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Osaka, Hiroshi, Daisuke Fujita, Kenichi Kobara, Yosuke Yoshimura, Hiromi Matsumoto, and Tadanobu Suehiro. "01 Prediction of Falls in Community-Dwelling Older People using an Accelerometer: The Results of a 1-Year Prospective Study." Age and Ageing 48, Supplement_4 (December 2019): iv1—iv2. http://dx.doi.org/10.1093/ageing/afz164.01.
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Abstract Background Fall preventive exercise for community-dwelling older people in Japan has a certain effect. The purpose of this study was to examine the predictors of fall risk in older people engaging in preventive exercise. Methods In this prospective study, we recruited 162 community-dwelling older people. We had them complete a self-report questionnaire containing items on weekly exercise frequency, exercise duration, exercise efficacy, amount of pain, number of diagnosis chronic diseases, health anxiety level, vision impairment, difficulty using the stairs, insomnia, fear of falling, history of falls, and forgetfulness, as well as the Falls Efficacy Scale. Walking speed and trunk acceleration during walking were also measured in all participants. From trunk acceleration, we calculated five gait parameters: fluctuation, weight shift, lateral balance, anteroposterior balance, and rhythm. Participants were classified as fallers or non-fallers according to the incidence of falls over a 1-year period from baseline assessment. Results Of all participants, 19 (11.7%) were classified as fallers and 143 (88.3%) as non-fallers. In comparing the fallers and non-fallers, we found significant differences in their exercise duration, exercise efficacy, amount of pain, history of falls, walking speed, and the gait parameters of weight shift and anteroposterior balance. A logistic regression analysis revealed that walking speed (odds ratio: 0.049, 95% confidence interval [CI]: 0.005-0.265, p=0.008) and weight shift (odds ratio: 0.021, 95%CI: 0.000-0.877, p=0.043) were predictors of falls. Conclusion The gait parameter of weight shift is the amplitude ratio of the auto-correlation function from vertical acceleration. This gait parameter is an original metrics and might show the temporal structure around the terminal stance. Measurement of gait parameters, in addition to physical performance, using an accelerometer seems beneficial for fall risk identification among community-dwelling older people engaged in fall preventive exercise.
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Jahouh, Maha, Jerónimo J. González-Bernal, Josefa González-Santos, Diego Fernández-Lázaro, Raúl Soto-Cámara, and Juan Mielgo-Ayuso. "Impact of an Intervention with Wii Video Games on the Autonomy of Activities of Daily Living and Psychological–Cognitive Components in the Institutionalized Elderly." International Journal of Environmental Research and Public Health 18, no. 4 (February 7, 2021): 1570. http://dx.doi.org/10.3390/ijerph18041570.
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As people age, the risk of disease increases and deterioration becomes more noticeable. These changes can increase the risk of cognitive impairment, with negative consequences for the quality of life and the ability to perform activities of daily living (ADLs) in older people, which translate into greater dependence and loss of wellness. This study aimed to determine the impact and effectiveness of the use of the Wii® game console (Nintendo Company Limited, Kyoto, Japan) on improving performance of basic and instrumental ADLs, as well as its relationship with cognitive impairment levels and mood in institutionalized older people. A longitudinal study was designed, whose study population consisted of people over 75 years of age who lived in a nursing-home or attended a day care center (n = 80; 45 women). Cognitive status was assessed using Lobo’s Mini-Cognitive Examination (MCE) and Global Deterioration Scale (FAST-GDS), while the psychological assessment used the Dementia Apathy Interview and Rating (DAIR), Yesavage scale for Geriatric Depression (EGD-15), and Goldberg Anxiety and Depression Scale (EADG). Differences from T1 to T2 in the control group (control; n = 40; 23 women; 83.25 ± 8.78 years; 76.35 ± 13.54 kg) and in the experimental group (Wii; n = 40; 22 women; 85.05 ± 8.63 years; 74.60 ± 13.01 kg) were evaluated using a paired Student’s t-test or Wilcoxon’s signed rank test, and a two-way repeated measures analysis of variance (ANOVA) test. Differences in Δ (%) and other tests at T1 and T2 were compared using the independent t-test or Mann–Whitney U test, with the treatment category as a fixed factor. The results showed that the Wii® video console had a positive influence for older people, increasing cognitive status and levels of ADLs, and psychological status. In addition, a positive correlation between performance of ADLs and cognitive status was observed, as well as a negative correlation with the psychological status. Through a rehabilitation program with a Wii® game console in the elderly, depression, anxiety and apathy levels were reduced, accompanied by an increase in memory and attention, as well as in performance of basic and instrumental ADLs.
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Sasaki, Yuri, Taishi Tsuji, Shihoko Koyama, Yukako Tani, Tami Saito, Katsunori Kondo, Ichiro Kawachi, and Jun Aida. "Neighborhood Ties Reduced Depressive Symptoms in Older Disaster Survivors: Iwanuma Study, a Natural Experiment." International Journal of Environmental Research and Public Health 17, no. 1 (January 3, 2020): 337. http://dx.doi.org/10.3390/ijerph17010337.
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Objective: As most studies relating to mental health and disasters have employed cross-sectional or follow-up assessments about psychological health with post-disaster information, the association between changes in social ties and mental health remains unclear. We examined the relationship between the changes in survivor neighborhood ties and depressive symptoms before and after a natural disaster. Methods: Participants were 3567 individuals aged ≥65 years living in Iwanuma city who had responded to questionnaires by the Japan Gerontological Evaluation Study both predating the 2011 Great East Japan Earthquake and Tsunami, and 2.5 years afterward. Changes in the depressive symptoms were assessed using the geriatric depression scale (GDS) at the baseline and follow-up survey. Changes in the neighborhood ties were assessed by asking the participants about their interactions with people in their neighborhood. Possible confounders were adjusted in a linear regression model. Results: Among the 3111 participants in this analysis, 1073 (34.5%) had increased GDS score after the disaster. There were 336 (10.8%) individuals who had neighborhood ties before the disaster, but had no ties afterward; their mean GDS score increased from 2.93 points in 2010 to 3.19 points in 2013. Among those who had not had ties before and after the disaster the mean GDS score remained almost stable, from 2.19 points in 2010 to 2.12 points in 2013. The participants with post-disaster ties were significantly less likely to have an increased GDS score compared with those who had not had ties before and after the disaster (β = −0.39; 95% confidence interval: −0.72, −0.06). Conclusions: Increased neighborhood ties after the disaster reduced the risk of depressive symptoms even when survivors suffered disaster damages. The study reinforces the importance of social capital in disaster recovery and suggests to local governments and local communities that fostering horizontal, neighborhood ties may improve disaster preparedness and mental health resilience.
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Kobayashi, Rei, and Masato Ishizaki. "Relationship Between Health Literacy and Social Support and the Quality of Life in Patients With Cancer: Questionnaire Study." Journal of Participatory Medicine 12, no. 1 (March 19, 2020): e17163. http://dx.doi.org/10.2196/17163.
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Background Low health literacy is associated with factors such as not taking medication as prescribed as well as poor health status and increased hospitalization and mortality risk, and has been identified as a risk factor for decreased physical function in older individuals. Health literacy is becoming an increasingly important issue because of the increased number of people affected by cancer who must make complicated treatment decisions. Health literacy has been shown to be positively associated with quality of life (QOL), and social support has been identified as important for addressing health-related problems and reducing the relative risk of mortality in patients with cancer. However, few studies have examined the relationship between health literacy, social support, age, and QOL. Objective The aim of this study is to examine the effects of health literacy, social support, and age on the QOL of patients with cancer. Methods An anonymous, self-administered online questionnaire was conducted from March 28 to 30, 2017, in Japan on patients with lung, stomach, or colon cancer that were voluntarily registered with an internet survey company. The survey covered basic attributes, health literacy, social support, and QOL. The European Health Literacy Survey Questionnaire, a comprehensive measure of health literacy instrument, was used to measure health literacy; the Japanese version of the Social Support Scale was used to measure social support; and the Japanese version of the Functional Assessment of Cancer Therapy-General (7-item version) assessment tool was used to measure QOL. Results A total of 735 survey invitations were randomly sent to patients with lung, stomach, or colorectal cancer, and responses were obtained from 619 (82.2% response rate). Significant effects on the QOL in patients with lung, stomach, or colon cancer were observed for health literacy, social support, and age, and for the interactions of health literacy and social support and of social support and age. Health literacy, social support, and the interaction between these variables also showed a significant effect on the QOL in patients 50 years or older, but not on those younger than 50 years. Conclusions The results of this study revealed that higher health literacy, social support, and age were associated with the QOL in patients with cancer. In addition, the relationship with QOL was stronger for social support than for health literacy. These findings suggest the importance of health literacy and social support and indicate that social support has a greater effect on QOL than does health literacy, while the QOL in patients with cancer aged younger than 50 years was lower than that of those 50 years or older. Therefore, elucidating the needs of these patients and strengthening social support based on those needs may improve their QOL.
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Imamura, Kotaro, Akizumi Tsutsumi, Yumi Asai, Hideaki Arima, Emiko Ando, Akiomi Inoue, Reiko Inoue, et al. "Association between psychosocial factors at work and health outcomes after retirement: a protocol for a systematic review and meta-analysis." BMJ Open 9, no. 8 (August 2019): e030773. http://dx.doi.org/10.1136/bmjopen-2019-030773.
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IntroductionThe world’s population is rapidly ageing, and health among older people is thus an important issue. Several previous studies have reported an association between adverse psychosocial factors at work before retirement and postretirement health. The objective of this systematic review and meta-analysis is to examine the association between psychosocial factors at work and health outcomes after retirement, based on a synthesis of well-designed prospective studies.Methods and analysisThe participants, exposures, comparisons and outcomes of the studies in this systematic review and meta-analysis are defined as follows: (P) people who have retired from their job, (E) presence of adverse psychosocial factors at work before retirement, (C) absence of adverse psychosocial factors at work before retirement and (O) any physical and mental health outcomes after retirement. Published studies were searched using the following electronic databases: MEDLINE, EMBASE, PsycINFO, PsycARTICLES and Japan Medical Abstracts Society. The included studies will be statistically synthesised in a meta-analysis to estimate pooled coefficients and 95% CIs. The quality of each included study will be assessed using the Risk Of Bias In Non-randomised Studies-of Interventions. For the assessment of meta-bias, publication bias will be assessed by using Egger’s test, as well as visually on a funnel plot. Heterogeneity will be assessed using the χ² test with Cochran’s Q statistic and I2.Ethics and disseminationResults and findings will be submitted and published in a scientific peer-reviewed journal and will be disseminated broadly to researchers and policy-makers interested in the translatability of scientific evidence into good practices.PROSPERO registration numberCRD42018099043.
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Lorbach, Edwina R., Kate E. Webster, Hylton B. Menz, Joanne E. Wittwer, and John R. Merory. "Physiological Falls Risk Assessment in Older People with Alzheimer’s Disease." Dementia and Geriatric Cognitive Disorders 24, no. 4 (2007): 260–65. http://dx.doi.org/10.1159/000107101.
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While, Alison E. "Falls and older people: understanding why people fall." British Journal of Community Nursing 25, no. 4 (April 2, 2020): 173–77. http://dx.doi.org/10.12968/bjcn.2020.25.4.173.
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Falls are common among older people and a major public health challenge. This article describes why falls are more common among older people, the potential causes of falls and what assessments should be undertaken to inform preventive interventions. District nurses are well placed to contribute to the understanding of why an older person has had a fall as part of a falls risk assessment.
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Tsuji, Taishi, Katsunori Kondo, Naoki Kondo, Jun Aida, and Daisuke Takagi. "Development of a risk assessment scale predicting incident functional disability among older people: Japan Gerontological Evaluation Study." Geriatrics & Gerontology International 18, no. 10 (August 14, 2018): 1433–38. http://dx.doi.org/10.1111/ggi.13503.
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O’Neill, Desmond. "Safe mobility for older people." Reviews in Clinical Gerontology 10, no. 2 (May 2000): 181–91. http://dx.doi.org/10.1017/s0959259800000290.
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Driving: a new geriatric giant?Over the last fifty years geriatric medicine has promoted the concept that functional loss in older people is primarily a health issue. For a major loss of function, such as incontinence or immobility, we recognize the need for detection, investigation and treatment. The diagnostic / therapeutic / rehabilitation paradigm takes precedence over the prosthetic approach. Not only do we appreciate the benefits of an interdisciplinary assessment, but we are also accustomed to estimating risk and competence when making decisions about discharging frail older people back to their home environment.
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Toosty, Nishat Tasnim, Aya Hagishima, and Ken-Ichi Tanaka. "Heat health risk assessment analysing heatstroke patients in Fukuoka City, Japan." PLOS ONE 16, no. 6 (June 21, 2021): e0253011. http://dx.doi.org/10.1371/journal.pone.0253011.
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Background Climate change, as a defining issue of the current time, is causing severe heat-related illness in the context of extremely hot weather conditions. In Japan, the remarkable temperature increase in summer caused by an urban heat island and climate change has become a threat to public health in recent years. Methods This study aimed to determine the potential risk factors for heatstroke by analysing data extracted from the records of emergency transport to the hospital due to heatstroke in Fukuoka City, Japan. In this regard, a negative binomial regression model was used to account for overdispersion in the data. Age-structure analyses of heatstroke patients were also embodied to identify the sub-population of Fukuoka City with the highest susceptibility. Results The daily maximum temperature and wet-bulb globe temperature (WBGT), along with differences in both the mean temperature and time-weighted temperature from those of the consecutive past days were detected as significant risk factors for heatstroke. Results indicated that there was a positive association between the resulting risk factors and the probability of heatstroke occurrence. The elderly of Fukuoka City aged 70 years or older were found to be the most vulnerable to heatstroke. Most of the aforementioned risk factors also encountered significant and positive associations with the risk of heatstroke occurrence for the group with highest susceptibility. Conclusion These results can provide insights for health professionals and stakeholders in designing their strategies to reduce heatstroke patients and to secure the emergency transport systems in summer.
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Kielich, Kajtek, Lynette Mackenzie, Meryl Lovarini, and Lindy Clemson. "Urban Australian general practitioners’ perceptions of falls risk screening, falls risk assessment, and referral practices for falls prevention: an exploratory cross-sectional survey study." Australian Health Review 41, no. 1 (2017): 111. http://dx.doi.org/10.1071/ah15152.
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Objective The study aimed to explore Australian general practitioners’ (GPs) perceptions of falls risk screening, assessment and their referral practices with older people living in the community, and to identify any barriers or facilitators to implementing evidence-based falls prevention practice. Methods Hardcopy surveys and a link to an online survey were distributed to 508 GPs working at one Medicare Local (now part of a Primary Care Network) located in Sydney, Australia. Data were analysed using descriptive statistics and key themes were identified from open text responses. Results A total of 37 GPs returned the survey. Only 10 (27%) GPs routinely asked older people about falls, and five (13.5%) asked about fear of falls during clinical consultations. Barriers to managing falls risk were identified. GPs estimated that they made few referrals to allied health professionals for falls interventions. Conclusions GPs were knowledgeable about falls risk factors but this did not result in consistent falls risk screening, assessment or referral practices. Due to the small sample, further research is needed with a larger sample to augment these results. What is known about the topic? Falls are a common and serious health issue for older people and fall prevention is vital, especially in the primary care setting. General practitioners (GPs) are key health professionals to identify older people at risk of falls and refer them to appropriate health professionals for intervention. Evidence-based falls prevention interventions exist but are not easily or routinely accessed by older people. What does this paper add? GPs believe that previous falls are an important falls risk factor but they do not routinely ask about falls or fear of falls in clinical practice with older people. GP referral rates to allied health professionals for falls prevention are low, despite evidence-based falls prevention interventions being provided by allied health professionals. There are several barriers to GPs providing falls prevention assessment and intervention referrals, particularly using the current primary health systems. What are the implications for practitioners? GPs need to recognise their potential significant contribution to falls prevention in the community and may require tailored training. Sustainable evidence-based referral pathways need to be developed so that older people can be referred to allied health professionals for falls prevention interventions in the primary care setting, and better local networks need to be developed to allow this to occur. Policy makers may have to address the identified barriers to multidisciplinary practice and funding of services to facilitate effective falls prevention programs in primary care.
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Harari, Danielle. "Faecal incontinence in older people." Reviews in Clinical Gerontology 19, no. 2 (May 2009): 87–101. http://dx.doi.org/10.1017/s0959259809990153.
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SummaryFaecal incontinence in older people is a distressing and socially isolating symptom and increases the risk of morbidity, mortality and dependency. Many older individuals with faecal incontinence will not volunteer the problem to their general practitioner or nurse and, regrettably, health care providers do not routinely enquire about the symptom. Even when older people are noted by health care professionals to have faecal incontinence, the condition is often managed passively, especially in the long-term care setting where it is most prevalent. The importance of identifying treatable causes of faecal incontinence in older people, rather than just managing passively, is strongly emphasized in national and international guidance, but audit shows that adherence to such guidance is generally poor. This article describes epidemiology, causes, assessment, diagnosis and treatment of faecal incontinence in older people.
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Fujiwara, Takeshi, James P. Sheppard, Satoshi Hoshide, Kazuomi Kario, and Richard J. McManus. "Medical Telemonitoring for the Management of Hypertension in Older Patients in Japan." International Journal of Environmental Research and Public Health 20, no. 3 (January 26, 2023): 2227. http://dx.doi.org/10.3390/ijerph20032227.
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Hypertension is the most frequent modifiable risk factor associated with cardiovascular disease (CVD) morbidity and mortality. Even in older people, strict blood pressure (BP) control has been recommended to reduce CVD event risks. However, caution should be exercised since older hypertensive patients have increased physical vulnerability due to frailty and multimorbidity, and older patients eligible for clinical trials may not represent the general population. Medical telemonitoring systems, which enable us to monitor a patient’s medical condition remotely through digital communication, have become much more prevalent since the coronavirus pandemic. Among various physiological parameters, BP monitoring is well-suited to the use of such systems, which enable healthcare providers to deliver accurate and safe BP management, even in the presence of frailty and/or living in geographically remote areas. Furthermore, medical telemonitoring systems could help reduce nonadherence to antihypertensive medications and clinical inertia, and also enable multi-professional team-based management of hypertension. However, the implementation of medical telemonitoring systems in clinical practice is not easy, and substantial barriers, including the development of user-friendly devices, integration with existing clinical systems, data security, and cost of implementation and maintenance, need to be overcome. In this review, we focus on the potential of medical telemonitoring for the management of hypertension in older people in Japan.
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Weiner, Michael, Susan Wells, and Ngaire Kerse. "Perspectives of general practitioners towards evaluation and treatment of cardiovascular diseases among older people." Journal of Primary Health Care 1, no. 3 (2009): 198. http://dx.doi.org/10.1071/hc09198.
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INTRODUCTION: Risk of cardiovascular disease (CVD) events increases with age. With treatment, individuals with highest risk accrue greater absolute risk reduction. New Zealands CVD guidelines provide no upper age limit for risk assessment. Guidance for treating those over 75 years is limited. Little is known about GPs attitudes regarding assessing and managing cardiovascular risk among older people. METHODS: A 39-item questionnaire including three cases representing various risk was developed and administered to 500 GPs randomly selected from a registry. RESULTS: Of the GPs, 379 were eligible; 86 (22%) responded to the questionnaire. Most were male (57%), between 40 and 59 years of age (74%), of European ethnicity (57%), had a medical degree from NZ (60%), and had been practising for at least 10 years (98%). Respondents were less likely to assess risk with increasing patient age and more likely to manage risk according to individual risk factors, rather than absolute risk. Marked variation occurred in intent to assess risk for a patient aged 78 years, according to living environment, co-morbidity, and functional status. In general, respondents indicated that they would usually assess risk for a 78-year-old community-dwelling patient without dementia but not for such a patient living in residential care or with dementia. DISCUSSION: This is New Zealands first report of GPs perspectives about assessing and managing CVD risk for older patients. Findings are consistent with international studies. More support and training in lifestyle assessment is needed, as well as clearer guidance for assessing and managing risk among older patients. KEYWORDS: Cardiovascular diseases; risk assessment; preventive medicine; geriatrics; public health
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Inoue, Machiko, Shoko Matsumoto, Kazue Yamaoka, and Shinsuke Muto. "Risk of Social Isolation Among Great East Japan Earthquake Survivors Living in Tsunami-Affected Ishinomaki, Japan." Disaster Medicine and Public Health Preparedness 8, no. 4 (July 21, 2014): 333–40. http://dx.doi.org/10.1017/dmp.2014.59.
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ABSTRACTObjectiveThe Great East Japan Earthquake and tsunami affected approximately 53 000 people in the city of Ishinomaki, Miyagi Prefecture. Approximately 30 000 people were relocated to temporary/rental housing. The remainder re-inhabited tsunami-affected houses, and their conditions were not known. As social isolation could affect physical and psychological health, we investigated the risk of social isolation among the survivors who returned to their homes.MethodsThe surveyors went door-to-door to the tsunami-affected houses and interviewed each household between October 2011 and March 2012. The participants’ risk of social isolation was assessed using 3 factors: whether they have (1) friends to talk with about their problems, (2) close neighbors, and (3) social/family interactions. We analyzed the groups at risk of social isolation and identified the related factors.ResultsThe elderly (older than age 65 years) were more likely to have close neighbors and social/family interactions, as compared with younger persons. Persons living alone were less likely to have social/family interactions. Non-elderly men who were living alone were the highest proportion of people without social/family interactions.ConclusionsOur findings suggested that men, particularly those younger than age 65 years and living alone, were at high risk of social isolation and may need attention. (Disaster Med Public Health Preparedness. 2014;0:1-8)
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Yorston, G. "Forensic Psychiatry and Older People - a UK Perspective." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70562-0.
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The number of older people in prison has quadrupled in the UK in recent years, such that older prisoners now make up 2.6% of the total prison population, despite the fact that the number of offences committed by older adults has remained static. Older prisoners have high levels of psychiatric and physical morbidity, and forensic psychiatric services are receiving increasing numbers of referrals of older adults. In the past, few of these referrals resulted in admissions to secure psychiatric beds, however, reflecting a reluctance by forensic psychiatrists to admit older adults, who were perceived as being at risk from younger patients. Over the past 10 years, however, specialist secure inpatient units have been established in the UK for the assessment and management of older mentally disordered offenders. This seminar will explore the research evidence and clinical experience relating to this group of patients.
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Tamura, Motoki, Shinji Hattori, Taishi Tsuji, Katsunori Kondo, Masamichi Hanazato, Kanami Tsuno, and Hiroyuki Sakamaki. "Community-Level Participation in Volunteer Groups and Individual Depressive Symptoms in Japanese Older People: A Three-Year Longitudinal Multilevel Analysis Using JAGES Data." International Journal of Environmental Research and Public Health 18, no. 14 (July 14, 2021): 7502. http://dx.doi.org/10.3390/ijerph18147502.
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Background: The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people. Methods: We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model. Results: The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78–0.98). Conclusions: Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.
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Yao, Nengliang, Tom Cornwell, and Cheryl Camillo. "COVID Vaccine Rollout for Older People: East Meets West." Innovation in Aging 5, Supplement_1 (December 1, 2021): 187. http://dx.doi.org/10.1093/geroni/igab046.711.
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Abstract Older adults should be one of the first groups to receive COVID-19 vaccines, because the risk of dying from COVID-19 increases with age. However, it takes time to distribute the vaccines to different countries, and the challenges in administering vaccines may differ by health system characteristics and local culture. This international symposium will discuss the vaccine rollout issues in eight countries (Isreal, Japan, South Korea, China, France, United Kingdom, Canada, and United States). We will use an interview and dialog format, instead of presentations. We will cover extensive topics including: Availability - What vaccines? Access, Acceptance, Caregivers – How are providers responding/handling caregivers wanting to be vaccinated?Cost/Financing Issues, Distribution Logistics/Transport/Safety, Lessons Learned, Mutations/Variants, Partnerships needed to vaccinate homebound patients (community partners; home health agencies, etc.), Who can/should provide vaccination? The situation with COVID-19 is still very fluid. Countries are at different stages of vaccinating older people. The chair didn't ask the speakers to write an abstract now, instead, the speakers will collect more information during the next few months and plan to have a prep meeting one month before the Annual Meeting.
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Nishikitani, Mariko. "A Quantitative Comparison of Social Interactions of Older Adults Pre-COVID-19 Between the United States and Japan." Innovation in Aging 5, Supplement_1 (December 1, 2021): 451. http://dx.doi.org/10.1093/geroni/igab046.1746.
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Abstract Using the Study on the Lifestyle and Values of Senior Citizens (The Eighth International Study by the Japan Cabinet Office), the social interactions were assessed in the context of health and life satisfaction of the older adults of the U.S and Japan to confirm the relationship between ICT usage and social interactions. The less social interaction was defined as those who answered that they had no "role in the family," "working," or "social activities such as volunteering." The proportion of less-social interaction people and non-use of ICT increased with age, but the proportions of Japanese were higher than that in Americans. The adjusted odds ratio for non-use of ICT to the risk of isolation of the older adults in Japan was 2.43 (95% CI: 1.59-3.73), but no significant relationship was observed in American older adults. Future research will examine the use of ICT by older adults in each country.
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Francisco, Priscila Maria Stolses Bergamo, Daniela De Assumpção, Flávia Silva Arbex Borim, Caroline Senicato, and Deborah Carvalho Malta. "Prevalence and co-occurrence of modifiable risk factors in adults and older people." Revista de Saúde Pública 53 (October 21, 2019): 86. http://dx.doi.org/10.11606/s1518-8787.2019053001142.
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OBJECTIVE: To estimate the co-occurrence of the major risk factors for chronic diseases in adults (18-59 years old) and older people (≥ 60 years old) living in Brazilian state capitals and the Federal District. METHODS: Cross-sectional study with population-based data from 35,448 adults and 18,726 older people collected in the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (System of Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey – Vigitel) in 2015. The prevalence of each of the five risk factors (smoking, overweight, physical inactivity, alcohol and unhealthy diet) was estimated, as well as their co-occurrence for the different possible combinations, according to socioeconomic and health self-assessment variables. The independent associations were verified via multinomial logistic regression to obtain the estimates of the odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: At least two risk factors were present in 38.5% of the adults and 37.0% of the older participants. The male adults and older participants who did not have private health insurance and classified their health as average or poor/very poor were more likely to have two or more concurrent risk behaviors. The greater chance of co-occurrence of smoking and alcohol abuse in adults (adjusted OR = 3.52) and older people (adjusted OR = 2.94) stands out. CONCLUSIONS: The subgroups with increased risk of developing multiple unhealthy behaviors and the most prevalent behaviors were identified. These findings are expected to contribute to the better targeting of health promotion and preventive care. It is worth noting that, for the adoption of healthy lifestyle habits, macro-social and inter-sectoral policies are more effective.
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Kosugi, Motoko. "Determinants of Preventive Behaviors for COVID-19 in Japan." International Journal of Environmental Research and Public Health 18, no. 19 (September 23, 2021): 9979. http://dx.doi.org/10.3390/ijerph18199979.
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As of June 2021, there have been more than 13,000 deaths in Japan due to the COVID-19 pandemic. Data from the Ministry of Health, Labor, and Welfare show that the mortality rate of COVID-19 greatly varies by age. In this study, using data from a questionnaire survey, an investigation was carried out to find differences in anxiety and risk perception, attitudes toward risk, and the frequency of implementation of countermeasures to infection among age groups that are prone to a greater risk of mortality, as well as the main factors that determine the frequency of implementation. Older people, who form a high-risk group, have a stronger tendency for anxiety and cautious attitudes toward COVID-19, and they more frequently implement preventive behaviors. The results of multiple regression analysis showed that the frequency of implementation of behaviors is determined not only by anxiety, cautious attitude, risk of aggravation to oneself, and perceived effectiveness of behaviors but also by regret, altruism, and conformity. In addition, almost no age-based gap was found between the determinants, suggesting that the motivation to take infection preventive behaviors is the same regardless of age.
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Roberts, Helen C., Stephen E. R. Lim, Natalie J. Cox, and Kinda Ibrahim. "The Challenge of Managing Undernutrition in Older People with Frailty." Nutrients 11, no. 4 (April 10, 2019): 808. http://dx.doi.org/10.3390/nu11040808.
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Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
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Ozaki, Etsuko, Daisuke Matsui, Nagato Kuriyama, Satomi Tomida, Yukiko Nukaya, and Teruhide Koyama. "Association between Sedentary Time and Falls among Middle-Aged Women in Japan." Healthcare 10, no. 12 (November 23, 2022): 2354. http://dx.doi.org/10.3390/healthcare10122354.
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There are many reports on the risk of falls in older adults but none regarding the risk among middle-aged people. We aimed to determine fall risk factors among middle-aged women. The participants comprised 1421 women aged 40 to 64 years; anthropometric and other measurements were obtained, and lifestyle factors were examined using a self-administered questionnaire. The participants were categorized into two groups (No-fall and Fall/Almost-fall) based on their questionnaire responses. The No-fall and Fall/Almost-fall groups comprised 1114 and 307 participants, respectively. Body mass index, abdominal circumference measurements, and prevalence of dyslipidemia were significantly higher in the Fall/Almost-fall group. Additionally, those in the Fall/Almost-fall group had a shorter two-step test, experienced difficulty performing the 40 cm single-leg sit-to-stand test, and had higher 25-question Geriatric Locomotive Function Scale (GLFS-25) scores than those in the No-fall group. The results of the adjusted logistic regression analysis indicated that physical activity, higher GLFS-25 scores, and sedentary time of more than seven hours were all risk factors for falling or almost falling. Longer sedentary time is a new risk factor for falls among middle-aged women. It is necessary for people to be concerned with their sedentary behavior, such as by reducing or interrupting continuous sedentary time.
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Romli, Muhammad Hibatullah, Lynette Mackenzie, Meryl Lovarini, Maw Pin Tan, and Lindy Clemson. "The Clinimetric Properties of Instruments Measuring Home Hazards for Older People at Risk of Falling: A Systematic Review." Evaluation & the Health Professions 41, no. 1 (December 22, 2016): 82–128. http://dx.doi.org/10.1177/0163278716684166.
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Home hazards are associated with falls among older people living in the community. However, evaluating home hazards is a complex process as environmental factors vary according to geography, culture, and architectural design. As a result, many health practitioners commonly use nonstandardized assessment methods that may lead to inaccurate findings. Thus, the aim of this systematic review was to identify standardized instruments for evaluating home hazards related to falls and evaluate the clinimetric properties of these instruments for use by health practitioners. A systematic search was conducted in the Medline, CINAHL, AgeLine, Web of Science databases, and the University of Sydney Library CrossSearch Engine. Study screening, assessment, and quality ratings were conducted independently. Thirty-six studies were identified describing 19 instruments and three assessment techniques. The clinimetric properties varied between instruments. The Home Falls and Accidents Screening Tool, Home Safety Self-Assessment Tool, In-Home Occupational Performance Evaluation, and Westmead Home Safety Assessment were the instruments with high potential for evaluating home hazards associated with falls. Health practitioners can choose the most appropriate instruments for their practice, as a range of standardized instruments with established clinimetric properties are available.
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Bots-VantSpijker, Pieternella C., Claar D. van der Maarel-Wierink, Jos M. G. A. Schols, and Josef J. M. Bruers. "Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study." PLOS ONE 16, no. 9 (September 24, 2021): e0257561. http://dx.doi.org/10.1371/journal.pone.0257561.
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Objectives To assess the oral health of older people who visit the community dental practice from both the dentists’ and the patients’ perspective. Materials and methods In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman’s rank correlation coefficient (rho) and an ordinal regression model. Results In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people’s assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication. Conclusions and clinical relevance Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.
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VENABLES, DAN, PAUL CLARKSON, JANE HUGHES, ALISTAIR BURNS, and DAVID CHALLIS. "Specialist clinical assessment of vulnerable older people: outcomes for carers from a randomised controlled trial." Ageing and Society 26, no. 6 (October 19, 2006): 867–82. http://dx.doi.org/10.1017/s0144686x06004831.
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‘Caring for carers’ is high on the United Kingdom policy agenda for community care. Although recent policy advocates the provision of services directly to the carer, research suggests that an alternative way of helping carers is through targeting enhanced services towards the cared-for person. This paper reports a randomised controlled trial of the effects on carer distress of an additional specialist clinical assessment for vulnerable older people at risk of residential or nursing home placement. The sample was composed of 142 informal carers of older people, randomly assigned to receive either the additional specialist assessment or the usual social services assessment. Carers were assessed using the modified Social Behaviour Assessment Schedule (SBAS), and data were also collected on older peoples' service use throughout the study period. Regression analyses indicated that changes in older peoples' behaviour, as opposed to carer or service-related factors, predicted changes in carer distress, and that the carers of the older people who experienced depressive symptoms received the greatest benefit from the specialist assessment. The study suggests that an effective means of improving outcomes for carers may be to target services towards the distressing behaviours of the person for whom they care, with symptoms of depression being particularly important.
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Magagna, Gisella, Emilia I. De La Fuente, Cristina Vargas, Luis M. Lozano, and José L. Cabezas. "Bayesian Estimation of the Prevalence of Suicide Risk in Institutionalized Older People." OMEGA - Journal of Death and Dying 66, no. 2 (March 2013): 121–33. http://dx.doi.org/10.2190/om.66.2.b.
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The assessment of suicide risk in institutionalized older people has received less attention in comparison with those not institutionalized. The studies carried out show contradictory data on the prevalence of risk in this population group. The current work estimates the prevalence of suicide risk through a Bayesian analysis and studies the risk factors of this behavior in a group of 110 institutionalized older people. A prevalence of 38.4% is obtained, and an association between suicide risk and the factors depression and perception of health. The results indicate to us the necessity for actions directed at decreasing the suicide rate in geriatric homes.
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Zubatsky, Max, and Nina Tumosa. "BUILDING NETWORKS TO ADDRESS AT-RISK OLDER ADULTS." Innovation in Aging 3, Supplement_1 (November 2019): S185—S186. http://dx.doi.org/10.1093/geroni/igz038.662.
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Abstract With the rise of older adults and the number of chronic health issues in this population, comes the need for greater collaboration across organizations and health care settings. Age-friendly health systems offer the benefits of providing the best care possible to individuals and families, connect people to specific community resources, and optimize the best access to services and programs. The Gateway Geriatric Workforce Enhancement Program (GWEP) has combined the efforts of Saint Louis University and a rural, critical access hospital to establish a care network across Missouri. Together, this partnership has created a number of services, initiatives, and projects to help older adults maintain independence and offer families ways to take of their loved ones in more effective ways. In this symposium, presenters from Social Work, Marriage and Family Therapy, Geriatric Medicine, Psychology and Nursing disciplines will introduce several areas of this age-friendly network. The four abstracts for this symposium include: 1.) Assessing At-Risk Older Adults through the Rapid Geriatric Assessment, 2.) Cognitive Stimulation Therapy for Individuals with Memory Loss, 3.) Predictors of Falls in Older Adults Across Partner Settings, and 4.) Development of program initiatives such as the Rapid Geriatric Assessment screening, Cognitive Stimulation Therapy, Falls Assessment in Seniors, and Care for Persons with Dementia in their Environments will be covered in detail. At the end of the four presentations, the presenters will highlight the importance of this collaborative network and ways for audience members to consider building an age-friendly network in their community.
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van Rhyn, Brianne, and Alex Barwick. "Health Practitioners’ Perceptions of Falls and Fall Prevention in Older People: A Metasynthesis." Qualitative Health Research 29, no. 1 (October 12, 2018): 69–79. http://dx.doi.org/10.1177/1049732318805753.
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Fall prevention has received a great deal of consideration and funding, however fall rates have not reduced accordingly. Health practitioners are key stakeholders in the process of implementing fall prevention evidence into their clinical assessment and management of older people at risk of falling. Investigating health practitioners’ clinical experiences and perceptions has been identified as a means to enhance the translation of knowledge. Four databases were searched for studies exploring health practitioners’ perceptions of falls and fall prevention. A metasynthesis of eight qualitative studies was conducted. The findings suggest that health practitioners face substantial barriers in the implementation of fall prevention practices. These include personal, interpersonal, and clinical barriers in addition to limitations of the research evidence. This knowledge hopes to enhance targeted dissemination of knowledge, reducing the research–practice gap and improving clinical outcomes for older people at risk of falls.
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van Zyl, Martin, Gillian Wieczorek, and Joe Reilly. "Venous thromboembolism incidence in mental health services for older people: survey of in-patient units." Psychiatrist 37, no. 9 (September 2013): 283–85. http://dx.doi.org/10.1192/pb.bp.112.041848.
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Aims and methodTo establish the incidence of venous thromboembolism (VTE) in mental health services for older people (MHSOP) in-patient units, and investigate current practice in terms of assessment of risk of VTE and treatment given. We conducted an incidence survey of VTE on in-patient units in MHSOP in a National Health Service trust, searching data of in-patients discharged over a 2-year period.ResultsOverall, 1495 individual patient records were searched. There were 17 confirmed VTEs, which is comparable with VTE incidence rates in general hospitals. There were no risk assessments done on admission and no thromboprophylaxis given. Use of compression stockings and mobilisation was limited.Clinical implicationsThe study confirmed a significant VTE incidence and the need for increased awareness among MHSOP staff. This can be met by improved training of VTE awareness and management for clinical staff and the use of a VTE assessment tool on MHSOP in-patient units.
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Stuck, Andreas E., André Moser, Ueli Morf, Urban Wirz, Joseph Wyser, Gerhard Gillmann, Stephan Born, et al. "Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial." PLOS Medicine 12, no. 10 (October 19, 2015): e1001889. http://dx.doi.org/10.1371/journal.pmed.1001889.
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Hickie, Ian, Sharon Naismith, Philip B. Ward, Keelin Turner, Elizabeth Scott, Philip Mitchell, Kay Wilhelm, and Gordon Parker. "Reduced hippocampal volumes and memory loss in patients with early- and late-onset depression." British Journal of Psychiatry 186, no. 3 (March 2005): 197–202. http://dx.doi.org/10.1192/bjp.186.3.197.
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BackgroundHippocampal volume reduction has been reported inconsistently in people with major depression.AimsTo evaluate the interrelationships between hippocampal volumes, memory and key clinical, vascular and genetic risk factors.MethodTotals of 66 people with depression and 20 control participants underwent magnetic resonance imaging and clinical assessment. Measures of depression severity, psychomotor retardation, verbal and visual memory and vascular and specific genetic risk factors were collected.ResultsReduced hippocampal volumes occurred in older people with depression, those with both early-onset and late-onset disorders and those with the melancholic subtype. Reduced hippocampal volumes were associated with deficits in visual and verbal memory performance.ConclusionsAlthough reduced hippocampal volumes are most pronounced in late-onset depression, older people with early-onset disorders also display volume changes and memory loss. No clear vascular or genetic risk factors explain these findings. Hippocampal volume changes may explain how depression emerges as a risk factor to dementia.
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Yoshida, Yasuko, Keisei Kosaki, Takehito Sugasawa, Masahiro Matsui, Masaki Yoshioka, Kai Aoki, Tomoaki Kuji, et al. "High Salt Diet Impacts the Risk of Sarcopenia Associated with Reduction of Skeletal Muscle Performance in the Japanese Population." Nutrients 12, no. 11 (November 12, 2020): 3474. http://dx.doi.org/10.3390/nu12113474.
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The World Health Organization has recommended 5 g/day as dietary reference intakes for salt. In Japan, the averages for men and women were 11.0 g/day and 9.3 g/day, respectively. Recently, it was reported that amounts of sodium accumulation in skeletal muscles of older people were significantly higher than those in younger people. The purpose of this study was to investigate whether the risk of sarcopenia with decreased muscle mass and strength was related to the amount of salt intake. In addition, we investigated its involvement with renalase. Four groups based on age and salt intake (“younger low-salt,” “younger high-salt,” “older low-salt,” and “older high-salt”) were compared. Stratifying by age category, body fat percentage significantly increased in high-salt groups in both younger and older people. Handgrip strength/body weight and chair rise tests of the older high-salt group showed significant reduction compared to the older low-salt group. However, there was no significant difference in renalase concentrations in plasma. The results suggest that high-salt intake may lead to fat accumulation and muscle weakness associated with sarcopenia. Therefore, efforts to reduce salt intake may prevent sarcopenia.
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Chen, Ming-Shu, and Shih-Hsin Chen. "A Data-Driven Assessment of the Metabolic Syndrome Criteria for Adult Health Management in Taiwan." International Journal of Environmental Research and Public Health 16, no. 1 (December 31, 2018): 92. http://dx.doi.org/10.3390/ijerph16010092.
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According to the modified Adult Treatment Panel III, five indices are used to define metabolic syndrome (MetS): waist circumference (WC), high blood pressure, fasting glucose, triglycerides (TG), and high-density lipoprotein cholesterol. Our work evaluates the importance of these indices. In addition, we attempted to identify whether trends and patterns existed among young, middle-aged, and older people. Following the analysis, a decision tree algorithm was used to analyze the importance of the five criteria for MetS because the algorithm in question selects the attribute with the highest information gain as the split node. The most important indices are located on the top of the tree, indicating that these indices can effectively distinguish data in a binary tree and the importance of this criterion. That is, the decision tree algorithm specifies the priority of the influence factors. The decision tree algorithm examined four of the five indices because one was excluded. Moreover, the tree structures differed among the three age groups. For example, the first key index for middle-aged and older people was TG whereas for younger people it was WC. Furthermore, the order of the second to fourth indices differed among the groups. Because the key index was identified for each age group, researchers and practitioners could provide different health care strategies for individuals based on age. High-risk middle-aged and healthy older people maintained low values of TG, which might be the most crucial index. When a person can avoid the first and second indices provided by the decision tree, they are at lower risk of MetS. Therefore, this paper provides a data-driven guideline for MetS prevention.
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Le Couteur, David G., Rosilene Ribeiro, Alistair Senior, Benjumin Hsu, Vasant Hirani, Fiona M. Blyth, Louise M. Waite, et al. "Branched Chain Amino Acids, Cardiometabolic Risk Factors and Outcomes in Older Men: The Concord Health and Ageing in Men Project." Journals of Gerontology: Series A 75, no. 10 (August 20, 2019): 1805–10. http://dx.doi.org/10.1093/gerona/glz192.
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Abstract Increased blood levels of branched chain amino acids (BCAAs) have been associated with cardiometabolic risk factors. Here, we studied 918 community-dwelling older men to determine the relationship between BCAAs and other amino acids with cardiometabolic risk factors, major cardiovascular endpoints (MACE), and mortality. BCAAs had robust associations with many adverse metabolic risk factors (increased glucose, insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), triglycerides; decreased high-density lipoprotein cholesterol). However, paradoxically, participants with lower levels of BCAAs had greater mortality and MACE possibly because increasing age and frailty, both of which were associated with lower BCAA levels, are powerful risk factors for these outcomes in older people. Overall, amino acids that were lowest in frail subjects (BCAAs, α-aminobutyric acid [AABA], histidine, lysine, methionine, threonine, tyrosine) were inversely associated with mortality and MACE. In conclusion, BCAAs are biomarkers for important outcomes in older people including cardiometabolic risk factors, frailty, and mortality. In old age, frailty becomes a dominant risk factor for MACE and mortality.
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Herghelegiu, Anna Marie, André Moser, Gabriel Ioan Prada, Stephan Born, Matthias Wilhelm, and Andreas E. Stuck. "Effects of health risk assessment and counselling on physical activity in older people: A pragmatic randomised trial." PLOS ONE 12, no. 7 (July 20, 2017): e0181371. http://dx.doi.org/10.1371/journal.pone.0181371.
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Preston, Louise, Duncan Chambers, Fiona Campbell, Anna Cantrell, Janette Turner, and Elizabeth Goyder. "What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review." Health Services and Delivery Research 6, no. 16 (April 2018): 1–142. http://dx.doi.org/10.3310/hsdr06160.
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BackgroundEmergency departments (EDs) are facing unprecedented levels of demand. One of the causes of this increased demand is the ageing population. Older people represent a particular challenge to the ED as those older people who are frail will require management that considers their frailty alongside their presenting complaint. How to identify these older people as frail and how best to manage them in the ED is a major challenge for the health service to address.ObjectivesTo systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on patient and health service outcomes.DesignA systematic mapping review.SettingEvidence from developed countries on interventions delivered in the ED.ParticipantsFrail and high-risk older people and general populations of older people (aged > 65 years).InterventionsInterventions to identify older people who are frail or who are at high risk of adverse outcomes and to manage (frail) older people within the ED.Main outcome measuresPatient outcomes (direct and indirect) and health service outcomes.Data sourcesEvidence from 103 peer-reviewed articles and conference abstracts and 17 systematic reviews published from 2005 to 2016.Review methodsA review protocol was drawn up and a systematic database search was undertaken for the years 2005–2016 (using MEDLINE, EMBASE, The Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium and PROSPERO). Studies were included according to predefined criteria. Following data extraction, evidence was classified into interventions relating to the identification of frail/high-risk older people in the ED and interventions relating to their management. A narrative synthesis of interventions/outcomes relating to these categories was undertaken. A quality assessment of individual studies was not undertaken; instead, an assessment of the overall evidence base in this area was made.ResultsOf the 90 included studies, 32 focused on a frail/high-risk population and 60 focused on an older population. These studies reported on interventions to identify (n = 57) and manage (n = 53) older people. The interventions to identify frail and at-risk older people, on admission and at discharge, utilised a number of different tools. There was extensive evidence on these question-based tools, but the evidence was inconclusive and contradictory. Service delivery innovations comprised changes to staffing, infrastructure and care delivery. There was a general trend towards improved outcomes in admissions avoidance, reduced ED reattendance and improved discharge outcomes.LimitationsThis review was a systematic mapping review. Some of the methods adopted differed from those used in a standard systematic review. Mapping the evidence base has led to the inclusion of a wide variety of evidence (in terms of study type and reporting quality). No recommendations on the effectiveness of specific interventions have been made as this was outside the scope of the review.ConclusionsA substantial body of evidence on interventions for frail and high-risk older people was identified and mapped.Future workFuture work in this area needs to determine why interventions work and whether or not they are feasible for the NHS and acceptable to patients.Study registrationThis study is registered as PROSPERO CRD42016043260.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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TILSE, CHERYL, JILL WILSON, LINDA ROSENMAN, DAVID MORRISON, and ANNE-LOUISE MCCAWLEY. "Managing older people's money: assisted and substitute decision making in residential aged-care." Ageing and Society 31, no. 1 (September 17, 2010): 93–109. http://dx.doi.org/10.1017/s0144686x10000747.
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ABSTRACTCurrent approaches to the assessment of cognitive capacity in many jurisdictions seek to balance older people's empowerment with their protection. These approaches incorporate a presumption of capacity, a decision-specific rather than global assessment of that capacity, and an obligation to provide the support needed for adults to make or communicate their own decisions. The implication is that older people are assisted to make decisions where possible, rather than using substitute decision makers. For older people, decision making about financial matters is a contentious domain because of competing interests in their assets and concerns about risk, misuse and abuse. In residential-care settings, older people risk being characterised as dependent and vulnerable, especially in relation to decisions about financial assets. This paper reports an Australian study of the factors that facilitate and constrain residents' involvement in financial decision making in residential settings. Case studies of four aged-care facilities explored how staff interpreted the legislative and policy requirements for assisted and substitute decision making, and the factors that facilitated and constrained residents' inclusion in decisions about their finances. The observed practices reveal considerable variation in the ways that current legislation is understood and implemented, that there are limited resources for this area of practice, and that policies and practices prioritise managing risk and protecting assets rather than promoting assisted decision making.
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SHAW, JAMES A., DENISE M. CONNELLY, and CAROL L. MCWILLIAM. "The meaning of the experience of anticipating falling." Ageing and Society 35, no. 9 (July 24, 2014): 1839–63. http://dx.doi.org/10.1017/s0144686x14000798.
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ABSTRACTFalling in later life continues to be a critical issue in gerontology research, health professional practice and ageing health policy. However, much research in the area of fall risk and fall prevention neglects the meaning of the experiences of older people themselves. This humanistic interpretive phenomenological study explored the meaning of the experience of anticipating falling from the perspective of older people in order to foster a more person-focused approach to fall risk assessment and fall prevention. Individual semi-structured interviews were conducted with nine participants over the age of 65 living independently in the community. Follow-up interviews with two key informants were completed to inform the emerging interpretations. For older participants residing in the community, the experience of anticipating falling meant confronting their embodied lived-identity in the context of ageing. Experiential learning shaped how participants understood the meaning of falling, which constituted tacit, pathic knowledge of vulnerability and anxiety with respect to falling. Findings emphasise the importance of critically reflecting on the social experience of anticipating falling to develop effective and relevant fall prevention interventions, programmes and policies. A lifeworld-led approach to fall risk assessment and fall prevention resonates with these findings, and may encourage health-care providers to adopt a sustained focus on embodied lived-identity and quality of life when engaging older people in fall prevention activities.
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Kato, Daisuke, Ichiro Kawachi, Junko Saito, and Naoki Kondo. "Complex Multimorbidity and Incidence of Long-Term Care Needs in Japan: A Prospective Cohort Study." International Journal of Environmental Research and Public Health 18, no. 19 (October 7, 2021): 10523. http://dx.doi.org/10.3390/ijerph181910523.
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Complex multimorbidity (CMM) has been proposed as a more nuanced concept of multimorbidity (MM). We sought to quantify the association of CMM and MM on the incidence of long-term care (LTC) needs in a cohort of older Japanese people. Our follow-up was based on a nationwide longitudinal cohort study of people aged over 65 years who were functionally dependent at baseline. Our outcome was incident LTC needs, based on certification under the Japanese LTC insurance scheme. We used both propensity score matching and inverse probability of treatment weights (IPTW) to compare individuals with and without MM versus CMM. A total of 38,889 older adults were included: 20,233 (52.0%) and 7565 (19.5%) adults with MM and CMM, respectively. In propensity-matched analyses, both MM (n = 15,666 pairs) and CMM (n = 7524 pairs) were statistically significantly associated with the six-year LTC insurance certification rate (MM, hazard ratio (HR) 1.07, 95% confidence interval (95%CI) 1.02–1.12; CMM, HR 1.10, 95%CI 1.04–1.16). Both MM and CMM were associated with a modest but statistically significantly higher rate of LTC insurance certification. These findings support the inclusion of multimorbidity in the assessment of LTC insurance needs, although the Japanese government currently has not adopted this.
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Arizaga-Iribarren, Nagore, Amaia Irazusta, Itxaso Mugica-Errazquin, Janire Virgala-García, Arantxa Amonarraiz, and Maider Kortajarena. "Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes." International Journal of Environmental Research and Public Health 20, no. 1 (December 21, 2022): 54. http://dx.doi.org/10.3390/ijerph20010054.
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Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.
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Ottaviani, Ana Carolina, Estefani Serafim Rossetti, Mariélli Terassi, Allan Gustavo Brigola, Bruna Moretti Luchesi, Érica Nestor Souza, Nathalia Alves de Oliveira, Keika Inouye, Sofia Cristina Iost Pavarini, and Fabiana de Souza Orlandi. "Factors associated with the development of diabetes mellitus in older caregivers." Revista Brasileira de Enfermagem 72, suppl 2 (2019): 30–35. http://dx.doi.org/10.1590/0034-7167-2017-0590.
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ABSTRACT Objective: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. Method: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. Results: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). Conclusion: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.
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Ohta, Ryuichi, Megumi Nishida, Nobuyasu Okuda, and Chiaki Sano. "The Smiles of Older People through Recreational Activities: Relationship between Smiles and Joy." International Journal of Environmental Research and Public Health 18, no. 4 (February 9, 2021): 1600. http://dx.doi.org/10.3390/ijerph18041600.
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Recreational activities are found to increase people’s smiles, arising joy in older people, but there is limited research on this topic within the Japanese context. This cross-sectional study aimed to measure the quality and frequency of smiles in older people living in rural settings using a smile analysis application. The participants comprised 13 females aged over 65 years who lived in Unnan City, Japan, and regularly attended recreational meetings. In this study, the recreational activity that the participants joined was a game called Mattoss. A video camera captured the participants’ faces, while a smile assessment application assessed their facial expressions for smiles and joy. A total of 2767 smiles were recorded. For validity, we calculated the Spearman’s rho score between smile and joy, which was 0.9697 (p < 0.001), while for reliability, we determined the Spearman’s rho score for each participant, which exceeded 0.7 (p < 0.001). Surges of smiles were induced by one’s own mistakes, successes, and big mistakes in the game and by severe or mild judgments by the referee. High validity and reliability of smile evaluation were demonstrated. The study found that smiling increased during recreational activities. Therefore, recreational activities can be encouraged for older people living in rural communities.
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Grimmer, Karen, Kate Beaton, Saravana Kumar, Kevan Hendry, John Moss, Susan Hillier, John Forward, and Louise Gordge. "Estimating the risk of functional decline in the elderly after discharge from an Australian public tertiary hospital emergency department." Australian Health Review 37, no. 3 (2013): 341. http://dx.doi.org/10.1071/ah12034.
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Objective. To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital. Methods. The cohort was generated by consecutive sampling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected. Results. Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of individuals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk). Conclusions. Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument’s moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may ‘slip through the net’, as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.
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Cox, Chantel, and Michael Vassallo. "Fear of falling assessments in older people with dementia." Reviews in Clinical Gerontology 25, no. 2 (May 2015): 98–106. http://dx.doi.org/10.1017/s0959259815000106.
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SummaryFear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.
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Khan, Mostafa Saidur Rahim, Pattaphol Yuktadatta, and Yoshihiko Kadoya. "Who Became Lonely during the COVID-19 Pandemic? An Investigation of the Socioeconomic Aspects of Loneliness in Japan." International Journal of Environmental Research and Public Health 19, no. 10 (May 20, 2022): 6242. http://dx.doi.org/10.3390/ijerph19106242.
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The COVID-19 pandemic has impacted social and economic aspects of people’s lives in different ways, causing them to experience different levels of loneliness. This study examines the extent of loneliness among men and women of various ages in Japan during the pandemic and attempts to determine the underlying causes. We used data from Hiroshima University’s nationwide survey conducted before and during the pandemic in Japan. The sample consists of 3755 participants, of which 67% are men and 33% are women with an average age of 51 years (SD = 13.64). Using mean comparison tests and probit regression models, we show that loneliness is a common occurrence among the Japanese population and that a significant number of people became lonely for the first time during the pandemic. In general, loneliness was greater among younger respondents, but older people became lonelier during the pandemic. Simultaneously, we observed significant differences in loneliness across age and gender subsamples. Although depression and subjective health status contributed to loneliness, we found no single explanation for the loneliness experienced by people during the pandemic; rather, subsample analysis revealed that the causes of loneliness for each group differed. Nevertheless, we discovered that older people are at a higher risk of developing loneliness during the pandemic due to a variety of socioeconomic and behavioral factors. The findings of this study suggest that health authorities should not generalize cases of loneliness, but rather intervene individually in each group to avoid further complications.
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Dolatabadi, Elham, Karen Van Ooteghem, Babak Taati, and Andrea Iaboni. "Quantitative Mobility Assessment for Fall Risk Prediction in Dementia: A Systematic Review." Dementia and Geriatric Cognitive Disorders 45, no. 5-6 (2018): 353–67. http://dx.doi.org/10.1159/000490850.
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Background: Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls. Summary: This systematic review provides a critical analysis of the evidence linking quantitative measures of gait and balance to fall risk in older adults with dementia. Various instrumented measures of gait and postural stability including gait speed and non-instrumented performance measures including Timed Up and Go were shown to be capable of distinguishing fallers from non-fallers. Key Messages: Existing reviews indicate that impairments of gait and balance are associated with increased risk of falls in cognitively intact older people. There are inconsistencies, however, regarding the characteristics most predictive of a fall. In order to advance fall prevention efforts, there is an important need to understand the relationship between gait, balance, and fall risk, particularly in high-risk populations such as individuals with dementia.
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Johansson, Maria M., Marco Barbero, Anneli Peolsson, Deborah Falla, Corrado Cescon, Anna Folli, and Huan-Ji Dong. "Pain Characteristics and Quality of Life in Older People at High Risk of Future Hospitalization." International Journal of Environmental Research and Public Health 18, no. 3 (January 22, 2021): 958. http://dx.doi.org/10.3390/ijerph18030958.
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This study deals with how pain characteristics in conjunction with other factors affect quality of life (QoL) in a vulnerable primary care population. We recruited vulnerable older people (75+, n = 825) living in south-eastern Sweden. A postal questionnaire included pain aspects, QoL (EQ-5D-3L, RAND-36 physical functioning, attitudes toward own aging, and life satisfaction), functional status, social networks, and basic demographic information. Pain extent and localization was obtained by digitalization of pain drawings reported on standard body charts. Most respondents were experiencing pain longer than 3 months (88.8%). Pain frequency varied mostly between occasionally (33.8%) and every day (34.8%). A minority reported high pain intensity (13.6%). The lower back and lower legs were the most frequently reported pain locations (>25%). Multiple linear regression model revealed three characteristics of pain (intensity, frequency, and extent) remained inversely associated with the EQ-5D-3L index score (R2 = 0.57). Individually, each of these pain characteristics showed a negative impact on the other three dimensions of QoL (R2 = 0.23–0.59). Different features of pain had impact on different dimensions of QoL in this aging population. A global pain assessment is useful to facilitate individual treatment and rehabilitation strategies in primary care.
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Sakamoto, Hironari, Shigehisa Uchiyama, Ayana Sato, Tomohiko Isobe, Naoki Kunugita, Hironao Ogura, and Shoji F. Nakayama. "Health Risk Assessment Based on Exposure to Chemicals in Air." International Journal of Environmental Research and Public Health 19, no. 23 (November 28, 2022): 15813. http://dx.doi.org/10.3390/ijerph192315813.
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Few studies have investigated personal exposure concentrations of not only some volatile organic compounds but also more types of chemicals including acidic gases and acrolein. We measured the personal exposure concentrations of 35 chemicals including these chemicals in indoor and outdoor air in Chiba-shi, Japan, for 7 days in summer and winter to assess the associated health risks in 22 people. The personal exposure concentrations of nitrogen dioxide were higher in winter than in summer, and those of formaldehyde, p-dichlorobenzene, and tetradecane were higher in summer than in winter. The personal exposure concentrations were mostly equal to or lower than the concentrations in indoor air, contrary to the results of a lot of previous studies. The high-risk chemicals based on personal exposure concentrations were identified as acrolein (max. 0.43 μg/m3), benzene (max. 3.1 μg/m3), and hexane (max. 220 μg/m3) in summer, and acrolein (max. 0.31 μg/m3), nitrogen dioxide (max. 320 μg/m3), benzene (max. 5.2 μg/m3), formic acid (max. 70 μg/m3), and hexane (max. 290 μg/m3) in winter. In addition, we estimated personal exposure concentrations according to the time spent at home and the chemical concentrations in indoor and outdoor air. We found that the estimated concentrations of some participants largely differed from the measured ones indicating that it is difficult to estimate personal exposure concentrations based on only these data.
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Rao, Rahul. "Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service." Advances in Dual Diagnosis 12, no. 4 (November 7, 2019): 200–208. http://dx.doi.org/10.1108/add-05-2019-0004.
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Purpose The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue. Design/methodology/approach Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over. Findings In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol. Research limitations/implications Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted. Practical implications Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment. Originality/value There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.