Attributes of person-centred communication: A qualitative exploration of communication with older persons in home health care

BACKGROUND

Previous research points to challenges related to the home healthcare of older persons and to the complexity of communication. Although person-centred care has been advocated widely, there remains a need for in-depth knowledge on how to enable person-centred and supportive communication in the care of older persons.

AIM

The aim of this study was to explore attributes of person-centred communication between nurses and older persons being cared for in their home.

METHODS

A descriptive study with a qualitative approach was conducted. A data set from the COMHOME-study consisting of 77 audio-recorded home healthcare visits between registered nurses and older persons was analysed with a method for qualitative thematic analysis.

RESULTS

The findings indicate that the attributes of person-centred communication comprise recognising, inviting and involving older persons. To facilitate this form of communication, attentiveness and responsiveness on the part of RNs seemed significant. Person-centred communication was facilitated when the RNs used verbal expressions to emphasise and acknowledge the older persons' views and were attentive to their emotions and expressions.

CONCLUSION

The nurses' attentiveness and responsiveness seems important for person-centred communication with older persons. Communication skills are needed to recognise, invite and involve older persons in their care and to support their health and well-being. Implication for practice The importance of communication which facilitate a person-centred approach by nurses should be acknowledged when caring for older persons and included in education and training.

Estimated Glomerular Filtration Rate Decline and Incident Frailty in Older Adults

BACKGROUND AND OBJECTIVES

Low eGFR is known to be associated with frailty, but the association between the longitudinal decline of eGFR and incident frailty in older persons remains to be determined. The objective of this study was to investigate whether a fast decline on eGFR would be associated with incident frailty.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Community dwellers, aged ≥70, were included in this secondary analysis of the 5-year Multidomain Alzheimer Preventive Trial (MAPT). eGFR was calculated using CKD-Epidemiology Collaboration equation at baseline and at 6, 12, and 24 months. The lowest quartile of eGFR slope (-4.1 ml/min per 1.73 m² per yr) defined a fast decline. The frailty phenotype (unintentional weight loss, exhaustion, low physical activity, slow gait, low handgrip strength assessed with a 0-5 score, where higher is worse; a score ≥3 defines frailty) was assessed at baseline, 6, 12, 24, 36, 48, and 60 months. Cox models were used to test the association between fast eGFR decline and incident frailty.

RESULTS

A total of 833 participants were frail neither at baseline nor at 2 years and had appropriate follow-up data. Median (IQR) baseline eGFR was 73 (61-84) ml/min per 1.73 m². Frailty occurred in 95 (11%) participants between 24 and 60 months. Among them, 31/207 (15%) had fast eGFR decline between baseline and 24 months, and 64/626 (10%) did not. In a Cox model adjusted for demographic variables, cardiovascular comorbidity, C-reactive protein, and baseline eGFR, a fast eGFR decline was associated with incident frailty (HR 1.67, 95% CI 1.03 to 2.71). Sensitivity analyses provided consistent findings.

CONCLUSIONS

In community-dwelling older adults with relatively preserved baseline eGFR, a fast eGFR decline is associated with incident frailty.

Home care services for older persons. The views of older persons and family members: A realistic evaluation

AIMS AND OBJECTIVES

The aim of the present study was to evaluate client-centred care in older persons' home care services from the perspective of older persons and family members. The following research questions were addressed: How do home care older persons and family members perceive client-centered care in their home care services? What kind of social mechanisms are realized when home care services are implemented?

BACKGROUND

Several older persons are dependent on home care services for their continued living at home. The fundamental value and best practice of home care is the client-centred care in services.

METHOD

The research method was realistic evaluation. Six families with six older person clients of home care and seven family members were interviewed. In the present study, the interview contained three themes (1) content and services of the home care, (2) activities and practices of the home care and (3) development of client centredness in home care. Research data were analysed with deductive content analysis.

RESULTS

Home care service should be based on analysis of older person's individual life situation. Social mechanisms such as interaction, participation, trust and adaptation are realised in implementation of home care services. The most significant outcomes of client-centred service were timely availability of services, safe care relationship and continuity of care, ability to influence on own services and appropriate price of services. Significant factors in quality of service were unhurriedness, kindness and competence of professionals.

IMPLICATION FOR PRACTICE

Social mechanisms, such as participation, trust, adaptation and interaction, should be taken in account in care relationship in home care. Client centredness and methods for evaluating it should be defined in practical work. Client-centeredness competence should also be included in all stages of professional education of home care.

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

AIMS

To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain.

DESIGN

Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach.

METHODS

The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis.

RESULTS

Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care.

CONCLUSIONS

Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care.

IMPACT

Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care.

TRIAL REGISTRATION

ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

The Relationship among Functional Health Literacy, Self-Rated Health, and Social Support among Younger and Older Adults in Ghana

It is well established that health literacy positively affects health outcomes, and social support influences this association. What remains unclear is which aspect of social support (instrumental, informational, and emotional support) is responsible for this effect and whether the influence differs from one population group to another. This study addresses these lacunae. It examines the impact each type of support makes on the relation between functional health literacy (FHL) and self-rated health status among younger and older adults in Ghana. Data were pooled from two cross-sectional surveys, together comprising 521 participants in the Ashanti Region. The results indicated that young adults were more likely to possess sufficient FHL and perceive their health more positively than older adults. While FHL was positively associated with health status, the relation was stronger when young adults received a high level of emotional support. Among older persons, informational support substantially moderated the association between FHL and health status. Thus, social support modifies the relations between FHL and health status among younger and older adults in different ways and to different degrees. Therefore, interventions to improve FHL and health amongst younger and older adults should pay due regard to relevant aspects of social support.

The Burden of Caring: An Exploratory Study of the Older Persons Caring for Adult Children with AIDS-Related Illnesses in Rural Communities in South Africa

Since the start of the HIV and AIDS epidemic, very little research has been conducted on the older persons’ provision of HIV-related care to adult children. This is despite the fact that a large proportion of adults who die of AIDS-related illnesses stay with their elderly parents during the terminal stage of their illnesses. This paper explores how older persons in rural settings experience caring for their adult children with AIDS-related illnesses. In-depth interviews took place with older persons aged 60 years and above. The qualitative data analysis was informed by thematic approach to identify and report themes using inductive approach. The paper found that the older persons undertake the caring role without resources and support. As a result, they are burdened with having to care for adult children with AIDS-related illness. Fatigue arising from the hard work of physically caring for their sick adult children day and night adds to the physical burden on the older persons. Older persons will continue to carry the burden of caring for people with AIDS-related illnesses due to the increase in the number of new infections in South Africa. There is a need to involve them in HIV/AIDS programmes; their experience and wisdom would surely contribute positively and assist in addressing HIV prevention.

Inflammation, Appetite and Food Intake in Older Hospitalized Patients

The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite (p = 0.003) and ESAS-appetite (p = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served (p < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status (p = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients' appetite (p = 0.003) and food intake (p = 0.011) whereas other variables such as infection (p = 0.960), chronic inflammatory diseases (p = 0.371), age (p = 0.679) and gender (p = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients.

Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions

Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

Social support networks and psychological wellbeing in community-dwelling older Ghanaian cohorts

BACKGROUND

Social support networks for older persons have been related to health outcomes including differences in psychological wellbeing (PWB). However, the specifics of this relationship remain unclear especially in sub-Saharan Africa. This study investigates the (1) relationship between aspects of social support and PWB among older persons in Ghana and (2) the extent to which this relationship is moderated by their education levels and locational characteristics.

METHOD

The study included 1,200 community-residing individuals aged 50 years and older who participated in an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) conducted between July 2016 and February 2017. Logistic regression models evaluated the associations of social support and their interactions with education and locational variables in PWB.

RESULTS

Several aspects of meaningful social support: family/friends contacts ( β = 0.958, p < 0.05), couple focused ( β = 0.887, p < 0.001), emotional bonds ( β = 0.658, p < 0.005), attending social events ( β = 0.519, p < 0.001) and remittances from children ( β = 0.394, p < 0.005) significantly related to improved PWB in later life. These associations remained robust and largely strengthened after accounting for respondents' background and health-related factors. Education and locational characteristics substantially influenced the associations between social support and PWB.

CONCLUSION

These findings suggest that especially in terms of PWB, aspects of meaningful social support networks are critical elements in later life. Strengthening opportunities for closer interpersonal relations with older persons may enhance their mental health, quality of life and independence.

Development of a Model on Determinants of Malnutrition in Aged Persons: A MaNuEL Project

In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub “Malnutrition in the Elderly (MaNuEL),” a model of “Determinants of Malnutrition in Aged Persons” (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

What can Sub-Saharan Africa learn from Canada's investment in active healthy ageing? A narrative view

Background

The number of older persons in Sub-Saharan Africa is increasing.

Aims

What can Sub-Saharan Africa learn from other countries that may enhance the health and wellness of older persons? Canada was conveniently selected as the country which has endorsed the need for action on active ageing, given that by 2026, 1 in every 5 Canadians will have reached the age of 65 years and 4% of the overall population will be 85 years and older.

Methods

English language electronic searches of computerized databases (PubMed, MEDLINE, EMBASE, CINAHL, and PsychINFO) were done to locate relevant published studies on Canada, from January 2000 to August 2014. Keyword combination included: physical activity/activities, exercise/s, older person/s, elderly, ageing adults, seniors, and older people.

Results

8 out of 400 plus articles were reviewed, and 4 key approaches in ensuring active ageing in Canada were identified. From these, 5 public health-oriented plans are recommended for Sub-Saharan Africa: (1) there should be a shift in the conceptualisation of what physical activity entails, (2) it is necessary to build and strengthen collaboration between various stakeholders involved in planning, (3) raising awareness among older persons and the general population on the benefits in participating in physical activity, (4) encourage older persons to participate in culturally relevant physical activity, and (5) laying a better foundation for future generations of older persons.

Conclusion

Though more elaborate planning is required, these recommended plans will contribute to achieving average life expectancy beyond 60 years in Sub-Saharan Africa.

Does the purchase of a mobility scooter alter physical activity levels in older adults?

Purpose: This cohort study investigated changes in physical activity, community mobility and social participation following the first-time purchase of a mobility scooter.Methods: A national sample of persons aged 65+ years was surveyed using customized semi-structured interviews that explored changes in physical activity via the International Physical Activity Questionnaire modified for the elderly, and community involvement. Participants were recruited at the point of purchase of their first mobility scooter, and interviewed at this time and again at 2 and 6 months post-purchase.Results: Eighteen participants (F = 10, M = 8) aged between 65 and 95 years were recruited. Physical activity levels remained unchanged in 12 participants, and declined by at least one category in five participants. All participants reported improvement to their self-perceived quality of life following acquisition of a mobility scooter. Participants did not access additional forms of physical activity, though nine reported increased social participation. At baseline, five participants stated that the scooter was used for journeys they formerly made by other motorized transport, and by the 6-month interview, this number had risen to 15 participants.Conclusions: It is unlikely that changes in physical activity were related to the ageing process given the relatively short time span of the study. Thus it can be inferred that participants viewed their mobility scooter as a vehicle for maintaining their lifestyle rather than as a means to seek out additional activities. Improvements to perceived quality of life may be attributed to continuing or furthering community and social engagement, and a sense of retained independence.Implications for rehabilitationAn awareness of possible changes in physical activity associated with the purchase of a mobility scooter is needed.The purchase of a mobility scooter provides a viable means of transport to facilitate access to physical activity situations.Over-reliance on a mobility scooter has the potential to decrease health-related physical activity.The development and dissemination of a targeted health message about maintaining (or improving) physical activity levels is warranted to increase the awareness in this growing group of new, and current, mobility scooter riders in an increasingly ageing population.

Exploring nursing competence to care for older patients in municipal in-patient acute care: A qualitative study

AIM

To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care.

BACKGROUND

An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance.

DESIGN

A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied.

METHODS

A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding.

FINDINGS

Two main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment."

CONCLUSION

Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success.

RELEVANCE TO CLINICAL PRACTICE

This study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.

Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials

OBJECTIVE

To summarise the evidence regarding the impact of individualised music listening on persons with dementia.

METHODS

Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions.

RESULTS

Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited.

CONCLUSIONS

The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.

Taking to Bed at the End of Life

OBJECTIVES

To evaluate the time course of "taking to bed" at the end of life and determine whether it differs according to age, sex, and condition leading to death.

DESIGN

Prospective longitudinal study.

SETTING

Greater New Haven, Connecticut.

PARTICIPANTS

A total of 651 decedents from a cohort of 754 community-living persons, 70+ years of age.

MEASUREMENTS

During the last 2 years of life, the occurrence of bed rest and number of days in bed, two indicators of bed rest burden, were ascertained each month. Bed rest was defined as staying in bed for at least a half day due to an illness, injury, or other problem.

RESULTS

The occurrence of bed rest increased modestly from 12.4% at 24 months before death to 19.0% at 5 months before death, before increasing exponentially to 51.6% at 1 month before death. The median number of days in bed fluctuated within a narrow range of 3 to 7 from 24 months to 4 months before death, before increasing substantially to a high of 14 at 1 month before death. In the last 2 years of life, the burden of bed rest did not differ by age but was significantly greater in women than men. Among the conditions leading to death, the burden of bed rest was highest among persons dying from organ failure and cancer, lowest for sudden death, and intermediate for frailty, advanced dementia, and other conditions.

CONCLUSION

The burden of bed rest at the end of life is greater in women than men, does not differ by age, and is highest among persons dying from organ failure and cancer. The steep increases observed in the last 3 to 5 months of life suggest that taking to bed may be an indicator that death is approaching and should prompt discussions about referral to hospice among older persons with serious illness.

General practice nurse-led screening for anxiety in later life in Australian primary care settings

OBJECTIVE

To test the feasibility of general practice nurse (GPN)-led screening for clinically significant symptoms of anxiety (CSSA) in older people and to estimate the prevalence of CSSA.

METHODS

General practice nurse-led screening for CSSA was undertaken in eight general practices by integrating the five-item Geriatric Anxiety Inventory-Short Form (GAI-SF) into the annual 75 years and older health assessment (75+ HA). Prevalence rates were calculated, and field notes were analysed.

RESULTS

Over 30 months, 736 patients were screened for CSSA, with a detected prevalence rate of 20.1%. The application of the GAI-SF into the 75+ HA was feasible and readily accepted by patients.

CONCLUSIONS

The five-item GAI-SF is an age-appropriate screening tool for CSSA in general practice settings. Further research is warranted, particularly in relation to the development and implementation of evidence-informed, general practice-based interventions for CSSA that can be effectively delivered to meet the needs of older people.

Cognitive dysfunction predicts worse health-related quality of life for older stroke survivors: a nationwide population-based survey in Taiwan

OBJECTIVES

This study investigated the associations of cognitive status with specific/overall health-related quality of life (HRQoL) in older stroke survivors in Taiwan.

METHOD

A subsample of 592 older stroke survivors in a nationwide population-based survey of cognitive-dysfunction prevalencewas analyzed. HRQoL was assessed using the EuroQol five-dimension questionnaire (EQ-5D).

RESULTS

Stroke survivors with dementia were 5.60 times more likely to have mobility problems, 12.20 times to have self-care problems, 16.61 times to have problems in usual activities, 4.31 times to have pain/discomfort, and 3.28 times to have anxiety/depression than stroke survivors with normal cognitive function. Stroke survivors with mild cognitive dysfunction (MCD) were 2.57 times more likely to have mobility problems, 3.17 times to have self-care problems, 3.31 times to have problems in usual activities, 2.11 times to have pain/discomfort, and 2.35 times to have anxiety/depression than those with normal cognitive function. Both dementia (b = -15.13, p < .001) and MCD (b = -6.24, p < .001) significantly contributed to lower EQ-5D VAS; both dementia (b = -.15, p < .001) and MCD (b = -.10, p < .001) significantly contributed to lower EQ-5D index.

CONCLUSION

Dementia and MCD strongly predicted worse overall and specific HRQoL dimensions, especially self-care and usual activities for older stroke survivors.

Behavior changes by a buddy-style intervention including physical training, and nutritional and social support

Aim

Previous research suggests that multicomponent interventions including physical training, and nutritional and social support are required to improve a person's behavior. As a pre‐specified secondary outcome, this analysis aimed to ascertain whether a “buddy‐style” intervention could produce physical activity and nutritional behavior changes in older adults.

Methods

A 12‐week, home‐based, randomized controlled trial was carried out with 80 older persons, who were randomly assigned to an intervention group (n = 39), including physical training and nutritional support, and a control group (n = 41). Trained non‐professional volunteers visited the participants at home twice a week. Physical activity and nutritional behavior were assessed through validated questionnaires.

Results

In total, 36 participants in the intervention group and 26 participants in the control group completed the final questionnaire. The intervention group showed significant improvements in physical activity behavior, such as light sport activity (β = 9.13, 95% CI 0.90–17.37 min/day; P = 0.030), muscle strength exercise (β = 68.18, 95% CI 46.45–89.91 min/week; P < 0.001) and overall activities (β = 0.69, 95% CI 0.21–1.18 h/day; P = 0.006), compared with the control group. Nutritional behavior improvements for the intervention group were observed in the consumption of legumes/nuts (β = 0.18, 95% CI 0.00–0.35 portions/day; P = 0.047) and fluids (β = 0.48, 95% CI 0.01–0.98 portions/day; P = 0.050), relative to controls.

Conclusions

A “buddy‐style” program in older adults living at home can produce effective physical activity changes and, to a lesser extent, changes in dietary behavior, and has the potential to be efficient and feasible. Geriatr Gerontol Int 2019; 19: 323–329.

Risk of Skin Cancers in Older Persons Living With HIV: A Systematic Review

Skin cancers-including basal cell carcinoma, squamous cell carcinoma, and melanoma-impose high incidence and morbidity in older persons. As life expectancy continues to increase in persons living with HIV (PLWH), this population may face an increased risk of non-AIDS-defining malignancies, such as skin cancers. We conducted a systematic review on skin cancer risks in PLWH, ages 50 years or older, as compared with age-matched, HIV-uninfected persons. Four studies met criteria and were included. No statistically significant associations were demonstrated between HIV infection and skin cancers in older persons. For those with a history of basal or squamous cell carcinoma, HIV infection was associated with higher risks of subsequent squamous cell carcinoma. Future studies are needed to elucidate and reduce morbidity of primary and multiple skin cancers to promote successful aging in PLWH.

Patterns of Marijuana Use and Health Impact: A Survey Among Older Coloradans

Access to recreational and medical marijuana is common in the United States, particularly in states with legalized use. Here, we describe patterns of recreational and medical marijuana use and self-reported health among older persons using a geographically sampled survey in Colorado. The in-person or online survey was offered to community-dwelling older persons aged above 60 years. We assessed past-year marijuana use including recreational, medical, or both; methods of use; marijuana source; reasons for use; sociodemographic and health factors; and self-reported health. Of 274 respondents (mean age = 72.5 years, 65% women), 45% reported past-year marijuana use. Of these, 54% reported using marijuana both medically and recreationally. Using more than one marijuana method or preparation was common. Reasons for use included arthritis, chronic back pain, anxiety, and depression. Past-year marijuana users reported improved overall health, quality of life, day-to-day functioning, and improvement in pain. Odds of past-year marijuana use decreased with each additional year of age. The odds were lower among women and those with higher self-reported health status; odds of use were higher with past-year opioid use. Older persons with access to recreational and medical marijuana described concurrent use of medical and recreational marijuana, use of multiple preparations, and overall positive health impacts.

Burden of Restricted Activity and Associated Symptoms and Problems in Late Life and at the End of Life

OBJECTIVES

To compare rates of restricted activity and associated symptoms and problems in the last 6 months of life with those in the period before the last 6 months of life.

DESIGN

Prospective cohort study.

SETTING

Greater New Haven, Connecticut.

PARTICIPANTS

Community-living persons aged 70 and older (N=754).

MEASUREMENTS

The occurrence of restricted activity (staying in bed for at least half the day or cutting down on usual activities) and 24 prespecified symptoms and problems leading to restricted activity was ascertained monthly for nearly 19 years.

RESULTS

Rates of restricted activity per 100 person-months were 36.5 in the last 6 months of life versus 16.1 in the period before the last 6 months of life (P<.001). Of 737 participants with 1 month or more of restricted activity, rates of restricting symptoms per 100 person-months of restricted activity ranged from 8.0 for frequent or painful urination to 65.6 for been fatigued, and rates of restricting problems ranged from 0.1 for problem with alcohol to 23.4 for been afraid of falling. Rates were significantly higher in the last 6 months of life than in the prior period for 13 of the 24 restricting symptoms and problems (P<.05), most notably for shortness of breath (38.6 vs 21.8), weakness (37.3 vs 18.9), and confusion (31.2 vs 9.8). Mean (standard error) number of restricting symptoms and problems was significantly higher in the last 6 months of life (6.1 (0.1)) than in the prior period (4.7 (0.03)) (P<.001).

CONCLUSION

Rates of restricted activity and associated symptoms and problems are substantially greater in the last 6 months of life than in the period before the last 6 months of life. Enhanced palliative care strategies may be needed to diminish the burden of distressing symptoms and problems at the end of life. J Am Geriatr Soc 66:2282-2288, 2018.

Predictors of quality of life of older persons in rural Uganda: A cross sectional study

Background: Little is known about the quality of life of older persons (OPs) in Uganda in particular, and Africa in general. This study examined factors associated with quality of life of older persons in rural Uganda. Method: We performed a cross-sectional survey of 912 older persons from the four regions of Uganda. Data were analyzed at univariate, bivariate and multivariate level where ordinal logistic regression was applied. Results: Older persons in northern (OR=0.39; CI=0.224-0.711) and western (OR=0.33; CI=0.185-0.594) regions had poor quality of life relative to those in central region. Those who were HIV positive had poor quality of life (OR=0.45; CI=0.220-0.928) compared to those who were HIV negative. In contrast, living in permanent houses predicted good quality of life (OR=2.04; CI=1.391-3.002). Older persons whose household assets were controlled by their spouses were associated with good quality of life (OR=2.06;CI=1.032-4.107) relative to those whose assets were controlled by their children. Conclusion: Interventions mitigating the HIV and AIDS related Quality of life should target older persons. The government of Uganda should consider improving housing conditions for older persons in rural areas.

Predictors of quality of life of older persons in rural Uganda: A cross sectional study

Background: Little is known about the quality of life of older persons (OPs) in Uganda in particular, and Africa in general. This study examined factors associated with quality of life of older persons in rural Uganda.

Method: We performed a cross-sectional survey of 912 older persons from the four regions of Uganda. Data were analyzed at univariate, bivariate and multivariate level where ordinal logistic regression was applied.

Results: Older persons in northern (OR=0.39; CI=0.224-0.711) and western (OR=0.33; CI=0.185-0.594) regions had poor quality of life relative to those in central region. Those who were HIV positive had poor quality of life (OR=0.45; CI=0.220-0.928) compared to those who were HIV negative. In contrast, living in permanent houses predicted good quality of life (OR=2.04; CI=1.391-3.002). Older persons whose household assets were controlled by their spouses were associated with good quality of life (OR=2.06;CI=1.032-4.107) relative to those whose assets were controlled by their children.

Conclusion: Interventions mitigating the HIV and AIDS related Quality of life should target older persons. The government of Uganda should consider improving housing conditions for older persons in rural areas.

Vitamin D Status and Depressive Symptoms in Older Adults: A Role for Physical Functioning?

OBJECTIVES

Depressive symptoms and low vitamin D status are common in older persons and may be associated, but findings are inconsistent. This study investigated whether 25-hydroxyvitamin D (25(OH)D) concentrations are associated with depressive symptoms in older adults, both cross-sectionally and longitudinally. We also examined whether physical functioning could explain this relationship, to gain a better understanding of the underlying mechanisms.

METHODS

Data from two independent prospective cohorts of the Longitudinal Aging Study Amsterdam were used: an older cohort (≥65 years, n = 1282, assessed from 1995-2002) and a younger-old cohort (55-65 years, n = 737, assessed from 2002-2009).

MEASUREMENTS

Depressive symptoms were measured at baseline and after 3 and 6 years with the Center of Epidemiological Studies Depression Scale. Cross-sectional and longitudinal linear regression techniques were used to examine the relationship between 25(OH)D and depressive symptoms. The mediating role of physical functioning was examined in the longitudinal models.

RESULTS

Cross-sectionally, associations were not significant after adjustment for confounders. Longitudinally, women in the older cohort with baseline 25(OH)D concentrations up to 75 nmol/L experienced 175 to 24% more depressive symptoms in the following 6 years, compared with women with 25(OH)D concentrations >75 nmol/L. Reduced physical performance partially mediated this relationship. In men and in the younger-old cohort, no significant associations were observed.

CONCLUSIONS

Older women showed an inverse relationship between 25(OH)D and depressive symptoms over time, which may partially be explained by declining physical functioning. Replication of these findings by future studies is needed.

Aortic stiffness and brain integrity in elderly patients with cognitive and functional complaints

Purpose

Cerebral white matter lesions (WML) and brain atrophy are frequent in older persons and are associated with adverse outcomes. It has been suggested that aortic stiffness plays a role in the pathogenesis of WML and gray matter (GM) loss. There is, however, little evidence on the association between aortic stiffness and brain integrity in older patients. In this study, we investigated whether aortic stiffness is associated with WML and GM volume in older patients with cognitive and functional complaints.

Patients and methods

Fazekas score was used to analyze WML on brain imaging data of 84 persons; in a subanalysis on 42 MRI scans, the exact volume of white matter hyperintensities (WMH) and GM was determined using a brain-tissue and WMH tool. Aortic stiffness, measured as aortic pulse wave velocity (aPWV) and central pulse pressure (cPP), and blood pressure levels were non-invasively measured by the Mobil-O-Graph.

Results

Mean age was 76.6 (±6.8) years. Age was correlated with cPP (Spearman's ρ =0.296, P=0.008), aPWV (r ²=0.785, P<0.001) and WMH volume (r ²=0.297, P<0.001). cPP did not differ between categories of Fazekas, whereas aPWV increased with increasing Fazekas score (P for trend <0.001). After additional adjustment for age, levels of aPWV did not differ between categories. Both cPP and aPWV were associated with WMH volumes (lnB 0.025, P=0.055 and lnB 0.405, P<0.001, respectively); after additional adjustment for age, estimates were less consistent. Both cPP and aPWV were negatively associated with GM volumes in multivariate analysis (B=2.805, P=0.094 and B=111.052, P=0.032).

Conclusion

Higher aortic stiffness was partly associated with increased volume of WMH and decreased volume of GM and slightly influenced by blood pressure. Age also plays a role in this association in older patients.