The Effects of Proton Pump Inhibitors in Acid Hypersecretion-Induced Vitamin B12 Deficiency: A Systematic Review (2022)

Gastroesophageal reflux disease (GERD) is the most common disease, for which proton pump inhibitors (PPIs) are a widely used class of drugs. Due to their efficacy and relative safety profile, PPIs are used chronically by GERD patients. Although it is a safe drug, particular attention focuses on the long-term adverse effects of PPI. The association with vitamin deficiencies has received additional focus since chronic PPI treatment increases the incidence of vitamin B12 deficiency, especially in the elderly. However, numerous studies regarding the establishment of an association between PPI and vitamin B12 status revealed conflicting results. In this systematic review, we systematically examined observational studies that focused on the impact of chronic PPI effects on vitamin B12 absorption and diagnostic biomarkers of vitamin B12 deficiency. Our review showed significant changes in diagnostic biomarkers of vitamin B12 status in long-term PPI users, including elevated homocysteine and methylmalonic acid (MMA) concentration levels defining cellular vitamin B12 deficiency. Although there is uncertainty regarding the exact mechanism, it supports the concept that long-term intake of PPI can have clinical implications for vitamins.

Molecular Epidemiology of Staphylococcus aureus and MRSA in Bedridden Patients and Residents of Long-Term Care Facilities

At present, multidrug-resistant microorganisms are already responsible for community-acquired infections. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious public health risk worldwide because of the rapid spread and diversification of pandemic clones that are characterized by increasing virulence and antimicrobial resistance. The aim of this study was to identify the prevalence and factors associated with nasal, oral and rectal carriage of S. aureus and MRSA in bedridden patients and residents of long-term care facilities for the elderly (LTCFs) in Botucatu, SP, Brazil. Nasal, oral and rectal swab isolates obtained from 226 LTCF residents or home-bedridden patients between 2017 and 2018 were submitted to susceptibility testing, detection of the mecA gene, SCCmec characterization, and molecular typing by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Logistic regression analysis was used to identify risk factors associated with the presence of S. aureus and MRSA. The prevalence of S. aureus and MRSA was 33.6% (n = 76) and 8% (n = 18), respectively. At the nine LTCFs studied, the prevalence of S. aureus ranged from 16.6% to 85.7% and that of MRSA from 13.3% to 25%. Living in an LTCF, male gender, a history of surgeries, and a high Charlson Comorbidity Index score were risk factors associated with S. aureus carriage, while MRSA carriage was positively associated with male gender. This study showed a high prevalence of S. aureus among elderly residents of small (<15 residents) and medium-sized (15−49 residents) LTCFs and a higher prevalence of MRSA in the oropharynx.

Gaps in the Utilization of Community Health Services for the Elderly Population in Rural Areas of Mainland China: A Systematic Review Based on Cross-Sectional Investigations

Background

While the community health service system was initially established in rural areas of mainland China, the utilization of community health service resources by the rural elderly population is not clear.

Methods

Cross-sectional studies on the utilization of community health services by the rural elderly population in mainland China published within the last 10 years were retrieved from the China National Knowledge Infrastructure (CNKI), Wan Fang, Medline and Web of Science (WOS) databases. The quality of the article was evaluated by the Critical Appraisal Skills Programme (CASP), and obstacles to the utilization of community health services by the rural elderly population were analyzed based on the Andersen model.

Results

Twenty-four studies were analyzed, and 3 gaps were found. (i) The cognition of rural elderly residents does not match the current health security system. (ii) There is a gap between the supply of health service resources in rural communities and the health needs of the elderly residents in these areas. (iii) The health services provided by rural primary health service institutions are not targeted.

Conclusions

In mainland China, the provision of community health services to the rural elderly population has improved significantly. However, several factors from the individual level to the system level lead to low levels of access and utilization. This finding means that under the leadership of the government, it is necessary to integrate the strength of multiple departments to cooperate in improving the welfare system, policy publicity, health education, financial support, system guarantees and resource exchange and sharing for the elderly population in rural areas and to jointly promote community health services for the elderly population in rural areas.

Association between Branched-Chain Amino Acid Intake and Physical Function among Chinese Community-Dwelling Elderly Residents

This study aimed to evaluate the potential associations of dietary BCAAs (isoleucine, leucine, and valine) with physical function in the elderly Chinese population. A validated semiquantitative food frequency questionnaire and anthropometric and physical function measurements were used to collect data. We modeled trends in physical function indicators for BCAA quartiles using multivariate linear regression models. Among 4336 (43.97% men) participants aged 72.73 ± 5.48 years, a higher dietary intake of BCAAs was positively associated with increased handgrip strength (all p trends < 0.001), shorter times for 4-m fast walking (all p trends < 0.001) and repeated chair rises (all p trends < 0.001). No linear association was found between subtypes of amino acids and any physical functions (all p trends > 0.05). Individuals in the highest quartiles of BCAA intake had a reduced risk of developing low muscle strength, and the multiadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for women and men were 0.50 (0.38−0.65) and 0.67 (0.50−0.91), respectively. Similarly, higher BCAA consumption was associated with a lower risk of developing low physical performance (4-m walking speed: OR = 0.68 [0.50−0.93]; repeated chair rises: OR = 0.66 [0.54−0.81]). Higher dietary BCAA intake might be beneficial for physical function in the elderly population.

Health Status and Individual Care Needs of Disabled Elderly at Home in Different Types of Care

For the disabled, paying attention to their health status is the starting point to discovering their survival problems, while meeting their care needs is the end point to solving their survival problems. As the country with the largest number of disabled elderly in the world, how to ensure this group could obtain appropriate home care is a major public health issue facing China. Thus, we conducted a cross-sectional study from October to December 2020 to explore the basic characteristics and health status of disabled elderly in different types of care who are living at home in 37 streets in Shanghai, as well as the individual care needs and its relevance. We observed the significant differences in the number of diagnoses (p = 0.03), smoking (p = 0.009), drinking (p = 0.016), exercise (p = 0.001), activity of daily living (p < 0.0001), and the quality of life (p < 0.0001) across care types. The care needs of the disabled elderly are diversified, of which a vast majority of them have not been fully guaranteed. The urgent need for improving the identification accuracy of care needs of disabled elderly, as well as the development of elaborate and personalized care programs for them, is needed.

Circulating Illness and Changes in Thermometer Use Behavior: Series of Cross-sectional Analyses

BACKGROUND

Temperature-taking behaviors vary with levels of circulating infectious illness; however, little is known about how these behaviors differ by demographic characteristics. Populations with higher perceived risks of illness are more likely to adopt protective health behaviors.

OBJECTIVE

We investigated differences in temperature-taking frequency and the proportion of readings that were feverish among demographic groups (age, gender, urban/rural status) over influenza offseason; influenza season; and waves 1, 2, and 3 of the COVID-19 pandemic.

METHODS

Using data from smart thermometers collected from May 1, 2019, to February 28, 2021, across the United States, we calculated the frequency of temperature-taking and the proportion of temperature readings that were feverish. Mixed-effects negative binomial and mixed-effects logistic regression analyses were performed to identify demographic characteristics associated with temperature-taking frequency and the proportion of feverish readings, respectively. Separate models were fit over five study periods: influenza offseason (n=122,480), influenza season (n=174,191), wave 1 of COVID-19 (n=350,385), wave 2 (n=366,489), and wave 3 (n=391,578).

RESULTS

Both temperature-taking frequency and the proportion of feverish readings differed by study period (ANOVA P<.001) and were the highest during influenza season. During all periods, children aged 2-5 years and 6-11 years had significantly higher frequencies of temperature-taking than users aged 19-30 years, and children had the highest proportion of feverish readings of all age groups, after adjusting for covariates. During wave 1 of COVID-19, users over the age of 60 years had 1.79 times (95% CI 1.76-1.83) the rate of temperature-taking as users aged 19-30 years and 74% lower odds (95% CI 72%-75%) of a reading being feverish. Across all periods, men had significantly lower temperature-taking frequency and significantly higher odds of having a feverish reading compared to women. Users living in urban areas had significantly higher frequencies of temperature-taking than rural users during all periods, except wave 2 of COVID-19, and urban users had higher odds of a reading being feverish in all study periods except wave 1 of COVID-19.

CONCLUSIONS

Temperature-taking behavior and the proportion of readings that were feverish are associated with both population disease levels and individual demographic characteristics. Differences in the health behavior of temperature-taking may reflect changes in both perceived and actual illness risk. Specifically, older adults may have experienced an increase in perceived risk during the first three waves of COVID-19, leading to increased rates of temperature monitoring, even when their odds of fever were lower than those of younger adults. Men's perceived risk of circulating infectious illnesses such as influenza and COVID-19 may be lower than that of women, since men took their temperature less frequently and each temperature had a higher odds of being feverish across all study periods. Infectious disease surveillance should recognize and incorporate how behavior impacts illness monitoring and testing.

Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts

BACKGROUND

Dementia is a global public health priority due to rapid growth of the aging population. As China has the world's largest population with dementia, this debilitating disease has created tremendous challenges for older adults, family caregivers, and health care systems on the mainland nationwide. However, public awareness and knowledge of the disease remain limited in Chinese society.

OBJECTIVE

This study examines online public discourse and sentiment toward dementia among the Chinese public on a leading Chinese social media platform Weibo. Specifically, this study aims to (1) assess and examine public discourse and sentiment toward dementia among the Chinese public, (2) determine the extent to which dementia-related discourse and sentiment vary among different user groups (ie, government, journalists/news media, scientists/experts, and the general public), and (3) characterize temporal trends in public discourse and sentiment toward dementia among different user groups in China over the past decade.

METHODS

In total, 983,039 original dementia-related posts published by 347,599 unique users between 2010 and 2021, together with their user information, were analyzed. Machine learning analytical techniques, including topic modeling, sentiment analysis, and semantic network analyses, were used to identify salient themes/topics and their variations across different user groups (ie, government, journalists/news media, scientists/experts, and the general public).

RESULTS

Topic modeling results revealed that symptoms, prevention, and social support are the most prevalent dementia-related themes on Weibo. Posts about dementia policy/advocacy have been increasing in volume since 2018. Raising awareness is the least discussed topic over time. Sentiment analysis indicated that Weibo users generally attach negative attitudes/emotions to dementia, with the general public holding a more negative attitude than other user groups.

CONCLUSIONS

Overall, dementia has received greater public attention on social media since 2018. In particular, discussions related to dementia advocacy and policy are gaining momentum in China. However, disparaging language is still used to describe dementia in China; therefore, a nationwide initiative is needed to alter the public discourse on dementia. The results contribute to previous research by providing a macrolevel understanding of the Chinese public's discourse and attitudes toward dementia, which is essential for building national education and policy initiatives to create a dementia-friendly society. Our findings indicate that dementia is associated with negative sentiments, and symptoms and prevention dominate public discourse. The development of strategies to address unfavorable perceptions of dementia requires policy and public health attention. The results further reveal that an urgent need exists to increase public knowledge about dementia. Social media platforms potentially could be leveraged for future dementia education interventions to increase dementia awareness and promote positive attitudes.

Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population

Objective To identify the risk factors for severe diverticular bleeding in an elderly population. Methods Using a comprehensive computerized hospital database, severe and non-severe diverticular bleeding cases were compared for 19 factors: the age, sex, body mass index, comorbid conditions (hypertension, cardiovascular disease, cerebrovascular disease, and chronic renal failure, including those undergoing dialysis), history of diverticular bleeding, use of low-dose aspirin, use of antiplatelet agent besides aspirin, use of anticoagulant agent, use of prednisolone, use of non-steroidal anti-inflammatory drugs, use of cyclooxygenase-2 selective inhibitors, changes in vital signs, hypoalbuminemia, bilateral diverticula, identification of bleeding lesion, and rebleeding. Severe bleeding was defined as the need for blood transfusion, emergency surgery, or vascular embolization. Patients A total of 258 patients were admitted for lower gastrointestinal bleeding between August 2010 and July 2020, among whom 120 patients over 65 years old diagnosed with diverticular bleeding were included in this study. Results Fifty-one patients (43%) had severe diverticular bleeding. Independent risk factors for severe diverticular bleeding were as follows: change in vital signs [odds ratio (OR), 5.23; 95% confidence interval (CI), 1.9-14.4; p=0.0014], hypoalbuminemia (OR, 12.3; 95% CI, 1.97-77.3; p=0.0073), bilateral diverticula (OR, 3.47; 95% CI, 1.33-9.02; p=0.011), and rebleeding (OR, 5.92; 95% CI, 2.21-15.8; p<0.001). The area under the receiver operating characteristic curve was 0.79 after cross validation. Conclusion Severe diverticular bleeding in elderly population may be predicted by changes in their vital signs, hypoalbuminemia, bilateral diverticula, and rebleeding.

Bridging the Gap in End Tuberculosis Targets in the Elderly Population in Eastern China: Observational Study From 2015 to 2020

BACKGROUND

With a progressive increase in the aging process, the challenges posed by pulmonary tuberculosis (PTB) are also increasing for the elderly population.

OBJECTIVE

This study aimed to identify the epidemiological distribution of PTB among the elderly, forecast the achievement of the World Health Organization's 2025 goal in this specific group, and predict further advancement of PTB in the eastern area of China.

METHODS

All notified active PTB cases aged ≥65 years from Zhejiang Province were screened and analyzed. The general epidemiological characteristics were depicted and presented using the ArcGIS software. Further prediction of PTB was performed using R and SPSS software programs.

RESULTS

Altogether 41,431 cases aged ≥65 years were identified by the surveillance system from 2015 to 2020. After excluding extrapulmonary TB cases, we identified 39,832 PTB cases, including laboratory-confirmed (23,664, 59.41%) and clinically diagnosed (16,168, 40.59%) PTB. The notified PTB incidence indicated an evident downward trend with a reduction of 30%; however, the incidence of bacteriologically positive cases was steady at approximately 60/100,000. Based on the geographical distribution, Quzhou and Jinhua Cities had a higher PTB incidence among the elderly. The delay in PTB diagnosis was identified, and a significantly prolonged treatment course was observed in the elderly. Moreover, a 50% reduction of PTB incidence by the middle of 2024 was predicted using a linear regression model. It was found that using the exponential smoothing model would be better to predict the PTB trend in the elderly than a seasonal autoregressive integrated moving average model.

CONCLUSIONS

More comprehensive and effective interventions such as active PTB screening combined with physical checkup and succinct health education should be implemented and strengthened in the elderly. A more systematic assessment of the PTB epidemic trend in the elderly population should be considered to incorporate more predictive factors.

Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool

BACKGROUND

Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes.

OBJECTIVE

We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners.

METHODS

We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention.

RESULTS

The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others.

CONCLUSIONS

This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.

Digital Technologies for Health Promotion and Disease Prevention in Older People: Protocol for a Scoping Review

BACKGROUND

Digital technologies could contribute to health promotion and disease prevention. It is unclear if and how such digital technologies address the health needs of older people in nonclinical settings (ie, daily life).

OBJECTIVE

This study aims to identify digital technologies for health promotion and disease prevention that target the needs of older people in nonclinical settings by performing a scoping review of the published literature. The scoping review is guided by the framework of Arksey and O'Malley.

METHODS

Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The information sources are bibliographic databases (MEDLINE, PsycINFO, CINAHL, and SCOPUS) and bibliographies of any included systematic reviews. Manual searches for additional studies will be performed in Google Scholar and most relevant journals. The electronic search strategy was developed in collaboration with a librarian who performed the search for studies on digital technologies for health promotion and disease prevention targeting the needs of older people. Study selection and data coding will be performed independently by 2 authors. Consensus will be reached by discussion. Eligibility is based on the PCC (Population, Concept, and Context) criteria as follows: (1) older people (population); (2) any digital (health) technology, such as websites, smartphone apps, or wearables (concept); and (3) health promotion and disease prevention in nonclinical (daily life, home, or community) settings (context). Primary studies with any design or reviews with a systematic methodology published in peer-reviewed academic journals will be included. Data items will address study designs, PCC criteria, benefits or barriers related to digital technology use by older people, and evidence gaps. Data will be synthesized using descriptive statistics or narratively described by identifying common themes. Quality appraisal will be performed for any included systematic reviews, using a validated instrument for this study type (A Measurement Tool to Assess Systematic Reviews, version 2 [AMSTAR2]).

RESULTS

Following preliminary literature searches to test and calibrate the search syntax, the electronic literature search was performed in March 2022 and manual searches were completed in June 2022. Study selection based on titles and abstracts was completed in July 2022, and the full-text screen was initiated in July 2022.

CONCLUSIONS

Our scoping review will identify the types of digital technologies, health targets in the context of health promotion and disease prevention, and health benefits or barriers associated with the use of such technologies for older people in nonclinical settings. This knowledge could guide further research on how digital technologies can support healthy aging.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37729.

Acceptability and Feasibility of Smart Phone Application "OSOMO Prompt" for Health Surveillance in Older Adults by Community Health Workers

The magnanimous functionalities and flexibility of smartphone device make them well suited for collecting field data, especially for the local healthcare professional. This paper describes the results of the acceptability and feasibilityfor community health workers (CHWs) after using smartphone application called 'OSOMO prompt' app. The results indicated that the comparison of means of one sample t-test responses to the questions on the perceived usefulness and perceived ease of use of 'OSOMO prompt' app. The CHWs found that the high average scores of using the 'OSOMO prompt' app were useful in their job (mean=3.97±.68) and easy to use (Mean=3.95±.62). The app also had high score point of improving the quality of CHWs work, easy to do CHWs job, clearly and stability app while all items of perceived usefulness and perceived ease of use were statistical significantly (p-value <.001). In conclusion, challenging of smartphone 'OSOMO prompt' app was feasible and acceptable to CHWs.

Update on the Accuracy of Conventional and Digital Full-Arch Impressions of Partially Edentulous and Fully Dentate Jaws in Young and Elderly Subjects: A Clinical Trial

To update the available literature on the accuracy of conventional and digital full-arch impressions using the latest hardware and software, participants of different age groups and dental status were investigated. An established reference aid-based method was applied to analyze five intraoral scanners (IOS) CS 3800 (CS), iTero Element 5D (IT), Medit i700 (ME), Primescan (PS), and Trios 4 (TR), and one conventional polyether impression (CVI). Forty-five participants were classified into three groups: Age 27.3 ± 2.7 years fully dentate, 60.6 ± 8.1 years fully dentate, and 65.7 ± 6.2 years partially edentulous. The IOS datasets were investigated using three-dimensional software (GOM Inspect), and plaster casts of CVI were analyzed using a co-ordinate measurement machine. The deviations of the reference aid to impressions were determined. No significant differences in age between the three groups were observed by the IOS in terms of trueness (p < 0.05). These findings were confirmed for precision, except for TR. In contrast to CS (mean ± standard deviation 98.9 ± 62.1 µm) and IT (89.0 ± 91.0 µm), TR (58.3 ± 66.8 µm), ME (57.9 ± 66.7 µm), and PS (55.5 ± 48.7 µm) did not show significant differences than those of CVI (34.8 ± 29.6 µm) in overall view. Within the study, the latest IOSs still showed limitations in the accuracy of full-arch impressions. However, they seemed to be unaffected by age and fully dentate or partially edentulous dentitions with small gaps.

Emerging and Legacy Per- and Polyfluoroalkyl Substances in an Elderly Population in Jinan, China: The Exposure Level, Short-Term Variation, and Intake Assessment

Human exposure to per- and polyfluoroalkyl substances (PFASs) has gained worldwide attention due to their widespread presence in the environment and adverse health effects, but the exposure assessment in the elderly is still lacking. This study aimed to assess exposures to 3 emerging PFASs (chlorinated polyfluoroalkyl ether sulfonic acids, Cl-PFESAs) and 15 legacy PFASs. The temporal variability of internal exposures and intake amounts of these PFASs were evaluated among a population of 76 healthy elderly adults (age: 60-69) in Jinan, China over 5 consecutive months. Fifteen PFASs were detected in whole blood with the mean total concentration (ΣPFAS) at 20.1 ng/mL (range: 5.0-135.9 ng/mL) dominated by perfluorooctanoic acid (PFOA) (9.0 ng/mL), perfluorooctanesulfonic acid (PFOS) (5.3 ng/mL), and 6:2 Cl-PFESA (1.6 ng/mL). Across the 5 month assessment period, significant variation was only observed for short-chain (C4-C7) perfluoroalkyl carboxylic acids, and their variations ranged from 53 to 334%. The median intake of PFOA and PFOS was estimated to be 1.46 and 0.92 ng/kg bw/day, respectively. Regression analysis showed that dietary ingestion, especially fish, was likely an important exposure pathway for PFASs among the elderly adults. Various pathways (e.g., dietary, water, air, and dust) should thus be considered to fully understand human exposure to PFASs.

An Exploratory Assessment of Factors with Which Influenza Vaccine Uptake Is Associated in Hungarian Adults 65 Years Old and Older: Findings from European Health Interview Surveys

Influenza vaccination is an imperative public health task for elderly people due to a higher risk of developing more severe complications. The main aim of our study was to determine the influencing factors of being vaccinated against influenza among subjects aged 65 and above. Data were from the Hungarian implementations of the European Health Interview Survey 2009, 2014 and 2019 studies with a final sample size of 3355. A multivariate logistic regression model with interactions was used to identify the possible factors associated with vaccination. Approximately 32% of the participants were vaccinated for the most recent influenza season. The most important factors were identified that contributed to influenza vaccination among individuals, which were the following: educational attainment, having a partner, the annual frequency of specialist and doctor visits, and having comorbidities. Respondents who thought that they could do a lot for their health had higher odds of being immunized. Being obese seemed to be a risk factor. According to our findings, the current influenza vaccination coverage was considered as low in Hungary; hence, the implementation of minor reformulations in the field of health policy is suggested.

Establishment of gender- and age-specific reference intervals for serum liver function tests among the elderly population in northeast China: a retrospective study

Introduction

Reference intervals (RIs) for younger population may not apply to the elderly population. The aim of this study was to establish gender- and age-specific RIs for serum liver function tests among the elderly population and to compare with younger population RIs currently used in China and other countries.

Materials and methods

This was a retrospective study, and subjects (≥ 18 year-old) were recruited from the laboratory information system (LIS) at the First Hospital of Jilin University between April 2020 and April 2021. The following parameters were collected: aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), total bilirubin (TBIL), and direct bilirubin (DBIL). The Tukey method was used to eliminate outliers. Reference intervals were established by the nonparametric method.

Results

A total of 23,597 healthy individuals were enrolled in the study. From all parameters AST, ALT, TP and ALB required no gender partition, while ALT, GGT, TP, ALB and DBIL required different partitions for age. Activities and concentrations of ALT, ALB, and TP showed a downward trend in the elderly aged 60-89. In contrast, DBIL showed a gradual upward trend.

Conclusion

The RIs for liver function tests among healthy elderly population were different from those among young population in China. There were apparent gender and age differences in the RIs of liver function for elderly and significant differences compared with national standards and RIs in other countries. Therefore, it is necessary to establish gender- and age-specific RIs for serum liver function tests among the elderly population.

Prevalence and Causes of Visual Impairment and Blindness in Elderly Population; an Urgent Geriatric Health Issue: Tehran Geriatric Eye Study (TGES)

PURPOSE

To determine the prevalence of vision impairment (VI) and blindness and their determinants in the elderly population of Tehran.

METHODS

In a cross-sectional study, multi-stage cluster sampling was used to select a sample of over 60 year population of Tehran. Optometric examinations included the measurement of uncorrected visual acuity, objective and subjective refraction, presenting and best corrected visual acuity. Vision impairment is reported according to the WHO definition. Visual acuity worse than 20/60 and 20/400 in the better eye was regarded as low vision and blindness, respectively.

RESULTS

According to presenting visual acuity, VI was found in 14.8% (95%CI: 13.1-16.5) of the participants, including low vision in 13.8% (95%CI: 12.2-15.4) and blindness in 1.1% (95%CI: 0.5-1.6). The prevalence of VI ranged between 7.8% (95%CI: 6.0-9.5) in subjects aged 60-64 years and 40.0% (95%CI: 33.0-47.0) in participants over 80 years (p < .001). Multivariable logistic regression analysis showed that older age (OR = 1.07(per year)), lower education level (illiterate versus college: OR = 3.55), and lower economic status (middle versus rich: OR = 1.30 and poor versus rich; OR = 1.72) had a significant relationship with an increase in the prevalence of VI, and older age (OR = 1.14(Per year increase)) and diabetes (OR = 2.62) had a significant relationship with blindness. Refractive errors (63.1%) was the leading cause of VI followed by cataract (22.5%). However, cataract (48.3%) was the leading cause of blindness.

CONCLUSION

Many older adults suffer from VI. Correction of refractive errors and cataract reduces a large percentage of VI. Age, education level, and economic status are other determinants of VI.

Association of the serum transaminase with mortality among the US elderly population

BACKGROUND AND AIM

Considering the inconsistent findings of research into the associations between serum levels of liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and gamma-glutamyltransferase [GGT]) and mortality among elderly people, we aimed to investigate the associations of ALT, AST, GGT, and De-Ritis ratio (DRR, defined as AST/ALT) and all-cause or cause-specific mortality among the US elderly people using National Health and Nutrition Examination Surveys data.

METHODS

We included 6415 elderly participants (≥ 65 years). Exclusion criteria included positive test for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection at baseline. Multivariable-adjusted Cox regression models calculating hazard ratios (HR) and 95% confidence intervals were developed for each of the liver enzyme measures.

RESULTS

All-cause cumulative mortality was 33.8%, of which 23.8% were cardiovascular disease (CVD) deaths, 15.6% were cancer deaths, and 60.6% were other cause deaths. Adjusted Cox models found increased all-cause mortality risk for low ALT (HR: 1.70), low AST (HR: 1.13), high GGT (HR: 1.25), and high DRR (HR: 1.68). Low ALT and high DRR predicted CVD mortality. Low ALT (HR: 1.91), low AST (HR: 1.16), high GGT (HR: 1.40), and high DRR (HR: 1.76) predicted other cause mortality.

CONCLUSIONS

Low ALT and high DRR were associated with increased CVD and cancer mortality. All serum liver enzyme measures were associated with all-cause mortality and other cause mortality in the US elderly population. Further studies may validate these findings in other elderly populations.

Range of Movement and Patient-Reported Outcomes in Shoulder Arthroplasty in the Elderly: A Comparison of Anatomical Versus Reverse Shoulder Replacements

Introduction Shoulder arthroplasty is in increasing demand in the elderly given the rising prevalence of glenohumeral osteoarthritis (OA) across the population. There is a dearth of evidence in the current literature comparing anatomical total shoulder arthroplasty and reverse total shoulder arthroplasty (RTSA) in the elderly population. This study compares patient-reported outcome measures and range of movement (ROM) between anatomical and reverse total shoulder replacements in matched patient cohorts over the age of 70 years. Materials and methods This retrospective cohort study compares range of movement and patient-reported outcomes between anatomical total shoulder arthroplasty and reverse total shoulder arthroplasty in matched cohorts over the age of 70 years at a single institution between 2011 and 2015. Overall, 75 patients were recruited, including 44 patients with anatomical total shoulder arthroplasty and 31 patients with reverse total shoulder arthroplasty. Cohorts were matched according to age, preoperative Oxford Shoulder Score (OSS), and preoperative range of movement. The minimum clinical follow-up was one year. Results At one year, range of movement metrics in flexion, abduction, and external rotation all demonstrated greater improvements in the anatomical total shoulder arthroplasty cohort in comparison to the reverse total shoulder arthroplasty cohort (p<0.0001). No statistical difference in Oxford Shoulder Score was evident between cohorts. Conclusion Anatomical total shoulder arthroplasty demonstrates a significant improvement in range of movement in comparison to reverse total shoulder arthroplasty in matched elderly patient cohorts. However, there was no statistical difference in functional assessment scores between reverse shoulder replacement and anatomical shoulder replacement.

A 24-year single-centre experience with Collum Femoris Preserving stem: clinical and radiological results in young and elderly population

OBJECTIVE

The primary aim was to evaluate the long-term follow-up of Collum Femoris Preserving (CFP) stem, specifically focusing on stem survivorship, complications, as well as on clinical and radiological results. The secondary study objective is an age-based sub-analysis (<65 years vs. ⩾65 years) of long-term results.

MATERIALS AND METHODS

We performed a retrospective analysis of patients who underwent CFP implantation between 1997 and 2009. A total of 311 patients (342 hips) were included with a mean follow-up of 15.8 ± 2.2 (range 11-24) years. 2 age groups were analysed: Group-Y (age <65) and Group-E (age ⩾65). Group-Y included 182 hips (mean follow-up 16.3 ± 4.2 years), whereas Group-E included 160 hips (mean follow-up 15.5 ± 3.7 years). Clinical (HHS, OHS and VAS) and radiological data were obtained at final follow-up. Any complications, reoperations, prosthetic components revisions and stem revisions were analysed.

RESULTS

According to HSS score, 95% of patients reported excellent/good results (95.6% Group-Y vs. 94.4% Group-E) with an overall stem survival rate of 93.3% (94% Group-Y vs. 92.5% Group-E; p = 0.37). Overall, 87% of stem revisions were performed with primary stems. The rate of prosthetic components revision was 9.9 % (9.9% in Group-Y vs. 10% in Group-E; p = 1). The reoperation rate was 10.8% (11.5% in Group-Y vs. 10.0% in Group-E; p = 0.73).

CONCLUSIONS

The CFP stem provides good clinical and radiological long-term results with low rate of complications in both young and elderly patients. No significant difference in stem revision and reoperation rates was observed between the 2 groups. Both in elderly and young patients, CFP stem allows revisions to be performed with primary stems.

Dynamics of the "Cognitive" Brain Wave P3b at Rest for Alzheimer Dementia Prediction in Mild Cognitive Impairment

Alzheimer's disease (AD) is the most common cause of dementia that involves a progressive and irrevocable decline in cognitive abilities and social behavior, thus annihilating the patient's autonomy. The theoretical assumption that disease-modifying drugs are most effective in the early stages hopefully in the prodromal stage called mild cognitive impairment (MCI) urgently pushes toward the identification of robust and individualized markers of cognitive decline to establish an early pharmacological intervention. This requires the combination of well-established neural mechanisms and the development of increasingly sensitive methodologies. Among the neurophysiological markers of attention and cognition, one of the sub-components of the 'cognitive brain wave' P300 recordable in an odd-ball paradigm -namely the P3b- is extensively regarded as a sensitive indicator of cognitive performance. Several studies have reliably shown that changes in the amplitude and latency of the P3b are strongly related to cognitive decline and aging both healthy and pathological. Here, we used a P3b spatial filter to enhance the electroencephalographic (EEG) characteristics underlying 175 subjects divided into 135 MCI subjects, 20 elderly controls (EC), and 20 young volunteers (Y). The Y group served to extract the P3b spatial filter from EEG data, which was later applied to the other groups during resting conditions with eyes open and without being asked to perform any task. The group of 135 MCI subjects could be divided into two subgroups at the end of a month follow-up: 75 with stable MCI (MCI-S, not converted to AD), 60 converted to AD (MCI-C). The P3b spatial filter was built by means of a signal processing method called Functional Source Separation (FSS), which increases signal-to-noise ratio by using a weighted sum of all EEG recording channels rather than relying on a single, or a small sub-set, of channels. A clear difference was observed for the P3b dynamics at rest between groups. Moreover, a machine learning approach showed that P3b at rest could correctly distinguish MCI from EC (80.6% accuracy) and MCI-S from MCI-C (74.1% accuracy), with an accuracy as high as 93.8% in discriminating between MCI-C and EC. Finally, a comparison of the Bayes factor revealed that the group differences among MCI-S and MCI-C were 138 times more likely to be detected using the P3b dynamics compared with the best performing single electrode (Pz) approach. In conclusion, we propose that P3b as measured through spatial filters can be safely regarded as a simple and sensitive marker to predict the conversion from an MCI to AD status eventually combined with other non-neurophysiological biomarkers for a more precise definition of dementia having neuropathological Alzheimer characteristics.

Prevalence of Noncommunicable Diseases in Japan Using a Newly Developed Administrative Claims Database Covering Young, Middle-aged, and Elderly People

Introduction

Noncommunicable diseases (NCDs) are an ongoing public health problem globally. The present study aimed to estimate the prevalence of NCDs in Japan using a newly developed, commercially available administrative claims database covering young, middle-aged, and elderly people.

Methods

We compared the age-stratified population distribution between the DeSC administrative claims database and the population estimates. We calculated the 1 year prevalence of several NCDs using the DeSC database and compared the prevalence of diabetes mellitus and hypertension between the DeSC database and the Japan National Health and Nutrition Survey.

Results

The age distribution of the population included in the DeSC database was similar to that of the population estimates. The estimated prevalence rates were as follows: diabetes mellitus (12.2%), hypertension (20.9%), ischemic heart disease (5.6%), heart failure (5.3%), cerebral infarction (3.4%), stroke (3.7%), gastric cancer (0.6%), colorectal cancer (0.8%), breast cancer (1.5%), prostate cancer (0.6%), cataract (7.1%), depression (3.5%), and osteoporosis (6.3%). The estimated prevalence of diabetes and hypertension was comparable with that of the National Health and Nutrition Survey.

Conclusions

The distribution of age and sex in the database was comparable with that of the population estimates. The prevalence of diabetes mellitus and hypertension was comparable with that in a previously reported national survey. Our data can be utilized as basic information for policymaking in clinical medicine and public health in Japan.

Can the implementation of family doctor contracted service enable the elderly to utilize primary health care services more equally? empirical evidence from Shandong, China

BACKGROUND

While the elderly are facing greater health risks, they also face more serious inequalities in utilization of medical services. The family doctor contracted service is the core policy of the Chinese government to cope with aging and to achieve the outcome that everyone has the right to primary health care. However, previous research has neither revealed the degree of inequality in the use of contracted services among the elderly in China, nor has it revealed what factors are related to the inequality in the use of services.

OBJECTIVE

Assess and decompose the inequality in the use of family doctors contracted services in the elderly population in China.

METHODS

A cross-sectional study of 1037 elderly people was conducted in Shandong Province, China. According to the first consultation rate of family doctors, the physical examination rate, the healthy lifestyle guidance rate and the chronic disease management rate, the situation of elderly people's utilization of family doctor contracted service was investigated. The concentration index is used to measure the degree of inequality in the use of family doctors contracted services by the elderly. In order to test the contribution of different factors to the inequality of utilization of family doctors contracted services, the concentration index was also decomposed.

RESULTS

The first consultation rate of family doctors for the elderly in Shandong Province was 24.6%, the physical examination rate was 65.8%, the healthy lifestyle guidance rate was 13.7%, and the chronic disease management rate was 52.2%. The horizontal inequality index of the healthy lifestyle guidance rate and the chronic disease management rate were 0.451 and 0.573, respectively, indicating that there is an inequality of pro-wealth. The concentration index of physical examination rate and chronic disease management rate is negative (- 0.260, - 0.518), which means inequality to the poor. Education level is the most important factor affecting the unequal utilization of health services for the elderly, followed by income.

CONCLUSION

The family doctor contracted service has had a positive impact on alleviating the health inequality in the utilization of basic medical and health services for the elderly. Although there is still inequality in terms of pro-wealth for the elderly, the utilization of family doctor contracted service has weakened the inequality of service utilization brought about by income. Enhancing the health literacy of the elderly, narrowing the gap between the rich and the poor, bridging the gap between urban and rural areas, and building a harmonious family relationship can promote the realization of basic medical and health care services for every elderly.

Bipolar hemiarthroplasty may reduce cerebrovascular accidents and improve early weight-bearing in the elderly after femoral neck fracture

Cerebrovascular accidents (CVA) in the elderly population after femoral neck fracture remain great concern for physicians. Specifically, surgical fixation techniques, such as bipolar hemiarthroplasty (HA) and internal fixation play a significant role in influencing the occurrence of postoperative CVA in the elderly population.In order to identify 2 cohorts, we used a rigid selection process based on our institution's database. The cohorts were comprised of a HA cohort and a cannulated screw cohort, of which underwent femoral neck surgery, performed by 3 fellowship trained surgeons from 2003 to 2014. Risk factors were documented and measured, including Coumadin use and hypertension, and postoperative complications such as CVA and death rate were also recorded. A P-value of <.05 was determined to be statistically significant.A power analysis was performed and achieved a power of 0.95. We found a non-significant reduction in CVA for bipolar HA (3.6% CVA vs 0.0% in the non-CVA group, P = .48) and a non-significant increase in CVA for cannulated screw use (7.6% CVA vs 14.4% in the non-CVA group, P = .11). In addition, we found a significant difference in terms of weight-bearing status at 6-weeks postoperatively (0.95 vs 2.0, P < .0001), favoring the bipolar HA group.Among the advantages of bipolar HA surgery, surgeons should consider its value in reducing the occurrence of postoperative CVA. Furthermore, patients who underwent bipolar HA had improved weight-bearing status postoperatively compared with cannulated screw fixation.

Association of Acute Perioperative Myocardial Injury With All-Cause Mortality Within 90 Days After Hip Fracture Repair in the Elderly: A Prospective Study

Introduction

It remains unclear whether acute perioperative myocardial injury (APMI) increases mortality in the elderly. This study aimed to investigate APMI’s association with mortality within 90 days after hip fracture repair in elderly patients.

Materials and Methods

This prospective study enrolled elderly patients admitted to the department of Traumatology and Orthopaedics in XXX Hospital, who underwent surgery in 2018–2019 with a 90-day follow-up. According to survival status within 90 days, survival and death groups were constituted. Clinical, demographic, and laboratory indicators and 90-day mortality post-surgery were recorded. APMI’s association with 90-day mortality post-surgery was analyzed by logistic regression.

Results

Totally 248 participants were enrolled, including 224 and 24 in the survival and death groups, respectively, for a mortality rate of 9.7%. Compared with surviving individuals, the death group was older [81 (75–86) vs 87 (82–89) years], and had higher incidence rates of APMI (24.6% vs 58.3%), intertrochanteric fractures (41.1% vs 62.5%), preoperative atrial fibrillation (8.9% vs 29.2%), and dementia (73.7% vs 95.8%) (all P<.05). They also showed higher pre-injury frail scale scores [1 (0–2) vs 3 (1–4)] and Nottingham hip fracture scores (NHFSs) [4 (4–5) vs 6.5 (5–7)], lower Glomerular filtration [62 (46.1–78.6) vs 44.37 (35–61.92) ml/min], and reduced odds of glomerular filtration rate <60 mL/min (75.0% vs 46.9%) (all P < .05). APMI (OR = 3.294, 95% CI: 1.217–8.913) and NHFS (OR = 2.089, 95% CI: 1.353–3.225) independently predicted 90-day mortality post-surgery (all P<.05).

Conclusions

APMI is associated with increased mortality risk within 90 days after hip fracture repair in elderly patients.