Ruoling Chen MBChB, MSc (Med Stats), PhD (Epid), FRSM

Reader in Public Health

Faculty of Education, Health and Wellbeing

University of Wolverhampton

Dementia Research in UoW CARE Selected publications and on-going studies

1. Chen R, Hu Z, Wei L, Wilson K. Socioeconomic status and survival among older adults with dementia and depression. Br J Psychiatry 2014; 204:436-40. (IF 8.0)

2. Chen R, et al. Passive smoking and risk of cognitive impairment in women who never smoke. Arch Int Med 2012;172:271-3. (IF 17.3)

3. Chen R. Association of environmental tobacco smoke with dementia and Alzheimer's disease among never smokers. Alzheimer's & Dementia 2012;8:590-5. (IF 12.4)

4. Chen R, et al. Incident dementia in a defined older Chinese population. PLoS ONE 2011;6:e24817. (IF 3.2)

5. Clifford A, Lang L, Chen R, Anstey KJ, Seaton A. Exposure to Air Pollution and Cognitive Functioning across the Life Course – a systematic literature review. Environmental Research 2016; 141 (IF 4.4)

Some Publications

On-going Projects

For Example Effects of Dietary Intakes on Incidence and Outcomes of Dementia PhD research project - Student: Aishae Bakre, supervised by Ruoling Chen and Angela Clifford

Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis Submitted to BMJ open, by Linda Lang, Angela Clifford, …., Ruoling Chen Care for people with dementia living in the community Prepared for a peer-review journal

Care for people with dementia living in the community: a household survey in China

Overarching aim is to examine care patterns of people with dementia living in the community. Care inequality

Methods

Over the past 8 years, we carried our a large household survey on older people aged ≥60 years in the rural and urban communities across 6 provinces of China.

Ruoling Chen

Methods

Ruoling Chen

Methods

Ruoling Chen

In 2010-2011, we carried out a face-to-face interview survey in Hubei province and examined 1,001 older residents. We employed a cluster randomised sampling method to choose residential

communities. We selected one rural community (Yanhe village in Wushan township of Wucheng county) and one urban community (Maojian sub-district in Shiyan city) as the study fields. Based on the residential registration lists, we tried to randomly recruit no fewer than 500 participants in each community. In total, we recruited 1,001 participants aged ≥ 60 years, and achieved a response rate of 91.8%.

Methods

Ruoling Chen

The main interview included A general health and risk factors record The Geriatric Mental State (GMS) questionnaire Other components of the 10/66 algorithm dementia research package

Methods

Ruoling Chen

A general health and risk factors record ¾ Socio-demography, Social networks and support, ¾ Lifestyles, cardiovascular (CVD) and other risk factors ¾ Measure systolic and diastolic blood pressure, body height and weight

and waist circumference

GMS-AGECAT ¾ The GMS data were analysed by a computer program-assisted

diagnosis, the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT), to assess the principal mental disorders in the study participants.

Methods

Ruoling Chen

The 10/66 dementia diagnosis requires four inputs from the interview:

¾ the GMS-AGECAT diagnostic output ¾ the Community Screening Instrument for Dementia (CSI-D) cognitive

test score (COGSCORE) ¾ the CSI-D informant interview (RELSCORE) ¾ the modified Consortium to Establish a Registry for AD (CERAD)

ten-word list learning task with delayed recall

Methods

Ruoling Chen

Before the Hubei study we completed the Anhui and other 4 provinces studies (Guangdong, Shanghai, Shanxi and Heilongjian ) using the GMS-AGECAT and totally interview 6,071 older people aged>=60.

But only 20% of participants had the informant interview. In 2010 to 2013 we re-interviewed 3,836 survivors in the cohort

the same protocol as that in the Hubei study above, ie, including informant interview.

Thus, there were 4,837 participants who were interviewed with

the CSI-D informant interview.

Methods

Ruoling Chen

Informant data In the informant questionnaire interview, we defined the informant to

be the person who knows the older adult best. They could be cohabitant with the older adults, but do not have to be, if a non-

cohabitant was better qualified to be the informant. They could be a family member, but not necessarily if a friend or neighbour was

better qualified to be the informant. Time spent with the older person may be a criterion for deciding the best

informant if there were several co-resident family members.

Methods

Ruoling Chen

In the informant interview, we documented (1) characteristics of the informant, (2) care arrangements for the older adult, (3) impact on the caregiver and

clinical information about the older adult. Whenever the older adult received care and support, we selected the main

caregiver as the informant for interview. The caregivers were asked about whether the older adult received care (1) a lot of time, (2) occasionally or (3) none at all.

Methods

Ruoling Chen

Statistical analysis Of 4,837 participants, 398 people were diagnosed with dementia

by the 10/66 algorithm, and 1,312 had diseases other than dementia.

These non-dementia diseases consisted of heart disease (coronary,

valvular or other cardiac related diseases), stroke, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer, Parkinson's disease or epilepsy.

Results Pe

rcenta

ge of

peop

lerec

eiving

care

(%) 88

42

268

24

10

125

11

18

622

4

15

483

32.7% of people with dementia received care, which was significantly higher than the proportions of people with diseases other than dementia (6.3%).

Results

Table 1. Numbers, percentages and odds ratios of the care received by people with dementia Results

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Age (years) 60-74 89 (33.2) 28 (21.5) ** Ref. 75-84 127 (47.4) 58 (44.6) 1.25 0.61-2.57 ≥85 52 (19.4) 44 (33.8) 2.18 0.96-4.91 Sex women 199 (74.3) 83 (63.8) * Ref. men 69 (25.7) 47 (36.2) 1.40 0.76-2.57

†Adjusted for age, sex, province, ADL and probability of dementia.

Table 2. Numbers, percentages and odds ratios of the care received by people with dementia Results

†Adjusted for age, sex, province, ADL and probability of dementia.

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Activity of daily living (score) §

0 223 (83.2) 32 (24.6) *** Ref. *** 1-4 25 (9.3) 20 (15.4) 2.79 1.27-6.10 5-28 20 (7.5) 78 (60.0) 18.03 9.20-35.33

Probability of Dem1066

≥0.29-0.4 151 (56.3) 28 (21.5) *** Ref. *** >0.4-0.6 42 (15.7) 21 (16.2) 2.03 0.87-4.73 >0.6-1.0 75 (28) 81 (62.3) 4.15 2.15-8.00

Table 3. Numbers, percentages and odds ratios of the care received by people with dementia Results

†Adjusted for age, sex, province, ADL and probability of dementia.

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Educational level >Primary Sch. 11 (4.1) 17 (13.1) *** Ref. **

<=Primary Sch. 257 (95.9) 113 (86.9) 0.24 0.08-0.70 Occupational class

Non-manual 51 (19) 39 (30.0) * Ref. *** Manual labourer 217 (81) 91 (70.0) 0.27 0.13-0.55

Table 4. Numbers, percentages and odds ratios of the care received by people with dementia Results

†Adjusted for age, sex, province, ADL and probability of dementia.

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Monthly income (RMB)

Personal ≥1000 64 (23.9) 52 (40.0) *** Ref. ** <1000 204 (76.1) 78 (60.0) 0.37 0.19-0.74 Family average ≥1000 144 (53.7) 62 (47.7) Ref. <1000 124 (46.3) 68 (52.3) 0.59 0.31-1.13 Living District Urban 52 (19.4) 52 (40.0) *** Ref. *** Rural 216 (80.6) 78 (60.0) 0.20 0.10-0.41

Table 5. Numbers, percentages and odds ratios of the care received by people with dementia Results

†Adjusted for age, sex, province, ADL and probability of dementia.

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Number of children

0-3 94 (35.1) 42 (32.3) Ref. ≥4 174 (64.9) 88 (67.7) 0.52 0.27-1.00 *

How far to your most closed relatives

Outside county/city or No relatives

11 (4.1) 2 (1.5) Ref.

Within same town or district

257 (95.9) 128 (98.5) 1.94 0.30-12.80

Table 6. Numbers, percentages and odds ratios of the care received by people with dementia Results

†Adjusted for age, sex, province, ADL and probability of dementia.

Care received Multivariate-adjusted Variable No (n = 268) Yes (n = 130) analysis N (%) N (%) P* OR† 95%CI Pǂ Visiting children and/or relatives*

Daily 86 (32.1) 34 (26.2) Ref. <Daily and ≥Monthly

93 (34.7) 54 (41.5) 2.08 0.97-4.47

<Monthly 89 (33.2) 42 (32.3) 1.63 0.73-3.64 Help available when needed

Yes 260 (97) 123 (94.6) Ref. No 8 (3.0) 7 (5.4) 1.81 0.42-7.73

* similar result for “Frequency of contacting and speaking to friends in village/community”

Table 7. Characteristics of caregivers for people with dementia and for those with other diseases Results

Caregivers for Age-sex-province Variable dementia (130) other dis. (82) adjusted analysis N (%) N (%) P* OR† 95%CI P Age (years) 60 - 95 48 (36.9) 49 (59.8) ** Ref. * 40 - 59 62 (47.7) 27 (32.9) 2.16 1.11-4.21 7 - 39 20 (15.4) 6 (7.3) 3.78 1.28-11.16 Sex Women 64 (49.2) 49 (59.8) Ref. Men 66 (50.8) 33 (40.2) 1.57 0.83-2.97 Marital status Married/cohabit. 120 (92.3) 72 (87.8) Ref. Never married 6 (4.6) 7 (8.5) 0.47 0.13-1.69 Separated/divorc. 4 (3.1) 3 (3.7) 1.32 0.21-8.47

Table 8. Characteristics of caregivers for people with dementia and for those with other diseases Results

Caregivers for Age-sex-province Variable dementia (130) other dis. (82) adjusted analysis N (%) N (%) P* OR† 95%CI P Educational level

≥Secondary sch. 41 (31.5) 34 (41.5) Ref. * Primary school 47 (36.2) 31 (37.8) 1.17 0.53-2.56 No school 42 (32.3) 17 (20.7) 3.23 1.28-8.17 Current employment status

Retired 32 (24.6) 33 (40.2) * Ref. Unemployed (look for job)

64 (49.2) 36 (43.9) 1.37 0.63-2.96

Employed 34 (26.2) 13 (15.9) 1.21 0.42-3.47

Table 9. Relationship between caregivers and people with dementia Results

Caregivers for Age-sex-province Variable dementia (130) other dis. (82) adjusted analysis N (%) N (%) P* OR† 95%CI P Relationship with patient

Spouse 31 (23.8) 39 (47.6) ** Ref. ** Daughter/son 42 (32.3) 17 (20.7) 2.47 1.08-5.68 Daughter/son-in-law

20 (15.4) 5 (6.1) 8.34 2.36-29.51

Other relative 6 (4.6) 5 (6.1) 1.46 0.36-5.90 Friend/ neighbour

11 (8.5) 9 (11.0) 1.69 0.53-5.42

Other 20 (15.4) 7 (8.5) 4.23 1.43-12.50 Normally living with older person

No 27 (20.8) 11 (13.4) Ref. Yes 103 (79.2) 71 (86.6) 0.59 0.24-1.40

Table 10 Caregivers’ ways of caring for people with dementia and for those with other diseases Results

Caregivers for Age-sex-province Variable dementia (130) other dis. (82) adjusted analysis N (%) N (%) P* OR† 95%CI P Care time A little 42 (32.3) 43 (52.4) ** Ref. A lot 88 (67.7) 39 (47.6) 2.09 1.09-4.04 * Have other* people help care

No 86 (66.2) 67 (81.7) * Ref. Yes 44 (33.8) 15 (18.3) 2.86 1.31-6.22 ** “Shift” care component

One or more family members

103 (79.2) 64 (78.0) Ref.

One or more friends/ neighbours

27 (20.8) 18 (22.0) 0.72 0.34-1.56

*Have any other relatives or friends regularly help to care for older person

Table 11. Caregivers’ ways of caring for people with dementia and for those with other diseases Results

Caregivers for Age-sex-province Variable dementia (130) other dis. (82) adjusted analysis N (%) N (%) P* OR† 95%CI P Given up or cut down on work to care for older person

No 94 (72.3) 66 (80.5) Ref. Yes 36 (27.7) 16 (19.5) 1.72 0.79-3.74 Anyone paid to help older person during the day

No 102 (78.5) 67 (81.7) Ref. Yes 28 (21.5) 15 (18.3) 0.90 0.40-2.02 Anyone paid to help older person during the night

No 108 (83.1) 74 (90.2) Ref. Yes 22 (16.9) 8 (9.8) 1.78 0.66-4.79

1. There are large inequalities in the community care for people with dementia in China.

2. The care patterns of people with dementia in China are different from those in the West. The care from young generation may increase economic deprivation.

Conclusions

3. Low levels of education and training in caregivers increase burdens of dementia and affect the quality of care.

Thanks

Any questions?

r.chen@wlv.ac.uk

Main collaborators: Prof Linda Lang, Dr Angela Clifford, Prof Zhi Hu, Prof Jiaji Wang, Dr Dongmei Zhang