Results: Compared with those with other chronic diseases, our sample with hypertension and DM had significantly more memory loss and poorer executive function. These signifi- cant differences were nullified when adjusting for age, gender, and education. Approximately one third had func- tional limitations ( n = 29, 32.2%), using a cutoff point of 35 or less (Duke Activity Status Index). Memory loss (delayed recall, b = 1.5, p = .016) and poor executive function (Trail Making Test Part A, b = j 0.2, p G .001) were predicting factors of functional decline, independent of age, gender, education, and comorbidity. Conclusions/Implications for Practice: Cognitive function, particularly memory and executive function, was poorer among chronically ill Korean adults in the community with hypertension or DM than their counterparts. Functional decline was worse in the presence of memory loss and poor executive function. Studies examining the mechanism by which overall functioning is impacted by cognitive decline and its relevance to functional declines in a larger representative sample are warranted. K EY W ORDS : cognition, functional capacity, community dwelling adults, chronic disease. The Journal of Nursing Research h VOL. 27, NO. 1, FEBRUARY 2019 O R I G I N A L A R T I C L E 1 1 PhD, RN, Professor, College of Nursing, Gachon University, Incheon, South Korea & 2 PhD, RN, Professor, College of Nursing, Jeju National University, Jeju, South Korea & 3 PhD, RN, Assistant Professor, College of Nursing, Chonnam National University, Gwangju, South Korea. Copyright B 2019 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
necessary for adhering to intricate therapeutic regimens (Angermann, Frey, & Ertl, 2012; Eggermont et al., 2012; Schneider et al., 2015). Subsequently, poor adherence fre- quently results in adverse outcomes, including further func- tional decline or mortality (O’Donnell et al., 2012; Raphael et al., 2012; Schneider et al., 2015) Despite the likelihood of cognitive decline, which may be a confounding condition in the management of chronic diseases (Eggermont et al., 2012; Hung, Wisnivesky, Siu, & Ross, 2009), there are currently limited evidence-based data on investigations of cognitive function and/or its relevance to clinical outcomes in chronic diseases (Raphael et al., 2012; Scanlan et al., 2007). Previous studies have been limited by multiple factors, including global measures used for cognitive assessment, design deficiency for investigating the relationship between cognitive function and hypertension and/or DM, and limited evidence on the functional implication of cognitive decline. Past studies have used a screening measure rather than a neuropsychological test battery that is designed to capture specific domains of cognitive impairment. In addition, few stud-
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