Dementia Research in UoW CARE

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
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
Socio-demography, Social networks and support,
Lifestyles, cardiovascular (CVD) and other risk factors
Measure systolic and diastolic blood pressure, body height and weight
and waist circumference
GMS-AGECAT
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:
the GMS-AGECAT diagnostic output
the Community Screening Instrument for Dementia (CSI-D) cognitive
test score (COGSCORE)
the CSI-D informant interview (RELSCORE)
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.

ResultsPercentageofpeople
receivingcare(%)
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.

Results
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

Results
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

Results
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

Results
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

Results
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
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
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
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
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

Dementia Research in UoW CARE

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