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Stroke and Heart Attack Symptom Recognition in Older US Adults by Cognitive Impairment Status
1Chronic Disease Epidemiology, Yale University, New Haven, Connecticut, USA.
Insights
Older adults with cognitive impairment are less likely to recognize stroke and heart attack symptoms, potentially delaying critical care. Living arrangements may influence symptom recognition in this vulnerable population.
Area of Science:
- Gerontology
- Neurology
- Cardiology
Background:
- Cognitive impairment significantly impacts older adults, a demographic at higher risk for cardiovascular diseases (CVDs) like stroke and heart attack.
- Symptom recognition is crucial for timely treatment of stroke and heart attack, but this is often impaired in older adults with cognitive deficits.
- Limited research exists on how cognitive impairment affects the recognition of stroke and heart attack symptoms in older US adults.
Purpose of the Study:
- To determine the impact of cognitive impairment on the recognition of stroke and heart attack symptoms among US adults aged 65 and older.
- To compare symptom recognition rates between older adults with and without cognitive impairment.
Main Methods:
- Utilized data from the 2014 and 2017 National Health Interview Surveys.
- Compared stroke and heart attack symptom recognition in US adults aged 65+ with and without cognitive impairment.
- Conducted adjusted analyses for CVD risk factors and stratified analyses by living arrangement and medical history.
Main Results:
- Older adults with cognitive impairment were 3.0–6.7% less likely to recognize individual stroke symptoms and 1.6–4.9% less likely to recognize individual heart attack symptoms.
- Recognition of all stroke symptoms was 9.7% lower and all heart attack symptoms was 6.7% lower in those with cognitive impairment.
- Adjusted analyses showed cognitive impairment was associated with slightly lower recognition of stroke (OR: 0.70) and heart attack symptoms (OR: 0.88).
Conclusions:
- Cognitive impairment presents a significant barrier to recognizing stroke and heart attack symptoms in older adults.
- Interventions are needed to improve symptom recognition, particularly for those with cognitive impairment who live alone.
- Living with others was associated with slightly better symptom recognition among those with cognitive impairment.
Introduction:
Cognitive impairment may make stroke and heart attack symptom recognition difficult, potentially resulting in treatment delays for those with these cardiovascular diseases (CVDs). Despite cognitive impairment affecting large numbers of older US adults who are also at increased risk of stroke and heart attack, little is known about stroke and heart attack symptom recognition in this population. As a result, this study sought to determine the impact of cognitive impairment on stroke and heart attack symptom recognition among older US adults.
Methods:
Using the 2014 and 2017 National Health Interview Surveys, we compared stroke and heart attack symptom recognition levels in US adults aged ≥65 years with cognitive impairment and those without cognitive impairment. Estimates of stroke and heart attack symptom recognition adjusted for CVD-related factors were assessed by cognitive impairment status. We also conducted analyses stratified by living arrangement and stroke and heart attack history for individuals with and without cognitive impairment.
Results:
US adults aged ≥65 years with cognitive impairment were observed to be 3.0-6.7% and 1.6-4.9%, respectively, less likely to recognize an individual stroke and heart attack symptom than similarly aged individuals without cognitive impairment. Recognition of all 5 stroke/heart attack symptoms was also lower among those with cognitive impairment, with this group being 9.7% less likely to recognize all stroke symptoms and 6.7% less likely to recognize all 5 heart attack symptoms compared to people without cognitive impairment. Following adjustment, individuals with cognitive impairment continued to have slightly lower recognition of certain individual stroke and heart attack symptoms as well as of all 5 symptoms of these conditions (stroke OR: 0.70 [95% CI: 0.58-0.85]; heart attack OR: 0.88 [95% CI: 0.75, 1.03]) than those without cognitive impairment. For individuals with cognitive impairment, living with others was linked with slightly better recognition of all individual stroke symptoms and heart attack history with better recognition of all individual heart attack symptoms.
Conclusions:
Additional work is needed to address the challenge of improving recognition levels for specific stroke and heart attack symptoms in older US adults with cognitive impairment and especially for members of this group who live alone.
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