Socio-demographic and clinical determinants of dementia in the oldest old: National survey of ageing and cognition in Trinidad

ABSTRACT

Objective: To determine social and clinical factors associated with dementia in the oldest old (>85 years). Design and Methodology: A survey in a nationally representative sample of people aged 85 years and older using household enumeration was undertaken. Dementia status was ascertained using standardized interviews and algorithms from the 10/66 schedule. Information was also obtained on age, gender, level of education, ethnicity and previous occupation. Self-report on the presence of angina, heart disease, stroke, diabetes, high cholesterol, and hypertension was elicited and corroborated. Results: Of the participants 61.5% were females. The mean age was 89.0 years and dementia was present in 47.2 % persons. Dementia was significantly associated with age >95 (OR=2.02; 95%CI 0.86- 4.69), female gender (OR=1.31; 95%CI 0.85- 2.02), East Indian ethnicity (OR=1.45; 95%CI 0.81-2.60), being widowed (OR=2.05; 95%CI 0.59-7), Hindu religion (OR=2.10; 95%CI 1.23- 3.58), history of working in the agricultural sector (OR=3.20; 95%CI 1.59-6.48). Level of education (OR=0.14; 95%CI 0.04-0.45), taking vitamins (OR=0.61; 95% CI 0.37-0.97) and being of mixed ethnicity (African and East Indian) were protective factors. Of the self-reported disease conditions, those with greater than 3 medical co-morbidities were 2 times (OR=2.21; 95%CI 0.48-9.94) more likely to have dementia than those with0-2 medical comorbidities. Dementia was not more likely to occur in diabetes (OR= 1.03; 95% CI 0.65-1.64) and hypertension (OR= 0.67; 95% CI 0.41-1.08). Conclusion: Our study, the first of its kind in Trinidad, supports more tailored policy and better planning of services for a rapidly expanding older population.