offs for other types of maltreatment. 

An Exploration of the Application of Item Response Theory to the Measurement of Child Abuse in Canada

Considerations Around the Measurement of Cognition in Large-Scale Cross-National Surveys: Lessons from the Health and Retirement International Network of Surveys (HRS INS) and the Harmonized Cognitive Assessment Protocol (HCAP)

Note: Not all authors listed; please see article (last page) for full list of Contributors).Background: Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation samples from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally. Methods: Using cognitive testing data and data on functional limitations from Wave A (2001–2003) of the ADAMS study (n = 744) and the 2000 wave of the HRS study (n = 6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all individuals over 70. Based on diagnostic information from the formal clinical adjudication in ADAMS, we fit a logistic regression model for the classification of dementia status using cognition and function scores and applied this algorithm to the full HRS sample to calculate dementia prevalence by age and sex. Results: Our algorithm had a cross-validated predictive accuracy of 88% (86–90), and an area under the curve of 0.97 (0.97–0.98) in ADAMS. Prevalence was higher in females than males and increased over age, with a prevalence of 4% (3–4) in individuals 70–79, 11% (9–12) in individuals 80–89 years old, and 28% (22–35) in those 90 and older. Conclusions: Our model had similar or better accuracy as compared to previously reviewed algorithms for the prediction of dementia prevalence in HRS, while utilizing more flexible methods. These methods could be more easily generalized and utilized to estimate dementia prevalence in other national surveys.

/pdf/use-of-multidimensional-item-response-theory-methods-for-17ov3oxhqs.pdf

Use of multidimensional item response theory methods for dementia prevalence prediction: an example using the Health and Retirement Survey and the Aging, Demographics, and Memory Study

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Use of multidimensional item response theory methods for dementia prevalence prediction: an example using the Health and Retirement Survey and the Aging, Demographics, and Memory Study