Article Review: Student's Name, Institution, Course, Profess

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Article Review Student’s Name Institution/Affiliation Course Professor Date Part 1 The article “Age-Related Changes in Instrumental and Basic Activities of Daily Living Impairment in Older Adults with Very Mild Alzheimer’s Disease” by Tabira et al. (2020) focuses on age-related changes linked to mild Alzheimer’s disease within the aging population. The authors acknowledge that age-related changes in patients with mild Alzheimer's have been rarely explored. Thus it clarifies the characteristics linked to Alzheimer’s disease cognitive impairment and compares how these impairments differ from older adults without the disease. To achieve this, the paper undertook a study whereby 107 older adults with mild Alzheimer’s disease were first-time patients at the Kumamoto University Hospital dementia clinic.

The control group encompassed 682 older adults living within that community. The results showed impairments in managing finances, medication, shopping, and dressing. Additionally, fewer individuals with this condition could conduct these activities independently. The article's main conclusion was that patients who have very mild Alzheimer’s disease depict considerably decreased activities of daily living independence from early old age. Tabira et al. (2020) acknowledged that aging is often linked to decreased independence among individuals; hence, they often require help with instrumentals and basic activities of daily living.

These include feeding, bathing, and others they would have done better. However, adults with mild Alzheimer’s disease require more care because Alzheimer’s disease is known to interfere with the psychological well-being of individuals. This condition results in psychological function impairment, a predictive element for dementia. Patients with this condition show the most significant impairment in minor activities of daily living, including using transport means, shopping, and handling finances and medicines. This article can be applauded for creating insight into how age-related impairments are worsened by conditions such as Alzheimer's disease, whether mild or severe.

Normally aging comes with significant impairments because as people age, they become more dependent even on simple tasks because of their frailty. However, illnesses can worsen this situation, thus requiring caregivers to attend to the needs of the older adult population. The control group was an excellent way to prove the difference between normal older adults and those affected by very mild Alzheimer’s disease. The control group is considered equally important to the experiment group because, without it, there will be no experiment (Curtis et al., 2018). Without the control group, the authors would not confidently determine the changes that occur in older adults with the condition and those without it.

This was a critical procedure to validate the findings and substantiate their claims. Additionally, as with any research, Tabira et al. (2020) outlined their methods to validate that older adults with very mild Alzheimer’s disease require more assistance with activities than normal older adults. The methodology gives legitimacy and offers scientifically sound findings. Additionally, it helps maintain the researchers on track, making their process seamless and effectively manageable. The methodology has allowed the authors to uncover new information that requires more attention regarding age-related changes among older adults.

Furthermore, the article encompasses applicability since the results and findings can help the medical field move forward toward caring for older adults. The lack of attention shows that older adults with very mild Alzheimer’s disease had otherwise been overlooked when it comes to the degree of help they need to carry out their activities of daily living. Still, now their needs can be met better. Overall, older adults continue to go through age-related changes as they grow older. They go through psychological changes that affect their ability to perform these activities.

The article considers how very mild Alzheimer’s disease can deepen these needs because of its impact on individuals' cognitive ability. It proves, through research on older adults with this condition, that they require more help due to the psychological impact of Alzheimer’s on their independence to conduct activities of daily living. Part 2 Depression Although feeling depressed is an everyday part of life, it is not normal for aging. According to studies, most older adults are satisfied with their lives despite facing more illnesses and physical issues than the younger generation (Canuto et al., 2018). However, if individuals experience depression during their younger years, they might face it even in older age.

Older adults might experience major depressive disorder, which includes symptoms that interfere with their ability to perform their daily tasks. Another is medicine or substance-induced depressive disorder, associated with using substances such as pain medication or alcohol. Another one is a depressive disorder due to a medical condition that is linked to separate illnesses such as multiple sclerosis. Older adults experience changes related to their mood, feeling empty and worthless; they get fatigued, walk or move slowly, and have difficulty concentrating. Delirium As people grow older, they begin to experience changes related to delirium.

Delirium encompasses a confused mental state that happens suddenly. An individual can change their mental status and suddenly start to act distracted and disoriented. This is common in older adults, especially those with dementia who need hospitalization. Over time, the aging starts to have brief confusion episodes and absentmindedness. They also have trouble thinking clearly and paying attention. Dementia Most older adults commonly experience age-related changes linked to dementia, especially because it is a common illness among the older adult population. These older populations start experiencing changes affecting their memory and social and thinking abilities. Older adults start to experience memory loss linked to their aging bodies, which could also be caused by dementia. Additionally, they experience changes in communication because they might find trouble finding words due to memory issues. Finally, they get challenges with spatial and visual abilities which can be characterized by their tendencies to get lost, such as when driving or walking.

Alzheimer’s Alzheimer’s is a common illness affecting older adults. It affects their cognitive abilities as they grow older. Additionally, the illnesses can also be linked to some of the age-related changes that older adults face. As people age, they start experiencing greater memory loss than in their younger years. This is common, especially for older adults with Alzheimer’s, as they experience a more significant memory loss and face cognitive challenges in general (Lee et al., 2018). For example, they might wander and get lost, repeat questions, and experience personality and behavior changes, such as becoming more irritable and moodier. Erectile dysfunction Most older adults have reported erectile dysfunction as they grow older. They experience lower libido and a lower mood for engaging in sexual activity. This can be associated with various conditions linked to the elderly. For example, several heart conditions have been linked to erectile dysfunction among the elderly, including heart disease and atherosclerosis (Tanaka et al., 2020). Other illnesses prevalent among the old that can be linked to erectile dysfunction include diabetes, stroke, and Parkinson's disease. Additionally, injury and trauma against the spinal cord and pelvic area can lead to nerve damage, thus resulting in erectile dysfunction. Even surgeries such as fistula surgery and orthopedic surgery also decrease sexual dysfunction. Suicide Suicide is among the leading causes of death in the United States, which affects individuals of all ages. Older adults are more susceptible to suicide for various reasons, including chronic illnesses and the passing of a loved one. Statistics show that although the older population makes up 12% of the population, they constitute approximately 18%. In 2020, for example, almost 46,000 suicides occurred, whereby 9,137 of these were older adults (National Council on Aging, 2021). The age-related symptoms contributing to suicide or suicide ideation among older adults include loneliness because they live alone or are homebound. Others include grief over a lost one, chronic pain, financial struggles, and cognitive impairment. Older adults start to avoid social activities, neglect themselves, including grooming and taking their meds, lack concern over their safety, and change or prepare their wills. Through these signs, an individual can recognize the risk of suicide and get help as soon as possible. References Canuto, A., Weber, K., Baertschi, M., Andreas, S., Volkert, J., Dehoust, M. C., ... & Härter, M. (2018). Anxiety disorders in old age: psychiatric comorbidities, quality of life, and prevalence according to age, gender, and country. The American Journal of Geriatric Psychiatry, 26(2). Curtis, M. J., Alexander, S., Cirino, G., Docherty, J. R., George, C. H., Giembycz, M. A., ... & Ahluwalia, A. (2018). Experimental design and analysis and their reporting II: Updated and simplified guidance for authors and peer reviewers. British Journal of Pharmacology, 175(7). Lee, S. D., Ong, B., Pike, K. E., & Kinsella, G. J. (2018). Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people. Journal of Clinical and Experimental Neuropsychology, 40(2). National Council on Aging. (2021). Suicide and Older Adults. Retrieved from ... Tabira, T., Hotta, M., Murata, M., Yoshiura, K., Han, G., Ishikawa, T., ... & Ikeda, M. (2020). Age-related changes in instrumental and basic activities of daily living impairment in older adults with very mild Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders Extra, 10(1), 27-37. Tanaka, Y., Bundy, J. D., Allen, N. B., Uddin, S. I., Feldman, D. I., Michos, E. D., ... & Greenland, P. (2020). Association of erectile dysfunction with incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA). The American Journal of Medicine, 133(5).

Paper For Above instruction

The intricate landscape of aging presents complex challenges, notably the decline in functional abilities among older adults, particularly those with neurodegenerative diseases such as Alzheimer’s. The recent article by Tabira et al. (2020) offers valuable insights into how very mild Alzheimer’s disease impacts the activities of daily living (ADLs) in older individuals, highlighting the progressive deterioration of independence associated with cognitive impairment. This review synthesizes their findings, the relevance of integrating population health frameworks with quality improvement (QI) methodologies, and presents a comprehensive plan for a two-year initiative aimed at improving adolescent mental health, demonstrating how these models can synergize to enhance health outcomes effectively.

Introduction

The aging process inherently involves gradual declines in physical, cognitive, and psychological functions. In particular, Alzheimer’s disease significantly exacerbates these declines, notably impairing basic and instrumental ADLs such as dressing, shopping, and medication management. Tabira et al.’s (2020) study underscores how very mild Alzheimer’s can diminish independence even in early old age, implying the need for targeted interventions that can delay progression and support caregivers. Furthermore, such health deterioration not only impacts individuals’ quality of life but also exerts a substantial burden on healthcare systems and caregivers. Addressing these issues requires a robust combination of population health principles and QI methodologies.

The Relevance of Population Health Frameworks

Population health frameworks serve as foundational tools to understand and address health issues comprehensively. The Three Domains of Public Health (2005)—health improvement, health protection, and health service delivery—provide a holistic approach that guides strategic planning in health initiatives. For aging individuals, especially those with early cognitive decline, health improvement strategies might focus on early detection, cognitive training, and community support mechanisms. Health protection involves safeguarding environments and policies to reduce risk factors for cognitive and functional decline, such as reducing exposure to neurotoxins or promoting safe physical activity.

The Dahlgren-Whitehead rainbow model (1991) further enriches this understanding by illustrating how individual, community, and societal determinants influence health outcomes. For instance, social support, socioeconomic status, and environmental factors interact with individual health statuses influencing progression or mitigation of age-related impairments. These frameworks collectively emphasize that health interventions must be broad, inclusive, and tailored, targeting multiple levels of influence.

Integrating Frameworks with Quality Improvement Methods

Quality Improvement (QI) methods such as Plan-Do-Study-Act (PDSA) cycles, process mapping, and stakeholder engagement are essential for translating frameworks into actionable strategies. For example, in addressing early Alzheimer’s-related decline, a PDSA cycle might test a community-based cognitive training program, measuring its impact on delaying functional deterioration. Process mapping can identify gaps in caregiver support and healthcare services, allowing targeted process redesigns to streamline referrals or resource allocation.

In the context of adolescent mental health, the integration of frameworks like the Ottawa Charter (1986), which emphasizes social justice and health equity, with QI techniques enables the development of tailored, stakeholder-driven interventions. For instance, combining community participation with iterative testing of mental health screening tools can lead to more accessible and acceptable services, ultimately reducing the incidence and severity of mental health disorders among adolescents.

Designing a Two-Year Population Health Improvement Initiative

The proposed initiative focuses on improving adolescent mental health within a specific community setting, employing a coordinated approach that integrates population health frameworks with QI methodologies. The primary goal is to reduce the incidence and impact of mental health disorders, including depression, anxiety, and suicidal ideation, over two years.

Using the Three Domains model, the initiative emphasizes health improvement through early detection programs, health protection by creating supportive environments in schools, and health service delivery through integrated mental health services. The Dahlgren-Whitehead model guides the identification of social determinants—such as socioeconomic status and social support—that influence mental health outcomes. The Beatties’ Structural Grid (1991) informs intervention strategies at different population levels—individual counseling, peer support groups, and policy advocacy.

The intervention employs the PDSA cycle to pilot a peer-led mental health awareness program. Initial planning involves community stakeholder consultations to ensure cultural relevance and acceptability. The ‘Do’ phase implements the program in selected schools, with outcomes assessed via surveys and focus groups. The ‘Study’ phase analyzes data to understand participation levels and mental health indicators. The ‘Act’ phase scales successful strategies while refining or discontinuing ineffective ones, exemplifying continuous quality improvement.

Furthermore, engaging adolescents, families, educators, and healthcare providers in participatory decision-making fosters a shared sense of ownership, aligning with the Ottawa Charter’s emphasis on social justice. Regular stakeholder meetings and feedback mechanisms ensure that the initiative remains adaptive and responsive to emerging needs.

Key milestones include baseline assessments at month 0, pilot program implementation at month 3, initial evaluations at month 6, mid-term review at month 12, and final outcomes measurement at month 24. These checkpoints facilitate iterative learning and adjustment, optimizing the impact of interventions.

Anticipated outcomes involve increased mental health literacy, early identification of at-risk adolescents, improved access to mental health resources, and a measurable reduction in mental health symptoms and suicidal ideation. Challenges such as stigma, resource limitations, and stakeholder engagement are mitigated through targeted communication strategies, partnerships, and capacity building.

In conclusion, leveraging the synergy between population health frameworks and QI methodologies creates a robust, adaptable blueprint for addressing adolescent mental health disparities. The iterative, stakeholder-informed process ensures that interventions are effective, sustainable, and aligned with broader health promotion goals.

References

• Canuto, A., Weber, K., Baertschi, M., Andreas, S., Volkert, J., Dehoust, M. C., & Härter, M. (2018). Anxiety disorders in old age: psychiatric comorbidities, quality of life, and prevalence according to age, gender, and country. The American Journal of Geriatric Psychiatry, 26(2).
• Curtis, M. J., Alexander, S., Cirino, G., Docherty, J. R., George, C. H., Giembycz, M. A., & Ahluwalia, A. (2018). Experimental design and analysis and their reporting II: Updated and simplified guidance for authors and peer reviewers. British Journal of Pharmacology, 175(7).
• Lee, S. D., Ong, B., Pike, K. E., & Kinsella, G. J. (2018). Prospective memory and subjective memory decline: A neuropsychological indicator of memory difficulties in community-dwelling older people. Journal of Clinical and Experimental Neuropsychology, 40(2).
• National Council on Aging. (2021). Suicide and Older Adults. Retrieved from...
• Tabira, T., Hotta, M., Murata, M., Yoshiura, K., Han, G., Ishikawa, T., & Ikeda, M. (2020). Age-related changes in instrumental and basic activities of daily living impairment in older adults with very mild Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders Extra, 10(1), 27-37.
• Tanaka, Y., Bundy, J. D., Allen, N. B., Uddin, S. I., Feldman, D. I., Michos, E. D., & Greenland, P. (2020). Association of erectile dysfunction with incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA). The American Journal of Medicine, 133(5).